I saw a patient today and looked back at a previous note, which said the following: "stressed out due to insurance."  It didn't surprise me, and I didn't find it funny; I see a lot of this.  Too much. This kind of thing could be written on a lot of patients' charts.  I suspect the percentage of patients who are "stressed out due to insurance" is fairly high. My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time.  He was not taking his medications as directed, and when asked why he had not come in recently he replied, "I can't afford to see you, doc.  You're expensive."

Expensive?  A $20 copay is expensive?  Yes, to people who are on multiple medications, seeing multiple doctors, struggling with work, and perhaps not managing their money well, $20 can be a barrier to care.  I may complain that the patients have cable TV, smoke, or eat at Taco Bell, but adding a regular $20 charge to an already large medical bill of $100, $200/month, or more is more than some people can stomach.  I see  a lot of this too.

Finally, I saw a patient who told me about a prescription she had filled at one pharmacy for $6.  She went to another pharmacy (for reasons of convenience) to get the medication filled, and the charge was $108.  I could see the frustration and anger in her eyes.  "How do I know I am not getting the shaft on other medications?" she lamented.  I told her that I see a lot of this.

Then I started considering how many doctors, nurses, and hospital administrators are "stressed out due to insurance," and I laughed.  I think the number of those not stressed out would be far easier to count.  In this blog I have recounted the overall cost the insurance situation takes from my own practice, and my own psyche.  I can't do it justice in a single post, it takes a huge toll on those of us in it.  The cost is high.

So what is the overall cost of a bad system?  Sure, the system itself uses money poorly and dumps buckets of money on things that have no impact on the health of patients.  Sure the system encourages doctors to not communicate, not spend time with patients, and to spend more time with the notes than with the patient.  But what is the toll of this toll?  What is the toll that simply having an insane system that demands huge sums of cash, yet does not give back a product worthy of that cost?  What is the toll of people suspicious that they are being gouged at the pharmacy, hospital, or doctor's office?  What is the cost of having a healthcare workforce that goes home more consumed by frustration about the system than by the fact that people are sick and suffering?

Our system is very sick, and the fact that it is so sick makes me sick.  It makes a lot of us sick.

I see a lot of that.