Our Future Healthcare System – The Capitalist Way


When I first arrived in America from Britain, back in 2002, I could see a doctor. Once my health insurance was sorted out and I’d ‘signed up’ with a family doctor I had only to pick up the phone and I’d have an appointment that day, or possibly the day after, or, at the very latest, the day after that.

To quantify the extent of my need the receptionist would take pains to ensure I was seen within a time-frame relative to my suffering. Rarely was my wait longer than three days, unless the doctor was on leave, or himself sick, in which case I could see another doctor, or choose to wait until my own was back in the office.

Then the family practice was taken over by a Catholic hedge fund.

Almost immediately a letter from the Pope was needed to get within spitting distance of my doctor. His appointment book was full for weeks. They could fit me in, “…let’s see, there’s a vacancy next month – how about the 27th?”

Of course, if it was urgent, I could always see the Nurse Practitioner.

The what? Isn’t she the one who combs kids’ hair for nits?

Does anyone ever visit a doctor if they DON’T consider it urgent? I suppose some do – like poor old Mrs Johnson from down the road. She used to be a regular every week with her sciatica and ingrowing toenail. She really only went for the company, and because she thought the doctor was wonderful. They can’t fit her in anymore since the Catholic hedge fund took over.

The last time I saw her was just before we moved. They were carrying her out of her house on a stretcher. Poor soul, she was eighty-one and dying of loneliness. The weekly visits to her family doctor were the only thing that had kept her going.

It was much better when we moved to our new place. It was five hundred miles away, and in a different state. The new family doctor was a woman. She was quite pretty. I liked her. And we didn’t have to wait months for an appointment. It was just like the old days.

“Oh, yes, Mr Adams, would you like to come in this afternoon? Or, we have an 11.30 tomorrow morning?”

It was the same at the local hospital, run by the town council. All the staff were cheery. They seemed very happy in their work, and ever so friendly.

Then a hedge fund bought out the whole medical system in the area. I didn’t find out until I tried to make an appointment to see our doctor.

“Well, if it’s urgent we advise people to go straight to the Emergency Room,” was the response I got one morning, after being told it would be three weeks till the doctor was available, “…or, you can see our Nurse Practitioner. She’s very good.”

“Is she a doctor?” I asked.

“No, she’s a Nurse Practitioner.”

I gave in. I could see the Nurse Practitioner the next day.

After receiving a prescription for my minor medical condition, I was waylaid in the outer office by the receptionist.

“Mr Adams, you have a copay of twenty dollars.”

Oh,” I responded, somewhat taken aback. After all, I didn’t see it was any business of theirs what my insurance copay would be. “Okay, thank you.”

I headed for the exit, only to be called back. “You’re expected to pay it before you leave.”

Now, I’ve always prided myself on being a mild-mannered individual, but this was too much. “I beg your pardon?”

The receptionist had the good grace to blush slightly. “They…” she began, looking down at her desktop, “…want you to pay it before you leave.”

“And who are ‘they’?” I asked.

The girl hesitated, unsure. She stammered, “It…it’s the new rules. I have to ask everyone.”

I leaned over the counter towards her, “Well,” I said, in a loud voice so the whole waiting room could hear, “‘they’ will have to learn that ‘they’ cannot always get what they want. I’ll pay when I get the bill, and my insurance company has confirmed the amount, and not a moment before.”

As I turned to leave I noted in the waiting room a well-built, white-haired gentleman in a fancy cowboy hat. He was grinning profusely at me while giving the thumbs-up.

That was two years ago. I’ve never again been asked to pay at the doctor’s office. Apparently, there’s a note on their computer to that effect, though I can only guess how it’s worded. What amazes me is how many patients do dutifully hand over their credit cards at the counter without so much as a word of dissent.

“Mr Cartwright, I’m so sorry you’ve just learned about the cancer and that you only have weeks to live. That’ll be two hundred and twenty dollars, please.”

I later learned from members of the hospital staff that the new ‘owners’ had installed credit card readers on every ward.

