The Illogical Laws of Diminishing Returns

I weep for my doc friends. Seems as though the insurance industry is painting yet another target on their collective backs. I spent a lunch hearing my friend, who is a family practitioner, explain how Medicare is planning on cutting docs' salaries by ten percent to…wait for it…make them more efficient. Hoo boy, now that’s what I call running a company of thousands on one brain.

My friend groused over a glass of white wine the other day. “I don’t know about you, Price, but decreasing my pay is not an incentive to work more efficiently. What’s more,” she said, stabbing what is probably her last bite of lobster for a while, “is our esteemed Governator wants to tax me, run my money back through the government, then pay me back with my own freaking money so that everyone can have health care!” She looked up at me with tears of frustration pooling in her eyes. “Is this why I studied my ass off in medical school? To have my own government tell me how much I’m allowed to make? This is damn scary. How much longer before I can’t stay in business?”

She went on to tell me about another friend of ours who decided to specialize in cosmetics and weight loss in order to compensate for his loss in earnings. Another left medicine all together and took up engineering.

“Want to know what the insurance asswipes did to me three months in a row?” she said. “They deliberately changed the insurance codes and didn’t tell my bookkeeper. That way they didn’t have to shell out reimbursement to me. Now, you take what they’re pulling on me and multiply that times thousands, and I can tell you who’s making the money. And it ain’t the docs. Oh sure, they said it was all a mistake. Mistake my lily white butt.”

I drank my chardonnay in one solid gulp.

“Oh, and you’ll love this," she said. "Ted Grapply, you know, the internist with the hairy ears? He had an insurance company deny payment because they needed to know if the patient was on birth control pills. The patient was a freaking man, for goddsakes. Want to know how long it took him to get that little disaster cleared up?”

"No," I said, fearing the answer.

"Four months."

I poured more wine into my dear friend’s glass, knowing I’d drive her home and help nurse her impending hangover.

“An’ you wonder how this affects you?” she said, slurring her words. “Well, lemme tell ya. Time, baby. And quality. Where I used to spend twenty five minutes with a patient getting their history and discussing health issues, explaining different meds an' such, I’m cramming ‘em in every ten minutes. My exam rooms are stacked up like LA International Airport at Thanksgiving. Is this the future of medicine? The only ones gettin’ the big bucks are the insurance CEOs as they collect record profits. And let’s not forget the bonuses. How is it that the gove’ment can tell me I’m makin' too much money but it’s okay for the insurance guys?”

“Politics?” I ask naively.

She pointed her salad fork at me. “Exactamundo! You don’ think that money doesn’t trickle into our benevolent politicians’ pants and bras? My mentor from med school just retired. At fifty-five years old. Told me he was sick of the whole mess. My building mates want to do a Nancy Reagan and just say no to accepting insurance all together. And you know what, Pricey? It’s up to you guys, the patients, to speak up for improving medical care. If you don’t, it’s gonna be some twirly headed bean counter who will decide just how desperately you need that liver transplant or heart valve replacement. We docs are being taken out of the equation.”

I felt my heart sink into my gut. This was supposed to be an afternoon of laughter and fun as she, as my medical advisor, helped me with my new novel. Instead it morphed into watching a dedicated doc grapple with thoughts of leaving a profession she’s dreamed of since the first grade when she stuffed dirt and grass in my bloodied knee after a rousing dodge ball session. God, how I wanted to just hug her 'til she stopped hurting.

She finished the conversation off with a final lament. “I should have listened to my first boyfriend and become an exotic dancer.” She did have the boobs for it.

As I watched her drain her glass, I thought about my next novel and thought about how easy it would be to weave this sickening topic into the plot. For not the first time that day, I held my bestest bud's hand and said, "Who is John Galt?"