Motivating the Healthcare Peasants, January 2014

For those joining the story late I should explain that I was once a Family Practice doctor.  Oh, philosophically I still am of course, but my work the last six years has been primarily in a rural Emergency Room.

My paperwork burden is much less these days as I do not have to get involved with decisions regarding staffing, "Strategic Planning", or more to the point, billing.

But once in a while something official turns up in my work mail slot.  Here, have a look:

Yesiree Bob, it is a check written out to me by a gigantic health insurance company.  And for the princely sum of Zero Dollars And 17 Cents.

I thought this was pretty funny so I took it down to administration.  I figured that since I was working for them that any money that came in for my care was rightfully theirs.  My thought was that I could sign it over and tell them to buy, well not a cup of coffee but maybe a little container of non-dairy cream to put into the cup of coffee.

But as it turns out this actually is money for me.  Caught up as I was in a moment of Scrooge McDuck enthusiasm it took a little explaining for me to understand how this windfall was possible.

I was told that part of reforming health care involves making the primary care drudges at the base of the food chain happier.  Maybe they will work harder, refer less routine stuff to the Apex Specialists. Heck, perhaps better pay will even cause them to be fruitful and multiply.

This is good, worthy and to be encouraged.  But if the Powers that Be had asked my opinion I would have just said cut the humble (FP/Peds/Internists) a check.  "Here's a couple grand, thanks for all you do."

But no.  Via some complex system a few pennies of positive reinforcement are calculated from the charges you submit.  I suppose in a large group practice or over the course of a year this could add up to something more than the rather insulting manifestation of approval that I got in the mail.  I guess this program has been around for a year now and so far this is the first check I have seen.

But perhaps I am being unfair.  What I am not showing for reasons of privacy is my name and address on the check.  They got the name right, but the address was a puzzler.  It was in another state.  But it did seem vaguely familiar and after a while it occurred to me....

Folks, the highly efficient, well oiled machinery that is health care financing in the Year of Our Lord 2013/4 has decided that my mailing address is at the hospital where my father practiced up until his retirement........a quarter century ago.

Obviously no human brain was involved in this.  Some deep archive of computer data made the link between my father and I based on our shared last name.  (For the record we do not have the same first name, nor have I practiced in his state after a brief moonlighting stint in 1985!).

It is very much like being a passenger on a trans Atlantic flight and seeing the pilot's cabin door swing open....and there being no living, thinking people up there at all.

It makes me wonder how many other tiny checks are being mailed out at 38 cents a pop.  And how much staff time and expense goes into doing so?  How many end up in the wrong state?  This one found its way to me somehow, but how many other little bits of financial detritus are swirling about in the drafty, ramshackle edifice that is our health care system?

Well, maybe I am over reacting a bit.  Perhaps I should close with a hearty "Rest Assured Citizens!". Clearly the wise and sapient beings that are reforming America's Health Care System have not only your best interests at heart but mine also.  As a hard working Family Doctor (albeit presently working hard in the ER) I bask in the esteem of the Exalted Ones.  I know how much they appreciate what I do.

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Addendum:  A few days later I got another check from a different insurance company.  It went to the proper address.  And while I do not feel substantially motivated it will cover my pub tabs on the spring trip to England.