Beating Our Healthcare System

10/25/2013 06:30 pm ET | Updated Jan 23, 2014


Every time you turn on the news, everyone's talking about healthcare. Namely, our very crappy system of delivering healthcare. And the Affordable Healthcare Act (ACA) seems even more terrible to some, and certainly carries a great deal of uncertainty about how it will affect individuals and our society. As it is, even if we have what is considered "good" insurance, we can still pay hundreds or even thousands out-of-pocket for a relatively small procedure. So a lot of people put off getting the care they need until it turns into something way worse (and more costly).

What the hell? Why is this so expensive? To pay for exorbitant surgeon fees? Not really. Surgeons can make between 20 percent-80 percent of what they bill the insurance. I recently spoke to a Harvard-trained orthopedic spine surgeon who made only $300 on an eight-hour spinal surgery. Hospitals and surgery centers that want to stay in business will bill the insurance an extreme rate for your surgery, because they know they are probably not going to get paid anything close to their actual rate. So they slap a warm blanket on you and bill your insurance $400 for it... and if you made it through the surgery seeing the bill may just kill you.

There is no one person or entity to blame. As a country, we have created a healthcare system where, for most people, their insurance company participates in every medical decision, something that is supposed to be between a patient and her doctor. In most cases, the insurance company determines not only what services and procedures are covered, but how much both the patient and the doctor can collect, thereby creating an implied conflict-of-interest.

Our healthcare system isn't going to get better anytime soon. That is why it is imperative that you keep yourself and your family healthy by taking preventative measures. But how do you actually do that?

"Preventative healthcare is more vital than ever," says Dr. Joseph Pinzone, an internist and endocrinologist in Santa Monica, California. "We now actually have ways to prevent many illnesses including cardiovascular diseases, many cancers, and metabolic diseases such as diabetes." However, in order to do this, doctors have to spend time with their patients and get to know them as people. This actually leads to ordering less, but more useful tests, and helps make the doctor-patient relationship a true partnership.

Dr. Pinzone is CEO and Medical Director at Amai an innovative medical and wellness practice and is known for spending one to two hours with each of his patients to listen to their concerns and accurately access their medical needs. He is also the author of Fireballs in My Eucharist - Fight Cancer Smarter, a ground-breaking new book about learning how to be the "CEO and Chairman" of your own healthcare. The book gained its title when one of his patients came in complaining about "fireballs in my Eucharist." She meant to say, "fibroids in my uterus," illustrating to Dr. Pinzone how grossly misinformed people are about their own health.

Preventative health is all about choosing the right doctor. So what should you look for? According to Dr. Pinzone, you need to:

1.Be able to connect with that doctor on a human level and communicate with him/her in an open and honest fashion.

2. Have a sense that the doctor truly cares about what happens to you.

3. Make sure that the doctor is able to deliver the healthcare you need within the context of your life.

Women tend to be the ones who make all of the health decisions for their families and sadly, some doctors can be very patronizing to women who they believe are overly sensitive about their bodies. That is why it is ultra important to find the right doctor and to go into your visit well-informed. Here are some tips from Dr. Pinzone:

1. You are in charge of your healthcare. Make sure your doctor works WITH you and not only gives you his/her opinion, but the rationale behind it.

2. Be assertive, open, and clear in communicating to your doctor what's important in your life.

3. Keep your healthcare providers accountable by writing down the: Who, What, When, Where and Why of your treatment plan; and then check that everything gets done when and how it should.

4. Consider having a "care partner" present during your visit, such as a spouse or good friend. Another set of eyes and ears can be vital in helping to communicate important health facts, ask key questions, and document the treatment plan.

5. Prepare for your doctor visit. This can be as simple as writing down what the doctor is going to want: a) Chief Complaint: "Why are you at this doctor's office now?"; and b) History of Present Illness: What exactly is bothering you? When did it start? Have you have you done anything about it? Does anything make it better or worse? Etc.

We can't continue to complain about our healthcare system without being proactive about our own health. If we can't change the policies for the better, let's change our health for the better by preventing any catastrophes before they start. Be informed. Be engaged. Be healthy.