A reader posted a comment awhile back about the hospital experience of her mother, who was just diagnosed with aplastic anemia. Briefly what happened:

“… the hospital attempted to discharge her. They indicated that she could receive the treatment for aplastic anemia on an outpatient basis. My sister challenged that as being unacceptable based on the standards of care associated with the treatment. Evidently, there was some concern on the part of the hospital Chief Financial Officer and others that they would not be reimbursed sufficiently by Medicare….

Medicare, the public plan that serves the 65 and over population has long been touted as the best America has to offer and promoted as the example for a successful public option that covers all. And it does offer decent coverage, from working in a doctor’s office I can attest to that. Proponents cheer to their hoarse that it’s administrative overhead is a paltry 4 or 5%. Once again very true. But here is the problem. The historically low cost of administrative duties has less to do with efficiency and more to do with high susceptibility to fraud, the program losses approximately 10 percent a year to fraudulent claims. Medicare historically does not inspect thei rbills and so they’ve been burned. According to a 1996 report(the most recent) conducted by the Inspector General of the Department of Health and Human Service, Medicare payed out $23.2 billion in improper payments. Data like this has forced the program to respond, and they have done so recently by lowering reimbursements rates. As America continues to get older, Medicare will continue to look at ways to save and experiences like the one shared above may become more common. In this case, the patient was eventually admitted to a room after a bit of a hassle, according to her daughter. I don’t have anything more than superficial knowledge of the what transpired, so I cannot comment directly on this specifics. But what I can say is—based on my own, frequent observation—-patients don’t challenge the system enough. Their sick and just assume the doctor or hospital or insurance company either knows best or isn’t worth the trouble of questioning. My intent here is not to encourage people to purposely give the system or doctor or insurance company a hard time, although the last example is admittedly tempting. But, as things currently stand, the system(being all of healthcare professionals, insurers, hospitals etc.) has a great advantage over the patient. The challenge is to level the playing field— from the patient’s side that means demanding a seat at the table and not just handing the keys over blindly. And to professionals that means having the perspective to understand a patient is entitled to a seat, even if it means going to extraordinary lengths to ensure they follow along in the discussion.

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