There are many reasons why the cost of our healthcare is so high but waste plain and simple remains the costliest of all. Many blame the professionals, but few blame the patients, and then only rarely. A few weeks ago I came across two patients from opposite ends of the socioeconomic spectrum. One who possessed extraordinary wealth and education; the other with very little of either. They had one thing in common, however; they were both willing to exploit, no, cheat their healthcare plan, for their own different reasons, and in spite of any evidence-based science that it would benefit them.
While at a social gathering I met a forty-year-old gentleman who told me in passing that he was going to have a colonoscopy. We were not well acquainted but he knew me by name and that I was a physician and so I guess he figured he could talk to me about it. I learned he was quite wealthy and had been educated at a prestigious college. He had no genetic risks for colon cancer and no symptoms, so I wondered aloud why he was going to get a colonoscopy at such a young age. The usual screening age for low risk individuals is 50.
He told me he and his friends, all of whom were making plans to do the same, figured it could do no harm to have one. He had already scheduled it already with a doctor he believes to be very qualified and who had already accepted his insurance. I suppose he might have expected me to be impressed with his forward-looking, preventative approach, but he was not happy with my response. "So you are going to have an unindicated procedure for which your doctor is going to have to commit insurance fraud because he’s going to have to put some fake reason why you needed it so he can get paid by the insurance company?" That was the end of our conversation. I’ll bet he thought I was quite an ass.
A few days later, on a Saturday afternoon, an elderly uneducated woman who has Medicaid paying for her prescription drugs called my answering service and told the operator it was an emergency and she needed to speak to a doctor. Her doctor had given her the wrong prescription, my text message said.This sort of mistake, though rare, can be quite serious, so I called her back within a few minutes, as I always do, and asked what the emergency was. She told me my partner at the practice had written her a script for a “genetic” (she meant “generic”) version of Norvasc and she refused to take “genetic” drugs.
Like many of you, I spend about $15,000 a year for my health insurance. I have a large co-pay for brand drugs and a smaller one for generics. I take generic drugs, my wife takes generic drugs, and my kids are given generic drugs. Generic drugs are good enough for a physician and his family who pays $15,000 a year out of pocket for his health plan but not good enough for a patient who pays nothing (Medicaid pays for her prescription drugs) for her care and doesn't even know the difference between “genetic” and “generic.”
When I told her that the two drugs were virtually identical and that her call was not an emergency, she became extremely upset with me. I reminded her that I was available for urgent calls only, and asked her not to abuse her privilege. I mentioned to her that my entire family takes generic medications and I would not call the pharmacy to authorize a brand name for her medication. She suggested she would leave our practice and find someone who would and I bet she just might. Leave and find a doctor willing to do whatever it takes to keep her as a patient, no matter what the cost to the health care system as a whole..