Understanding the American Healthcare System: A Critical Analysis
The Intricacies of Healthcare Explored
Have you ever felt overwhelmed by the complexity of the American healthcare system? You’re not alone. Many Americans grapple with understanding the nuances of this intricate framework. In this episode of “The Rehab,” host Mark Leeds, D.O., and guest Lloyd Sederer, M.D., embark on a deep dive into these complexities. They explore the labyrinthine nature of healthcare, a concern that touches each of us personally.
As Dr. Sederer, a distinguished psychiatrist and public health expert, delves into the industry’s challenges, listeners find themselves engrossed. His experience brings to light the immense hurdles within the system. The conversation is not just academic; it’s a lifeline for those lost in the healthcare maze. Dr. Sederer’s insights resonate with anyone who has navigated the perplexing world of medical care.
For-Profit Corporations and Patient Care
The influence of for-profit corporations on healthcare cannot be overstated. This dynamic drastically alters the landscape of patient care. As Dr. Sederer points out, profit-driven motives often overshadow the fundamental goal of health services. The priority shifts from patient well-being to financial gain.
This shift is a critical issue that Dr. Sederer and Mark Leeds discuss with urgency. They underscore the importance of understanding how these corporations operate. Only then can we begin to see the effects on our personal healthcare experiences. It’s a topic that directly impacts our lives and the care we receive.
The Impact on Healthcare Workers
Consider the healthcare workforce, tirelessly at the frontline. They too are victims of this profit-centric approach. Dr. Sederer sheds light on how the industry’s focus on revenue affects these essential workers. It’s a reality often overlooked but deeply felt by those within the system.
The conversation between Mark Leeds and Dr. Sederer becomes more than an intellectual exercise. It’s a call to acknowledge the human aspect of healthcare. Their words offer a perspective that connects with listeners who know healthcare workers or who have witnessed their struggles firsthand.
Insights from “Caught in the Crosshairs”
In his book “Caught in the Crosshairs of American Healthcare,” Dr. Sederer offers an in-depth analysis. He explores the pervasive influence of profit-driven entities on healthcare. His writing serves as a guide through the convoluted system, providing clarity and understanding.
The book is not just a critique but also a beacon of hope. Dr. Sederer proposes solutions that could benefit patients, healthcare professionals, and even the judicial system. These ideas are discussed in the podcast, sparking hope and engagement among listeners. It’s a conversation that goes beyond the problems, offering pathways to improvement.
Exploring Actionable Measures
What can be done to address these complexities? This question forms the crux of the discussion between Mark Leeds and Dr. Sederer. They don’t just dwell on the problems; they explore actionable measures. These suggestions provide listeners with a sense of empowerment and direction.
The episode concludes on a hopeful note. The challenges of the American healthcare system are vast, but not insurmountable. Mark Leeds and Dr. Lloyd Sederer’s conversation opens doors to understanding and potential change. It’s an episode that not only enlightens but also inspires action and hope.
Transcript
Mark Leeds, D.O. [00:00:00]:
Dr. Lloyd Sederer, Lloyd Sederer, MD. You’re a distinguished psychiatrist and public health expert, and a prolific nonfiction author, about to release your or has it released yet, the 14th book?
Lloyd Sederer, M.D. [00:00:21]:
Yes. Yesterday.
Mark Leeds, D.O. [00:00:23]:
Oh, okay. Oh, great. So it’s and it’s already a bestseller from from what I hear. And you you are currently an adjunct professor at Columbia University, the School of Public Health. You’ve served as chief medical officer, and executive vice president of McLean Hospital, which is a Harvard teaching hospital. You served as mental health commissioner in New York City in the Bloomberg Administration, chief medical officer of the New York State Office of Mental Health, which is the nation’s largest state mental health agency. And in those positions, you’ve done an incredible amount of good. I mean, that that just summarizes a huge career of decades where you’ve Probably saved countless lives.
Mark Leeds, D.O. [00:01:02]:
I know there’s a great story you told me about how you instituted a policy that mental health clinics in New York had to offer Suboxone treatment, which is life saving.
Lloyd Sederer, M.D. [00:01:10]:
Yes.
Mark Leeds, D.O. [00:01:11]:
Yeah. That’s incredible. And you’ve you’ve won a ton of awards. I mean, I I don’t wanna take up all our time listing them, but, people people should go to your website and read your, your profile and definitely read your blog post and follow you on social media. But let’s talk about the book, Caught in the Crosshairs of American Healthcare. It’s a great book and and you talk about your experiences at, McLean and, issues in American health care, which I think we all know. I think anybody listening who is an American knows that health care is a mess. So you tell us a little bit about the book.
