True Story -  A 72 year old woman at an Arizona Pain Management Clinic.

“I couldn’t  help notice that yellow Hummer in the parking lot,” she says to the physician after he injects medication into her back. “If you doctors didn’t insist on having such fancy cars, maybe healthcare wouldn’t be in the crapper.”

The doctor helps steady her as she limps toward her walker. She has been in pain for a long time.  He leads her into his office - a space he shares with another physician and two nurse practitioners - and asks her to have a seat.

“More bad news?” she aks.

He nods and types several commands on the keyboard until Mrs. Smith’s file appears. “Can you see this?” he asks.

She leans her weight onto her forearms and peers through her reading glasses at the computer screen. “It says $48.47.”

“$48.47 is what I was paid to spend thirty minutes with you in this office and to provide an injection in your back. $48.47 is meant to cover the medicine I injected, the salary of my medical assistant, the rent on this building and the gas for my 1998 Volkswagen rusting out there in the parking lot.”

She leans back in her chair.  “I had no idea.”

Most people don’t. The wealthy physician driving a Mercedes to the country club every Wednesday afternoon is a thing of the past, yet according to what I read and remarks from patients such as Mrs. Smith, many people still perceive physicians as overpaid components of our failing system.

But physicians are merely the public facade associated with the problems of healthcare. We are tangible beings in a world of nameless, faceless telephone voices. We are also the individuals who daily witness people struggling to make copays, opting against regular health screening and selecting which prescriptions they can afford to refill each month. 

So why in this election year with phrases like Universal Healthcare and Single Payer System breathlessly bandied about by politicians, do physicians appear so reluctant to join in on the excitement?

Perhaps it’s because we’ve already worked closely with a single payer system: Medicare. And it’s sucking money like never before.

In Arizona where the Medicare population is immense, we are witnessing an alarming trend: medical providers are “opting out” and dropping their participation status in the Medicare system. It’s a big deal. Seniors living on fixed incomes are finding it increasingly difficult to obtain basic medical care in a state which prides itself on retirement opportunities. 

The medical community cites poor reimbursement and unreasonable compliance standards as their reasons for exiting. The paperwork required for Medicare patient visits exceeds what other health insurers require and the penalties for non-compliance with these administrative demands are steep: up to $10,000 per violation.

Ten thousand little reasons to opt out.

And although the actual hands-on providers of medical care may be shaking their heads at the catastrophic failings of the current system, there is one group who is delighted with Medicare: Big Pharmaceutical.

The senior prescription drug plan, Medicare Part D,  was designed in such a way  that the federal government would not be permitted to negotiate prices of drugs with the drug companies.

Say What?

It’s true. The Pharmaceutical Industry has been able to maintain a healthy profit margin partly due to the fact that the Federal Government simply pays whatever the drug companies charge for their drugs. Where else is pricing competition so blatantly ignored?

Not at the VA.  The Veterans Administration negotiates drug prices and on average, pays 58% less for drugs than Medicare Part D.  For example, in 2007, Medicare paid $1483 for an annual supply of the cholesterol lowering drug Zocor while the VA paid $127 for the same tablets.

Senator Obama is already promising to repeal this loophole which enables the upper management teams of big Pharma to purchase more yacht fuel but I’m skeptical that he’ll enjoy any success against the high-powered pharmaceutical lobbyists.  Do we really expect that any self-respecting corporation would give up a 17% profit margin without a fight? 

Big Pharma insists that without a large profit margin, no new medications will be developed and cancer will never be cured. As it stands, only the wealthiest can afford to have cancer.

If the current Medicare system is a portent of what we can expect from current plans for Universal Healthcare, I’ll be waiting for a second opinion.

Next topic:  Managed Care Organizations