Two observations on health care delivery. One from a trip to Montgomery and another from a trip to Mayo’s Barber Shop. The hair cut was yesterday. One of my fellow customers was speaking of the cancer treatment received by a family member. Although we have a comprehensive cancer center in Mobile (the Mitchel Cancer Institute) with world class physicians treating the disease in question, my barbershop buddy chose to go to a competing concern (The Cancer Treatment Centers of America). This was likely prompted by the advertisements on television (in 1996, they were sued for being overly aggressive and their commercials are still worrisome), the promise of “holistic” care, and the fact that Blue Cross of Alabama would pay for the care. Turns out, the differences between our local comprehensive cancer center and the CTCA include the aggresive approach of CTCA, the presence of shareholders and the profit motive. An article in Business Week follows a patient who maxes out her $1,000,000 policy limits but is very happy with her care. It seems that some of what they sell is “hope”. The second difference is that CTCA will likely not treat uninsured cancer sufferers from Mobile Alabama as is required of the local cancer center (as CTCA requires $125,000 up front and reserves of $250,000 prior to starting treatment). What for-profit healthcare concerns may be selling to their shareholders is the ability to generate a lot of charges posted to each patient’s insurance policy.

My trip to Montgomery was to attend a board meeting of the Alabama Academy of Family Physicians. I have known most of these “Family Docs” for over 10 years. They have fought for many of the programs that now exist to get folks who might consider practice in rural Alabama into medical school. The group has seemed beaten down the past couple of times we’ve met. Partly this is because Blue Cross of Alabama, our single payor, has raised the codes billed by Family Docs by 20% over the past 19 year whereas the codes billed by our “partialist” colleagues have been raised over 300%. Also, it is because they would NEVER consider limiting access by making someone take out a mortgage to see if their diabetes/hypertension/arthritis would benefit from the care of their hometown physician.

The system that has evolved over the past 60 years requires a lot of overpayment from some areas to allow care to be provided at some level to all who presented for care. For-profit organizations such as CTCA take money away from communities such as ours. If they had demonstrably better outcomes and if care were available without such cost shifting, it might be justifiable. Unfortunately, the outcomes aren’t easily researched (try googling “outcomes” and “cancer centers” and getting unbiased information) and paying for indigent care is still not easily done in places like Mobile. I’m still waiting to see Congress solve this one.

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