Why Insurance Meddling in Doctor Decisions and Pharmacies Must STOP


On July 16th, 2018, HHS took down the guidelines for doctors website, www.guidelines.gov.  I'm pretty sure that's who made it not-ok for ER's to give vitamin IV's, which have helped me a great deal. So I hope it's obvious why I'm glad it's gone. I'd be even happier if guidelines written by insurance companies were also repealed. Clinical Practice Guidelines, published by insurance companies, and many other government bureaucracies bind doctor's hands so that in some cases it's impossible to give you proper medical care.  Here's more of them.  They're not going to go away easily. 

Their original purpose was to help people identify correct treatments.  But in effect it has merely helped identify when they've been treated with a non standard treatment so if it turns out badly, they have some basis on which to sue for malpractice and hopefully that way they can afford to have the correct treatment or be compensated for a loss they can't recover from. 

Image by: http://www.freepik.com/nensuria
They also became a teaching tool for new doctors.  But, they created as many problems as they solved.  New doctors in particular were afraid to go outside of them, even if their patient wasn't getting any better. New treatments weren't added to them if insurance companies resisted it, or if drug companies would've preferred to give a different treatment.  

The standard treatment became a function of what's cheapest for insurers, and most profitable for drug companies.  

It resulted in reports like this where a Goldman Sachs employee actually states that it's better for business to fail to cure patients.  That article has to be read to be believed, it gives examples of how keeping people sick longer can be more profitable.  But the fact is, most people with chronic illness already knew they were being ignored.  We already knew our tendency to buy vast quantities of supplements and OTC drugs was seen as profitable.  

We also suspected that when all the PPI's (indigestion pills) became OTC practically overnight,  that a profit center was born in our stomachs.  Ever notice that IBS has few good clinical choices, but when it turns into IBD, most of the solutions are surgical? I did, and to me that's a red flag.  Somehow this marriage of insurance and drug companies that somehow produced these copious "guidelines" managed to convince a generation of doctors that any "stomach complaint" (or flu like complaint) was not something that needed a solution.  So a generation of patients became convinced that there's nothing we can do, until we became housebound or bedridden, or sometimes ended up in wheelchairs.

If you have a rare illness, or are a woman in your middle years and your body is falling apart for no good reason, or if you have an unpopular illness (I count ME/CFS among the unpopular, but common illnesses), you might have had the thought yourself that you're tired of doctors telling you you're fine when you're not. CPG's caused a type of blindness, that if it wasn't a defined illness, it must not exist and therefore must be in the mind of the patient.  

Websites centered on chronic illness, lifelong illness, and rare illness sprung up.  Patients began the arduous process of comparing their experiences online with other patients, and formulating a theory of what's wrong with them, outside the doctor's office.  Supplements were sold by the ton because doctors weren't helping, despite the rise of polypharmacy.  People on youtube started a series of daily videos titled something like "40 day fast." Results were mixed.  
In attempting to force everyone to use only modern, "proven" therapies, it forced everyone with an undefined illness to basically revert to medieval medicine. This was made worse, because at the same time, insurance companies were limiting access to lab testing.
Will insurance premiums go up? Yes. Certainly. But offering people care that isn't helpful, but is cheap... that's not good either. In the past few years my husband and I have been buying cheaper insurance because buying the max coverage doesn't even work anymore. They still nickel and dime you for everything, the only difference is, do you pay more per month, or not?

Even while signed up for the most expensive health plan, I have had to switch to a compounding pharmacy so that I can have them look at prices for me and I can plan for the inevitable times when my insurer decides... I have too many of a drug per month, or I have no good reason (according to them) for using Valtrex, or I should use imitrex instead of Zomig (I'm allergic to imitrex, but an insurance rep actually suggested it anyway). 

Insurance meddling must stop. Let doctors be doctors and incentivize them to pick the solution with the best overall health and quality of life outcome, not the cheapest one. 

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