Making Demands

Are healthy people patients?  Sometimes I wonder.

If you’re healthy, you rarely see a doctor.  If you go for a “routine” checkup every five years, you just aren’t very affected by the system.  You might not even know what the system is.  Your health insurance premium is deducted from your paycheck, so you never really see that money – not the way you would if you had to write a check in that amount every month.  The cost doesn’t sink in.  Or maybe you’re fortunate enough that your employer picks up the tab, so it doesn’t cost you anything to have insurance.  Those blue-moon office visits require a co-pay (less than your cable-tv bill), but insurance covers the rest.  Healthy people aren’t perceived as patients.

The average person I talk with doesn’t even have a doctor.  They say things like, “I haven’t been to a doctor in years,” or, “I’ll have a checkup when I’m 50.”  A variety of excuses all add up to the belief that there’s no reason to establish rapport with a doctor unless you’re ill.  If people aren’t sick, they don’t see themselves as patients in need of a physician.


In a recent article speaking about the current healthcare system, KevinMD says,

Neither the time physicians spend with their patients, nor the use of the tools necessary to facilitate a stronger patient-doctor relationship, are valued … E-patients can help, by recognizing the constraints on physicians and demanding that changes be made in the health system that will help doctors better meet the needs of empowered patients.

Interesting idea, but I just don’t see how this would ever happen.

First, because healthy people – those who don’t have a doctor, or those who show up every few years for a check-up just to reassure a spouse that everything is still okay – are not likely to feel any compulsion to press for changes.  They don’t need to email their (non-existent) doctor, or insist on longer appointments, or pay by the hour instead of by the appointment, as long as their insurance pays the bill for their rare encounters with the medical profession.  People with the time, energy, and resources to facilitate change don’t think of themselves as patients caught in a broken system desperately in need of being fixed.

Those who do see the need for change, who care, who desperately want change, are those who aren’t healthy.  They have seen, up close and personal, how the system needs a major overhaul.  Unfortunately, their conditions that put them in a position to experience the shortcomings of our current system also put them in a position of not having the time and energy needed to push changes through the appropriate channels.

Yet here is Dr. Pho saying that patients should demand changes.

“Demands” is a strong word.  I don’t really see how patients could demand changes.

Strike?  Historically, employees were sometimes subjected to horrible working conditions.  With the creation of unions, employers suddenly learned that they didn’t hold all the power.  When all the employees of a company banded together and refused to work unless their demands were met, things improved for employees everywhere.  The tactic was successful because employers lost money when nobody would work for them.  “No workers” led to “no production” led to “no income.”  The employers benefitted financially by making things better for employees.

Healthcare is different.  There is no patient’s union.  We can make a list of “demands” but to whom would those demands be made?  What is the “or else” with which someone is threatened if the system doesn’t change in response to our demands?

I suppose I could threaten my insurer:

  • Pay my medical bills promptly, or else…  what?
    …I’ll pay them myself and wait for you to get around to sending me a reimbursement check.
    Guess that doesn’t give the insurer any motive to change.
  • Pay my doctors what they’re worth, or else… what?  
    …I won’t go to the doctor any more.
    Right.  The insurers would love that.  The threat of patients/doctors not seeing one another doesn’t hurt insurers financially.  It helps them.  If patients make demands to the insurance company and say, “Change the system or I refuse to see a doctor,” then the insurer is in the position of raking in premiums but not making any payments.
  • Pay my doctors for their time and expertise, or else… what?
    …they’ll stop accepting the insurance you provide.
    That means I’d either have to change to a doctor willing to accept the ever dwindling insurance payments, or I’d have to pay out of pocket instead of going through insurance.  Either way, the insurers would save money.
  • Offer me a better policy, or else…
    …I’ll take my business somewhere else.
    Since they only want the business of healthy people from whom they can milk the premium without having to actually make any payments for healthcare, they’d be only too happy to drop my policy now that I’m costing them money.

Or maybe I could demand that my doctors stand up to the insurance bullies.  Then again, overworked doctors with waiting lists of people looking for a physician would drop any patient who makes waves.

Our senators and representatives recently demonstrated that they’re not interested in making the changes that patients and doctors have said need to take place.  People might demand, “Make these changes or we’ll vote you out of office,” but most people aren’t single-policy voters.  Obviously, our congressmen aren’t too worried about it so demands in that area are unlikely to be effective.


Strikes work because everyone participates.  I don’t see that happening in healthcare.  Even if there was a suitable “or else” situation that would have the potential of forcing appropriate change, the price would be too high.  How many individual patients would willingly forego medical care and give their lives just to make a point that the system needs to change?  How many physicians, after all their training, would turn their backs and watch needy patients die or become permanently disabled when it’s in their power to make a difference?

It might sound good to say that patients should demand changes in the system, but from where I sit, it’s just empty words.


4 thoughts on “Making Demands

  1. As a family physician, I feel for your frustration and appreciate your insights about people and “the system” (which I refer to as the Non-System).
    Primary care physicians are a scarce, valuable resource that has been misused and, therefore, is disappearing. The next level of care after primary care costs about ten times what primary care costs. (If you’re heavily invested in non-primary care such as hospitals are, you want it to go away or fail. So you close your family medicine training center such as the two largest hospitals in my area of Ohio have done. Suddenly, people can access your high quality, parts oriented, technology loaded centers of excellence much easier.)

    The primary care physicians are the moat that protects people and pocket-books from the castle of “narrowists” (who are extremely valuable when someone needs their expertise). We also generally like people and care what happens to them. We are system experts who have to help patients to know where to go when they need sub-specialist care or expensive/ risky imaging (aka, radiation).

    Your quandary about insurance and the family physician’s quandary about insurance companies might both benefit from Direct Primary Care (such as QLiance in Seattle) which allows people to pay a monthly fee to the doctor (still less than the monthly cable bill). This works well for those with no insurance or high deductible HSA’s to have a fixed amount for basic primary care. (There are other fees for some services so see QLiance or Health Access Rhode Island to get an idea of what they might be if this interests you or your readers.) This is different from concierge medicine.

    In Direct Primary Care, the family physician makes more money, has less billing expense, less paper work, less seething about hassles, has more fun with patient care and looks much better to medical students when making career specialty selection decisions.

    Your insights about the Non-System are accurate. The usual suspects (aka, the Medical-Industrial Complex) are steering the ship into more and more disasters. Frustration abounds. I believe that people will find ways to rise up slowly but surely to retain their humanity and their health options, including innovative medical care strategies.

  2. Pingback: Cross-Posting « ∞ itis

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