“Good morning, Mr Jacobson, we’re just about to take you down to theater for your heart bypass. The total cost, with taxes, is fifty-seven thousand, three hundred and twenty-two dollars and fifty-five cents. Sadly, I’m afraid your insurance only covers one third of that, so I must ask you to slide your Visa card through this machine. But don’t worry, if the operation’s unsuccessful, you can apply for a partial refund.”

The mind boggles.

A few months back I needed to see the doctor.

“Well, Mr Adams, I’m afraid the Doctor’s rather booked up at the moment but I can get you in with our P.A..”


“The P.A. – Ms Fassbender. She’s very good.”

“Excuse me, what’s a P.A.?”

“Oh, she’s our new Physician’s Assistant.”

“And what exactly is a ‘physician’s assistant’?”

“Oh, well, she assists the doctor…”

“So, she’s a nurse?”

“No, she’s a physician’s assistant.”

I could sense this conversation was going nowhere. “I’ll wait and see the doctor.”

A few minutes of research on the internet convinced me I’d made the right choice. A physician’s assistant is nothing more than a poorly qualified stand-in for the doctor. All that’s required after college is a further two year course and they can make diagnoses, prescribe medicines, arrange admittance to a hospital, and generally do everything a fully qualified, four years at medical school, three years of residency training, family doctor can do.

What’s more – and here’s the crunch – you’ll be charged the exact same amount for a visit to a P.A. as you would when seeing a doctor. Yet the P.A.’s salary is only a fraction (40%, or less) of the doctor’s.

American hospitals and medical centers are fast becoming nothing more than cash-cows for the greedy, capitalist, corporate-controlled hedge funds that are now running America.

There was a time when a doctor’s office or hospital was considered a Temple of Healing. They’re rapidly being converted into the Wal-Marts of medicine.

The time is surely approaching when the receptionist in the doctor’s office will be replaced by a computer screen. A locked metal gate will separate the waiting room from the medical staff. At the time of your appointment a digital voice will instruct you to enter the treatment area by sliding your credit card through the reader on the gate. It will check your credit, deduct the fee, and only then, open the gate. If your credit is bad and doesn’t cover the fee, the only door that it opens will be the exit.

3 Replies to “Our Future Healthcare System – The Capitalist Way”

  1. Super post RJ! You’re such a good writer!

    Our doctor’s office has a sign on the desk informing that co-pays must be paid before leaving. We haven’t run foul of it so far as our supplementary insurance to Medicare covers just about everything (at a cost!)

    We’ve been reasonably lucky with our GP and medical centre so far, apart from grumpy staff on the desk (dang, but they’re a miserable, verging on rude, lot); and a doctor who, though I think is very efficient, must charge by the word and by the minute – it’s hard to get more than the odd sentence out of him during the very short time he spends with us. Still, that doesn’t bother me, I like to get it all over as quickly as possible.

    With regard to bad attitudes among medical office staff (it was the same in England as I recall too), I often grumble and wonder why this variety of staff isn’t trained in the same school as wait staff in chain restaurants. They fall over themselves to be helpful and friendly – I guess it’s because we don’t tip office staff.

    You’re right – things are not improving. Your vision of the future could well prove to have been precient.

  2. Twilight – thanks for the compliment. You don’t do so bad yourself these days. I think bad attitudes usually reflect the aura prevalent in the workplace, and medical staff are no exception. We’re fortunate, the office staff here are very pleasant, (once I sorted out the copay business!) and though the doctors are not easy to get an appointment with I’ve managed to discuss the deteriorating services with my own doctor at some length. The upshot is that doctors don’t like the way things are going anymore than we do. And why should they when the powers that be replace them with ill-trained and less qualified staff, for a third of the cost.
    While profit continues to be the overriding factor in almost every facet of our lives these days we’ll continue to see deteriorating services, overly-harassed employees, and our medical facilities stretched to the limit.

    George – I was about to explain ‘co-pays’ but decided it would take too long, so instead we’ll play you some music…no, that’s wrong…instead, see the next post.

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