Lloyd Sederer, M.D. [00:01:47]:
1st, Thank you for having me on, Mark, and I always love speaking with you online or otherwise. And thanks so thank you again. I tell stories. This is not a technical book. It has a lot of particular details here and there, but I think that the way to understand things is through stories. It’s ancient way of communicating. So it’s the story Told in different ways about how for profit corporations have taken control Oh, for medical care in the United States to the great detriment of you, me, Other other people who are dependent on medical care. And I use this in illustration, McLean Hospital where, I was, chief medical officer.
Lloyd Sederer, M.D. [00:02:44]:
As an example, because I it’s a first person example. I was there. I was there during when the Impact hit when managed care hit when suddenly the referrals to the hospital tanked when we started to hemorrhage money. And it took 5 or 6 years, and we righted the ship, and it has prospered since then for the past 30 years. But I had that firsthand Very answer. It wasn’t abstract, and I tell that story as well. And I tell it in some ways also by, Providing, clinical cases. So talk about some of the patients I’ve worked with.
Mark Leeds, D.O. [00:03:27]:
Yeah. Yeah. And and health care, I I I don’t think there’s any easy, great solutions. You know? You look around the world, and there’s other countries that have health care included as part of the government. And, there there’s a, like a a meme on social media that, you know, with all all this military action unfortunately going on in the world where they they show some fancy American bomber flying by. And they say, oh, the world’s gonna find out why we don’t have free health care, which is, you know, which could be you might say is good or bad. I mean, know, at least we might feel safe or the world feels safe in some degree, maybe, maybe not, but there goes our health care flying by as a multibillion dollar bomber.
Lloyd Sederer, M.D. [00:04:06]:
To me there needs to be another meme that represents not just spending money on bombers, but Siphoning money off to corporations, to insurance companies, to managed care companies, and, this is So fundamental, their regulations is called medical loss ratio, the percentage of dollars, Patient care dollars that can be siphoned off by an insurer, and it often is up to 15%. So we start out in American Health Care in all these ways and including, programs, Medicare, Medicaid, where the payer or the payer’s manager administrative manager, like a managed care company, Takes 15% off the top.
Mark Leeds, D.O. [00:05:02]:
Oh, 15%. Well, that’s that’s, So what we pay for health care, I mean and and and, of course, like, we we pay a huge amount for health care. It’s unaffordable to to most people. I mean, just the the thought of medical bills coming in. It’s like, you know, what did I just pay for? You know, you get, like, this $1,000 bill for for a bill for $1,000 for going to the ER. And it’s like, wow. Why am I paying $1,000? And then it’s like, no. You didn’t pay for your whole your whole visit wasn’t 1,000.
Mark Leeds, D.O. [00:05:29]:
That was just for you to sit in a room. And now there’s just a call from every doctor and radiology, and each different entity sends a bill. And, it it and there’s no way that all that one Interesting thing in in South Florida, I think or maybe in the state of Florida, which I think is different from other states, is that there was a period of time where people had to get MRIs for for pain management. And this was kind of tied in with the pill mill, issue that, you know, for these Pill Mills to to try to be legal, they would require people to get spinal MRIs, you know, low back MRI. And so the MRI businesses jumped in and said, well, we can do MRIs for 2 or $300. A a study that normally costs 3 to $5,000, the same exact study. And in fact, if you if you went into the same MRI center with insurance, it would be billed for 1,000 of dollars, and they somehow figured out a way that on the side, they can charge a cash paying patient 2 or 300 for the exact same study. So we’re definitely overpaying.
Mark Leeds, D.O. [00:06:25]:
These things are being charged a lot more than than the value of what they’re worth.
Lloyd Sederer, M.D. [00:06:30]:
Yeah. It’s like going into a marketplace, with shops everywhere and, you know, maybe a retail price In the window, but inside, if you talk to the owner, in this case, an insurer, you can bargain down the price so you can get it for cheaper.
Mark Leeds, D.O. [00:06:49]:
Yeah. And I think that, hospitals, like, what I’ve from what I’ve heard, and this is a good tip probably for people that get a big bill from the hospital, I think you can negotiate like we have a right to negotiate to get Medicare what Medicare would pay. So if they charge you $1,000 and you find out Medicare would have only paid $200 for that same visit. You should be able to negotiate with the hospital and and do it quickly. Because if you wait too long, you lose, apparently, the the window of time to be able to do that.
