Here’s how much of your thousands of dollars in medical insurance premiums actually go to the medical doctors who do the work.

This is a settlement from Cigna for $89.57 of a $475.00 medical bill including a complete medical physical and a new patient office consult of moderate complexity. This represents about one to two hour of our medical and administration time providing service including review of records, intake, and documentation. A full roster of patients like this (which we don’t have, thank God…) works to be about $30 per hour per doctor. That’s gross revenue… not salary, not profit, and this is for one of “America’s most exclusive communities” (gag)… At 160 hours of work per month, that’s $4800 per month in sales, which is just barely enough to make minimum payments and rent.

Let me tell you what happens now:

Either:

1) I debit this patient’s payment card for the remaining unsettled balance ($250). Unfortunately, more and more people provide to us completely maxed payment accounts. Either this charge will clear and ruin this patient’s monthly financies, or this patient will be denied due to abject poverty, or because this is Greenwich, Connecticut, this patient is on Trust Fund Welfare, whomever is the “poppa/mamma bear” of this family will try to confront the medical doctor directly and complain. If bear already (unfortunately) knows me by name, they will demand that I am disciplined.

I assure you 100% that this patient is completely convinced that he “saves money” by buying medical insurance and would simply not believe that not only is all insurance —especially medical insurance— an almost guaranteed financial loss in all expected circumstances, but also, that his “fiscal responsibility” doesn’t protect him from being billed twice —once for “insurance,” and again because insurance refused to pay.

Aside: isn’t it funny how much money we spend trying to “save money?”

2) I don’t debit this patient. I inform the patient that he may apply for financial assistance, the patient has a private freak out about how “everything is circling the drain,” and I never hear from the patient again. Meanwhile, the office itself either:

a) goes bankrupt (“acquired”) and nobody gets any medical care outside of the hospital meatgrinder (and hospital collections are far more ruthless and expensive)

b) increasingly charges fewer patients with some financial support for the poor while people in the middle —enough to pay something but not enough to qualify for financial assistance— …get no service whatsoever.

Healthcare is diverging: either you get Private Flight service, or you get the DMV factory line. If you are somewhere in the middle: I have news for you, you better pick a side now, because it’s not so much that flight is impossibly expensive… it’s that it’s not for sale… to you.

Note: there is little correlation between quality of insurance and socioeconomic status —unless you are an informatic or organized labor.