THIS TIME ON CODE WACK!
What is the true cost of the American health insurance system? What toll is it taking on both patients and providers? And what do we need instead?
To find out, we recently interviewed Dr. Linda Peeno, a physician, ethicist and health insurance industry whistleblower who testified before Congress and who has spent nearly four decades working to protect patients from harm and death by corporate healthcare systems.
Dr. Peeno was played by actor Laura Dern in the 2002 docudrama “Damaged Care,” and she was also featured in Michael Moore’s 2007 documentary “Sicko.”
SHOW NOTES
WE DISCUSS
Besides your own experience with the managed care industry, can you give some other examples of moral or ethical issues doctors face in our market-based healthcare system?
“I think at this point, it practically permeates every aspect of practice….you just think about an average primary care physician. They’re probably under some sort of constraints for productivity. Time constraints are, are there, they can’t, you know, they have a patient that comes in, maybe is facing something terminal or a family member. … Somebody’s gonna give you a report about your productivity numbers, the minute you spent with a patient, the coding, all of that.
“So it even starts at that level, like, you know, the time spent and then the fights you have to have with the insurance companies. Or if, you know, like one of my doctors just said, we don’t fight anymore. ‘Now I don’t fight anymore. If your insurance company doesn’t pay for this test. I say, okay, you can either have it or you can pay for it out of pocket. I’m not gonna get involved.’ So a lot of doctors, you know, have sort of given up … ” – Dr. Linda Peeno
It is a huge burden on physicians, standing up to insurance companies.
“… I fear what we end up doing, like we’ve done in so many other areas of our society, is we select out those people who aren’t affected by it. The definition of a moral injury is that it violates your sense of conscience. Well, what if you no longer have a sense of conscience?
“You know, what if you’re just like this physician, you know, ‘You need an echocardiogram and your insurance company won’t pay for it, then figure out how to pay for it. You know, I’m not gonna worry about it.’ Over time … the people who survive are the ones that can, you know, … put that Teflon shield on. That’s what concerns me about physicians who I call them ‘the hybrid physicians’ like I was.
“You know you go to work for a system that has its own mission and goals and most of them are economic. And what do you do with your inherent primary medical oath?” – Dr. Linda Peeno
What’s the human cost of all this? And what can we do to make health care work for us again?
“… we don’t know what the human cost is. But I mean, I think still the general rule is, it’s so simple: Know the insurance companies are there to make money, period. I mean, they take in the premiums and they pay out claims. And their goal is to keep as much of those premiums or dollars coming in, whatever source, state, government, federal government as much as possible, and design all the systems as that money flows through to keep as much money as possible…
“… Whatever we do, it’s gotta be universal and more, and, you know, I support anything that’s single payer. But I have to also remind all my single payer friends, you know, the worst thing would be to have single payer run through a for-profit system. That’s what Medicare Advantage is. For a specialist that’s not covered in your network, it’s gonna kick in.” – Dr. Linda Peeno
Helpful Links
“Between You and Your Doctor: the Private Health Insurance Bureaucracy”, Testimony of Dr. Linda Peeno, U.S. House of Representatives Committee on Oversight and Accountability
Unnecessary insurance claim denials compromise patient care and provider bottom lines, STAT News
Health insurance claim denials are on the rise, to the detriment of patients, PBS and Kaiser Family Foundation
Moral injury harms providers and patients, American Association of Medical Colleges
We all pay a price for doctors’ moral injury, Becker’s Hospital Review
Episode Transcript
Read the full episode transcript.
Biography: Linda Peeno, M.D.
Dr. Peeno is a physician and ethicist who has spent nearly four decades working to protect patients from harm and death by corporate health care systems.
In the 1990s, Peeno’s medical expertise was used by corporate health care to deny care that would have saved a patient’s life. Consequently, she quit her high-paying job and has devoted herself over the following decades to defending patients against the sophisticated managed-care and profiteering machinery that she knows from experience contributes to untold harm. Testifying before Congress in 1996, she asked, “What kind of system have we created when a physician can receive a lucrative income for adding to the suffering of patients?” Since that moment, Dr. Peeno has testified before Congress and state legislatures numerous times and has assisted in more that 150 legal cases in an attempt to expose the for-profit systems that have broken medicine and healthcare.
In 2002, Laura Dern played Dr. Peeno in a docudrama, “Damaged Care,” and she was featured prominently in “Sicko,” Michael Moore’s 2007 documentary about the U.S. healthcare system.
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