The United States healthcare system is regarded as the best and the most innovative in the world. Aside from the billions of dollars invested in health and medical research, pockets of excellence are visible across the country. Nonetheless, the fragmented and complicated healthcare marketplace created a system that is antithetical to its global reputation. A stunning reality of the healthcare system is that the finances and resources do not translate to better access to care, coordination, and affordability. The increasing complexity of care, care fragmentation, increasing burden of chronic diseases, limitations of outcomes measurement, limitation of evidence for the care provided, and lack of transparency in both performance and cost are a few of the challenges physicians and patients alike face daily.
Healthcare providers dedicated to providing the best care for every patient put in their best effort, ensuring that each patient receives care efficiently.
However, complicated insurance coverage, political landscape, consumer preference, and current socioeconomic structure through health policy decisions about funding, regulations, and reimbursements affect organizations and delivery of care in a way that limits healthcare provider’s options.
Health care has been an important topic of debate in the United States throughout the last decade. As different political parties hold different viewpoints regarding how to run the system properly, each side attempts to create legislation reflecting their political ideology. Stakeholders like insurance and pharmaceutical industries prey on these inconsistencies by spending millions of dollars lobbying to influence potential reforms. As a result, establishing long-term solutions to our health care system failed to materialize.
Sadly, the brunt is generally felt across all demographics and occupations. After a lengthy monologue, Dr. Amir Shalev lamented to Top Doctor Magazine during an interview: “Your pain is out of proportion. There is nothing else we could do.”
Dr. Shalev, who is also a doctor, listened in disbelief while a physician discharged him in excruciating pain. Even though he has dedicated his life to providing care to patients, he quickly realized the dangerous lapses in the healthcare system when the tables are turned.
Dr. Amir Shalev is a podiatrist specializing in diabetic foot care in Las Vegas providing comprehensive medical care for a broad spectrum of foot and ankle conditions.
Even as a health provider, Dr. Shalev had a fair share of the lapses in the healthcare system when his ulcerative colitis became worse. “So often I’d have a flare-up and would go on steroids or spend a few days in the hospital, and then I would go into remission.” In 2019, he requested to see pain management but was denied. In May 2020, Dr. Shalev, who was immunocompromised and trying to avoid going to the ER, contacted his GI doctor, who started him on steroids again.
“When my condition got worse, they gave me all the pain medications I needed. When I went to one hospital, all they did was a CT scan. They gave me pain management injection and fluids, and after five days, they repeated it, told me my pain was out of proportion and sent me home.” Dr. Shalev complained.
Since the right hand does not know what the left hand is doing, Dr. Shalev disclosed that the healthcare system might become appalling unless we see a drastic change. “When I was discharged in pain, I perforated at home. The next day, my colon ruptured. I went to my GI five days later, and he took one look at me, wheeled me to the OR for emergency surgery, where they took out 95% of my colon. He told me if I was 24hrs later, I probably wouldn’t be able to come; I would be dead.”
While describing physician’s complicity in the problem, the Nevada-based doctor noted that patients also play a part in the problem, making it difficult for doctors to do their job. Dr. Shalev, who was a patient a few times, describes his experience when he was receiving care. “When I had emergency surgery, I was in the ICU for five days, and I have nerve tuber been in the ICU.
I had what is termed ICU delirium, an acute fluctuating disturbance of consciousness and cognition common to patients.” Speaking further on his experience as a patient, Dr. Shalev described how he pulled out everything attached to his body, including the NG, which made him bleed. “When they got everything back in me, they restrained me, tied me down, and I still pulled everything out. I did not cooperate with them until after the third night when my wife stayed with me to calm me down.”
The healthcare system in the US has a trifecta of high cost, below-average outcomes, and unequal access compared to other highly developed countries. Some of the factors creating a downstream effect in the healthcare system were created by the health insurance industry. During the interview, Dr. Shalev criticized the insurance companies leeching off the hardworking Americans and creating severe health challenges. “Part of the problem is the way the fixed schedule gets reduced every year. This kind of forces doctors to see more patients to make ends meet, pay off student loans, and couple that with Medicare decreases because they want to force Medicare guidelines on physicians.” Dr. Shalev said.
For example, Dr. Shalev continued, “…in Vegas, Medicaid did not cover podiatrist services for 2018. So, if some Medicaid patients needed podiatrist services, they had to pay cash.” Now, Medicaid does cover podiatry, but many doctors still won’t see Medicaid patients even though they are the population that needs it most. “I know some practices that will never see them. If you only have a 15-minute time slot and you have someone else who triples the pay, you will definitely go to the other patient. I may start picking my patients too. Right or wrong, unfortunately, that is what the insurance companies are forcing podiatrists to do.” Dr. Shalev informed.
The federal government influences the health care system by creating reforms to improve quality and value in the healthcare industry. By establishing Medicare and Medicaid, it ensures access to insurance coverage for most of the population. Additionally, multiple pieces of legislation were created over the years expanding federal healthcare programs, including the Affordable Care Act (ACA) of 2010. As the role of government expanded, multiple initiatives were created. Overall, progress has eluded the health care system.
Dr. Shalev provided a perspective regarding the influence the government has on the health care system. “There are a lot of things out there that are not known or used because they are not familiar to us but are available in other advanced countries. Sadly, we have different government entities that are involved, which should not be part of the equation, but unfortunately, it is.”
For example, Dr. Shalev continued, “stem cells regenerative medicine became more legal or more mainstream in the last 5 to 8 years because the government allows things to be studied and done. Although it’s been done in Europe for over 30 years, it’s new to us.”
Going forward, Dr. Shalev told us that he might be forced to ask what insurance a patient has before seeing them. “My goal is to do the best for the patient, hopefully, their insurance covers it, but if they don’t, there is not much I can do, but I try to work with them to find a cheaper cash alternative.” Dr. Shalev believes that patient care comes first before money, “but I have always liked doing the right thing so that I can sleep at night,” he concluded.