The U.S. Healthcare Cartel: Protocols for Making Money

The American healthcare system has evolved from one that reacts to need into one that alleges to prevent or forestall need. If you say this fast, it sounds good. Wouldn’t we all rather not need to visit doctors and hospitals, or have surgery, or take drugs? Wouldn’t we all rather do what we can to enjoy good health and a longer life? Sure, but at what cost? That’s the question that isn’t asked, because to ask it threatens derailment of the revenue train enjoyed by insurance companies, pharmaceutical companies, hospitals and physicians. Can anything be done to benefit the healthcare consumer? Sure, but don’t bet on it happening anytime soon.

Let me add a quick caveat: I believe the overwhelming majority of products and services provided to Americans by physicians, hospitals, even drug companies is first rate. This dispatch has way more to do with the money side of healthcare than it does the healthcare itself. The money side is majorly messed up.

Insurance companies discovered a long time ago that a bringing in a little money, over and over and over, from a whole lot of people and businesses is a solid recipe for financial success. It’s called the recurring revenue model and it’s one of the secrets of how treasure is transferred almost magically from us to them, with them, in this case being the healthcare cartel. The rest of the healthcare system would pick up on the recurring revenue concept, just a little later on.

In the past, we employed physicians when we presented with symptoms of some kind. Now, assuming we have insurance, we find ourselves visiting physicians on a preventive schedule, perhaps two, three, or four times a year. A phlebotomist, often in a hospital setting, draws blood, which is analyzed by an expensive piece of technology. Our primary care physician then tells us what the numbers reveal and makes recommendations based on the findings. It all follows a protocol. Remember that word: protocol.

Sometimes, when we’re injured or when we present with certain specific symptoms (think chest pains), we’re sent directly to the ER where, again, a protocol involving a costly battery of tests drives the next few hours or days of our lives.

Typically, part of any healthcare delivery transaction involving medical doctors includes pharmaceuticals. High cholesterol? Pharmaceuticals. And, of course, stop eating animal fat like meat and dairy, and maybe exercise a little. No one suggests that the diet and exercise alone might do the trick. That would constitute healthcare protocol heresy. Pop a statin every day for the rest of your life AND do those other things. And, don’t fret about those potentially nasty side effects.

The pharmaceutical industry was the second leg on the health care stool to jump onto the recurring revenue bandwagon. Don’t take drugs just to get well or for symptomatic relief and then stop. Keep taking them until the day you die from something else.

Pharma, the American Hospital Association, the American Medical Association and other, smaller affiliated trade groups have managed over time to convince legislators, Medicare, Medicaid, the VA, and private insurance carriers, of the efficacy in codifying these protocols. Then, they persuade their insurance provider partners to reimburse based on these protocols that provide recurring revenue streams for their members. We just follow along like sheep ready for shearing. We don’t even feel it when it happens.

Take, for example, gastrointestinal specialists. They have protocols they follow involving endoscopies and colonoscopies. These protocols are developed and then handed down from the research arm of the American Gastroenterology Association, a physician trade group. Gastroenterologists perform these tests at hospitals or at outpatient clinics operated by groups of gastroenterology specialists. We’re told to have one periodically beginning at certain ages, depending on if there’s a family history of digestive disorders or when certain symptoms present. We’re scared by words like esophageal cancer and colon cancer so we do as we’re told.

The carrot for taking these tests is that early detection of any condition other than a clean bill of health can help forestall something else really bad from happening. The stick is that if you don’t go along with this protocol, which is covered by most insurance, then if/when something ugly does surface the insurance provider might not reimburse the physician or hospital. We told you to take the test and you didn’t. No insurance for you. A refusal could also result in your physician not continuing to provide care, or your hospital refusing services.

In other words, do what you’re told or there are consequences.

This, in a nutshell, is the cartel-like nature of the American health care system. Once again, American healthcare delivery is terrific, and I’m sure lives are saved by these protocols. But, make no mistake about it: they’re all in this together, health insurance companies, pharmaceutical firms, physicians, and hospitals.

The only folks not in on the game are healthcare consumers. And, the only way that game ever ends is with a universal, single payer healthcare system with the leverage to take on all of those powerful interests. But those trade associations, whose only job is to protect the interests and bottom lines of hospitals, physicians, insurance and pharmaceutical companies, have more collective clout with the U.S. Congress and with state legislatures than even the National Rifle Association. They are not going to let universal health care happen without a well-financed lobbying war to end all wars.

For now, the best you can do is take care of yourselves!