Lloyd Sederer, M.D. [00:07:15]:
Yes. That’s true. With Medicare and that’s traditional Medicare. That’s not what’s called Medicare Advantage, Which are the managed care companies that now provide insurance to 50% of Medicare beneficiaries. That’s like 30,000,000 people, and they are for profit companies, and they are defrauding many of them in serious ways to frauding the federal government By what’s called upcoding, putting a code for a higher rate or a higher risk adjustment so that they get paid more, by adding procedures like you were discussing a spinal tap. And they, they make They they make a lot of money, and they pretend or they they offer the client, the subscriber, It’s gonna cost less. We’re gonna have better access. It’s gonna be better quality, and none of that is true.
Lloyd Sederer, M.D. [00:08:19]:
None of that. So it’s, that They’re fraudulent in their average parsing, and they’re fraudulent in their billing. So fraudulent that the federal government, Health services has brought a lot of them, quite a few of them to, the Department of Justice, and the Department of Justice has taken them to court And one. But the sad part of that story is they get a fine. $10,000,000, whatever. And that’s such a fraction of their revenue that They just pay the fine and keep doing the same thing. That’s how greedy and that’s how fraudulent, these some of these companies are particularly the Medicare Advantage companies.
Mark Leeds, D.O. [00:09:10]:
Yeah. And another point that you’ve made, is that things have gotten to the point where doctors don’t wanna even be in this business anymore. And I know and my my father who Probably would have been, he’d be a little bit older than you at this point, but he, he had told me that, like, in the seventies when he started his practice that that I I think I heard it from other people also that that was the golden age of medicine, that that doctors were happy. They had good careers. They could have their own little practice, and and, and things changed dramatically. Like, when I went to medical school, HMOs were, like, well entrenched. In fact, that part of our education of learning managed care. And it was, in fact, other I remember hearing other doctors in in training say, You know, you you you guys all miss the golden age of medicine, you know, like when we were all happy and doing well.
Mark Leeds, D.O. [00:09:59]:
And, and I’ve also heard stories from you I’ve heard people say, that the business people in in the business of medicine saying that the best way to to be successful is to have patients be captive audience. And I think that ties in with what you’re saying about Medicare Advantage is that Once you’re in one of these plans, you’re you’re stuck. You know? You can’t you only have, like, short windows, I guess, to jump from one to another, and and maybe there’s nothing really good to jump to. You’re jumping from one bad situation to another.
Lloyd Sederer, M.D. [00:10:30]:
This is a huge problem, workforce problem. Doctors fleeing medicine. It began with COVID, but has it has Been sustained so that it’s now affecting our ability to get care because hospitals are not adequately staffed, Not with doctors, with nurses, with technicians. Very hard to get an appointment. And when you get an appointment, particularly primary care, you get a 10 minute appointment Yeah. With doctors mostly typing into the electronic medical record. So the whole Nature delivery of medical care has changed to to, in a destructive way since when your dad practiced.
Mark Leeds, D.O. [00:11:12]:
Yeah. Yeah. And and, you know, there there’s, there’s definitely things that we need in in medicine. Like, if if someone has something life threatening. And and, you know, like, they need a surgery for a trauma or they need a major surgery, and and they’re gonna come out of it fine. And and without, you know, the medication or the surgery or the procedure, they would die, but, you know, they can live a long life if if they get that. Those things are essential. And some of them are very expensive.
Mark Leeds, D.O. [00:11:39]:
But then a lot of medical care, you know, kind of to me, it never made sense that that insurance would cover every Last thing in your healthcare that, you know, that, you know, like when I get car insurance, I don’t expect it to pay for an oil change or tires. You know, routine wear and tear and routine service should probably be something that people pay for. But because, like you said, because big business is involved and insurance is involved, prices get driven up where, you know, it shouldn’t cost what it costs to get basic service, to go to a doctor’s visit or get a, you know, like we’re saying, the MRIs are 10, 20 times more expensive than what they should be. And, you know, you hear about people going to Mexico and other countries and in some areas actually getting decent medical care for a fraction of what they get it for here for various reasons, whether it’s, prices driven up by insurance or, I mean, they some people say it’s because of, you know, fear of litigation, but I I I think it’s more the, the the insurance and the fact that you can’t charge one price and also deal with insurance, and so they drive prices up.
