A Friend Stopped By | 09/30/2009 3:00 am

The Most Powerful Person in the Health-Care Debate, by Judy Bachrach

By Judy Bachrach

Image: Dirck Halstead

Editor’s note: Judy Bachrach writes for Vanity Fair, and is the creator of thecheckoutline.org, an online advice column for friends and relatives of the terminally ill.

Before the health-care debate goes any further — and it will go a lot further, no matter what kind of bill gets passed in Congress — let’s stop and examine who’s really responsible for making sure health-care costs are lean, sensible and bear some sort of resemblance to the quality of the actual medical services performed.

You are.

That’s right. The first thing every patient forgets when she checks in at her doctor’s office and observes the person behind the desk, completely mute, immobile and sunk into what appears to be a deep coma – is that she’s the one in charge. And by that I mean you the patient are in charge of everything: the doctor’s prices, the doctor’s courtesy, the doctor’s assistants, the doctor’s promptness (or lack thereof) and above all, the quality of the doctor’s services.

There are rules I invariably follow whenever I check in with anyone whose last name ends in MD, and they all have to do with how much I will pay for any visit to any doctor, no matter how exalted, revered or specialized. I know it sounds strange, especially in this day and age when far too many women are in awe of practitioners, but I’m the one who sets the doctor’s fees. I’m the one who makes sure those fees are more or less what my insurance will cover. I’m the one who insists that specific services, promptness and courtesy be offered in exchange for those fees.

And not only for me, but for any relative or friend, especially if that relative is elderly and cannot fight for herself.

To read more, click here to go to obit-mag.com.

38 Reader Comments (so far…) Sign In or Register to comment

No you’re wrong—the most important people in the health care debate are the lobbyists. Their money is the power to buy our elected reps to do their bidding. It’s obvious.

By F P on 09/30/2009 7:58 am

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" I am dying with the help of too many physicians". ______ Alexander the Great

Fast forward and sub the word " insurers" for " physicians", and we see who really makes decisions about our health, our quality of life, and whether we live or die. We can thank the lobbyists for making certain our congressional representatives are nicely rewarded for their votes. We can thank our elected representatives for being just as greedy , heartless, and despicable as the insurance companies.

By Maggie W on 09/30/2009 10:02 am

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Yep—and I really think we need not call them representatives any longer since most of them aren’t no matter how broad the definition..

By F P on 09/30/2009 10:15 am

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They are still representatives. They just represent whatever lobbyist/interest group pays for them- rather than the people that live in their district/state.

By Sandy B on 09/30/2009 12:43 pm

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Most people think that the MD decides what to charge for his services. Wrong~~it’s the insurance companies and Medicare that tell the MD what he will charge. Also, the MD still has his overhead costs…rent, utilities, payroll, and speaking of payroll, the MDs had to hire more people just to deal with the insurance paperwork. Which is why, when I came out of retirement, I decided never to work in a doctor’s office again…

By Diana T on 09/30/2009 10:49 am

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I agree FP. The lobbyist bought Obama with big Pharma and even AARP was willing to get into bed with the public option. It is sickening really. They need to let us buy our insurance from where ever and who ever we want to. I am tired of having my choices dictated to me, by the state and certainly by the government.

By Eyes Open on 09/30/2009 6:29 pm

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If you trust insurance companies more than the state or your government - that about says it all.

By starry Nite on 10/02/2009 11:36 pm

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If by "control" you are referring to whether or not you go to the doc who charges too much, then heck, that’s what everyone IS doing by not going to any doc at all. Isn’t that one of the biggest problems we’ve been talking about in health-care reform?

By rocky rocky on 09/30/2009 8:40 am

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Seriously? that would require people actually having access to doctors in the first place. I hear what you’re saying. But it’s definitely from the perspective of someone who hasn’t experienced the kind of powerlessness that comes from having a health crisis you couldn’t pay for even if the doc took 20% off his fees. Not to mention the kind of time and effort that would go into trying to negotiate everything that has to do with your medical care. Sorry… but this just didn’t make a ton of sense to me in terms of most peoples realities today. Sure those of us with the income and the insurance to have some sort of power may be able to negotiate a fee. But get real… we aren’t the majority these days.

By Chrome Toe on 09/30/2009 8:51 am

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Exactly.

By F P on 09/30/2009 8:53 am

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Yes, Chrome Toe, I fully agree. When was the last time this woman was in a doctor’s office, had to wait 1-2 hours, complained about it and got any results? I have a friend who use to refuse to wait longer than 20 min. to see her doctor, saying her time was just as valuable as his. Well, unfortunately, my friend died of toxic shock because she couldn’t get in to see her doctor and her infection had spread too far by the time they air-lifted her to a hospital. We as patients have very little leverage in this health care game. We are powerless to set the rates, decide what insurance companies will cover and what they won’t, how much perscription drugs cost, etc., etc., etc. We’re in charge of NOTHING, and therefore, cannot possibly be the most important people in this health care debate.

By Nanny hasSeven on 09/30/2009 11:53 am

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I pay for COBRA insurance through my previous employer. Paying for insurance when one is unemployed is difficult enough, but when the emergency room I visited, two months after the fact, insisted I needed to pay for part of my bill out-of-pocket (I twisted my ankle in the subway), I was livid. I received the bill in the mail with a shock; no one said anything at the hospital at the time they took my insurance info; they said everything would be fine. Do you ever feel like you should have a hidden tape recorder with you at all times?

I called the rep and said, "No, I am not paying this bill." After ten minutes on hold they said, "Okay, it’s taken care of." I was not going to back down, so this was good news.

If I had just paid the bill they sent me, I would have been out a chunk of money. But I complained and settled it. It was an unfair situation, but it is only a small example of what the author here is speaking about—I read the link. The billing people count on folks to be intimidated and just pay the thing. When people fight back against unfair costs tacked on, it can work. I am not saying it works in all situations, but the specialized one she writes about with her "Aunt Sylvia" certainly qualifies. She was being screwed and was prepared to take the situation on and not give up. Doctors depend on the public to just pony up unfair (negotiable) fees.

I recently got big deductions on eye doctor and dental fees after explaining I am unemployed and my insurance does not cover them. It cannot hurt to ask. They are being hit by the economy also, and want to keep the loyalty of their past customers.

By kermie b on 09/30/2009 10:07 am

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Ok! If we’re in charge, why do we have to pay a bill even if we’re not satisfied with the doctor’s visit? We go to a doctor’s visit. Not greeted well. Have to sit awhile. Finally get in. Met a too like business nurse. She asks straight questions, wants the facts, just the facts. Wait longer still. Then see a doctor. Don’t agree with the doctor. Leave mad. Get a bill in the mail. If I want to disagree with the billing. I have to call. Be put on hold. Told to call another number. Call them and repeat this process. It’s ridiculous!

By Grande Camper on 09/30/2009 11:00 am

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Good point, and that happens on a regular basis. Several weeks ago, a man wrote his story in a short newspaper editorial . He received several bills; many parts he did not understand. The questionable charges amounted to around $16,000. He realized that there were multiple errors. Alll total, he spent 36 frustrating phone hours getting that mess straightened out. He finally got insurance to pony up.

No matter how good we might think our insurance is, it would be wise to document every time that nurse gets you a glass of water or the doctor says " Good morning". The clock is ticking.

By Maggie W on 09/30/2009 11:36 am