Where is the care in my healthcare?

What’s wrong with health care in America?

Here’s one clue: Out-dated sacred cows trump logic.

A recent series of New York Times articles addressed the repercussions of the sharp rise in type 2 diabetes cases in New York City. An installment that appeared last week noted that three of four centers designed to be “boot camps” to treat type 2 diabetes had been forced to close because they couldn’t turn a profit.

The article offers this example of survival of the most profitable. Insurers often refuse to pay a modest fee for a diabetic to consult a podiatrist in hopes of preventing foot problems caused by diabetes. But nearly all insurers will cover foot amputations, which run about $30,000.

Another example: Most insurers won’t cover consultations between diabetics and nutritionists. Meanwhile, about 100 new dialysis centers have opened in New York in recent years. The additional centers are needed to accommodate the rising numbers of diabetics with kidney problems.

The Times article offers this unsettling quote from Matthew E. Fink, M.D., the former president of Beth Israel Hospital: “It’s almost as though the system encourages people to get sick and then people get paid to treat them.”

How did we come to this? We used to be a country where doctors actually gave patients care. It wasn’t necessarily “health care,” because health was just one part of the larger picture. Doctors cared. In emergencies they made house calls. After an illness, they checked to see how you were doing. And they solved problems the best way they knew how — without automatically resorting to prescriptions and surgery, or having to check the insurance company “approved treatment list” first.

I know there are still doctors like that out there; it seems they just aren’t listed in my HMO-approved directory.