Lloyd Sederer, M.D. [00:12:41]:
Yes. And the primary purpose of a of a for profit corporation, The primary purpose is to make a profit. Yeah. It used to be that medical services, the primary purpose was to see serve the patient, To serve the family, to serve you and me. That has been wiped out, and it extends now. There was a piece recently in The Times because it has been shown over and over again that that’s the case with for profit corporations. Huge insurers like United, Aetna, Anthem, That they’ve been squeezing the dollar out for a long time and in some ways in in the Spanish care plans fraudulently. But now not for profit hospitals, which about half of the hospitals in the country are not for profit.
Lloyd Sederer, M.D. [00:13:37]:
The ones we tend to know the most are university hospitals, University of Florida, whatever. And they’re also behaving like profiteers, And that’s because executive compensation, the CEO of that university hospital, actually not for profit, His or her compensation is determined 70 75% of their compensation is Determined by what kind of revenue, what kind of profit they bring in. So it’s they’re not they’re not running an organization that’s Meant to take care of people that are running an organization that’s, meant to deliver a a profitable commodity.
Mark Leeds, D.O. [00:14:26]:
Even a nonprofit hospital is is playing that same game of of profit.
Lloyd Sederer, M.D. [00:14:32]:
Many many many are, And that’s, become, just how ubiquitous The, greed and the destruction of quality ethical medical care has become. And that’s why I wrote this book. Not I’m the only one, but I want to pitch in my voice because I’ve lived it. I saw what Was needed to save a hospital from going under from being sold, when threatened by Managed care when threatened by insurers. We did it, but it took a lot. It was a hard time and but we succeeded, and other people can seed. And I’ve people have asked me now, I’ve thought about this even more. Is there any are there any solutions to this, you know, corporate, Raping, if you will, of medical care.
Lloyd Sederer, M.D. [00:15:34]:
They’re and I see 3. And these are 3 that are in our control. It’s not waiting for a miracle from the federal government or the miracle of universal health. 1st is patients and families. The second is professions, and the third is judicial, Not not federal government, but the courts. 1st, patients and families. And what I have Urge people and discover worst is you have to be a demanding patient or family. You can’t just be meek or afraid of the doctor because you’ll just get bypassed.
Lloyd Sederer, M.D. [00:16:18]:
And my experience is that the best patients Or what we used to call difficult patients. Now they’re demanding, which is they’re demanding what’s due them. They’re demanding to know What’s the matter with them? Why is the doctor has proposed this plan? What the alternatives are? What the costs are? It’s always our demanding patients that begin to tip the balance about what’s going on. So that’s Really, critical in terms of 1 solution. The 2nd solution is professions. And I’ll just concentrate on the doctors for a moment because the doctors have 2 tools to win Against corporatization that they’re starting to use, but not very much. The first is to unionize Because then they can strike, and striking is a very powerful way of Fighting back against control back control because if doctors go on strike, a hospital doesn’t make money. Beds are unfilled, so we’re basically then attacking the what’s most important, to these companies, which is Revver, which is Prophet.
Lloyd Sederer, M.D. [00:17:37]:
The, the second is I know some examples of this, Particularly in California, there are large doctor groups that have very big contracts with insurers, Particularly Medicare Advantage in one practice in in, California Did not renew its contract with this private Medicare company. And we shocked everybody. 30,000 subscribers, 30,000 Patients and their families were suddenly had no place to go, had no doctor, had no care system to go to. That is Disruptive in a way that will change things painfully, but will change. So the 2 things are, unionizing going on strike and, basically, not doing business with these companies. And when asked, these large practices, why they do that, they say 2 things. Well, it’s just too much of a burden to deal with them, the administrative hassles, And they pay poorly. Why should I renew this contract? And the third reason is, or third method of fighting back Is, judicial.
Lloyd Sederer, M.D. [00:19:00]:
And what I mean by that is that courts, administrative courts, can appoint A special master to a company to an organ to a state or federal agency. Basically, they are suddenly put in charge. Everything has to run through them, and that’s how Culture can be changed because this is a a culture of greed, and a special master is there to see that The companies does right that it serves the people it’s supposed to serve. And so the third is a Court appointed special master over some of these companies, particularly the ones, I imagine, who are repeatedly fraudulent Because of fines, they’re not doing anything to change them. Those are 3, methods of fighting that are within our grasp Spend I don’t need to wait, for a miracle.
Mark Leeds, D.O. [00:20:01]:
Yeah. And would that help as far as with because, You know, I see, like, probably the real problem is corrupt politicians. You know, they’ve they’ve done a lot to make sure that doctors are not corrupt. You know, they’ve you know, we can’t even a a drug company can’t even give us a free pen anymore. And, you know, when I first started, they could they could buy us tickets to Baseball or football game and and put us in a fancy box and get served dinner. And, you know, that that was probably kind of extreme, but, you know, we can’t even accept a pen with the name of drug company because we’re being influenced. But every one of these companies I’m sure has a lot of lobbyists that are doing all kinds of favors for politicians, and they don’t You know, I feel like if politicians had to had the same rules that doctors had, you know, that that they can’t get paid off and they can’t have special favors and take a lot of money from people. I mean, all all the stuff that happens.
Mark Leeds, D.O. [00:20:50]:
I mean, it just seems like these companies can get away with anything. But may maybe by following, those three steps, that that you outlined just now that that at least, you know, I don’t think we’re gonna change politics and get rid of lobbyists and get rid of you know, change that whole thing. But, but there are some things that we can do now to to make a difference.
Lloyd Sederer, M.D. [00:21:10]:
Yes. Yes. The federal government, anyway, which might Stand a chance to correct things is paralyzed at this point.
Mark Leeds, D.O. [00:21:21]:
Yeah.
Lloyd Sederer, M.D. [00:21:21]:
And the divisiveness is is, appalling. And it prevents any action, so particularly a difficult action like holding payers or insurance companies or Private equity companies to task. It’s never gonna happen, because of how funded they are in these pharmaceuticals as well, and because the federal government, the Congress, has decided, We’re not gonna do anything, to help one another, which is not what government is supposed to be about. It’s supposed It’s be about coming together to help.
Mark Leeds, D.O. [00:22:02]:
Yeah. Well, that, that thing about private equity, that I think is a major thing that that’s become a much bigger issue lately. I’ve noticed almost every private hospital in South Florida has been bought by 1 company. And I when I looked them up, they’re one of the largest private equity companies. And now people are saying, only go to public like, the hospitals we used to be told to stay away from, the public hospitals, the county hospitals. Now people are saying those are the only places you should go because these companies are gonna kill people by trying to profit. You know? They the things that make them money are things that could be very dangerous to patients.
Lloyd Sederer, M.D. [00:22:34]:
Yes. And the and sometimes you you know the pride you know of Because they’re massive, private equity companies, but sometimes it’s silent or it’s hidden because there, A hospital needs money to operate the building services. A private equity company shows up and says, well, we’ll give you $4,000,000 a year for the next 4 years, so you can do this and that. But you have to pay us On our investment, not 4% like a a bond, but 15%. So also another way by which Money is siphoned off, and, basically, the hospitals and other doctor groups are required to, Fund indirectly. Fund these private equity companies, which do very well for their investors because they’re Automatically siphoning off money from patient care.
Mark Leeds, D.O. [00:23:37]:
Yeah. And and I think, yeah, I think people also need to like you said, they need to be more informed. You know, if if necessary, bring when you go to the doctor, bring someone to to represent you, to be, you know, a family member that’s knowledgeable. And now, yeah, now with some of these new AI tools, like, we can all be kind of be a genius, and we can take contracts and feed them into the AI and say, you know, read the fine print for me. And, you know, I mean and there there’s things, you know, things that are, like, magical. Like like, Insurance companies, you can sometimes if you write a letter at the right time and fax it to the right number, you can actually get results. And you almost never get results when you call them on the phone and yell at them. Know, that seems like a tactic to delay things.
Mark Leeds, D.O. [00:24:18]:
And, there’s, like, little tricks like, you know, demand a third party arbitration or something like that. You know, things like that. And and magically things happen when you say the right words, you know, as per, the fine print and the contracts.
Lloyd Sederer, M.D. [00:24:32]:
Yes. That is being a demanding patient or a demanding subscriber, which is not taking it, lying down. It is not letting yourself be exploited.
Mark Leeds, D.O. [00:24:42]:
Yeah. Yeah. Definitely. So, Dr. Lloyd Sederer, thank you for joining me, and, I recommend everyone Go to Amazon. Go to your nearest bookstore. Buy this book Caught in the Crosshairs of American Healthcare. It’s a very good book. Very enjoyable read and a lot of insight into your experience at at McLean and, and also a lot of interesting analysis of the health care system and and solutions, ideas for what we can do today to make a difference.
Mark Leeds, D.O. [00:25:11]:
Thank you.
Lloyd Sederer, M.D. [00:25:12]:
you. Thank you, Mark. Always a pleasure to be with you.
