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Menachem's Writings Liars, Damned Liars and Insurance Agents About ten years ago, I was back in Australia. I asked my brother how business was going. He's an electrophysiologist, which for those who don't know this profession, is a cardiologist who specialises in the electricity of the heart -- in their own words, an electrician. (Let's give him a plug for those of you in the Antipodes that may need his services -- Dr Dennis Kuchar for your next pacemaker.) The other cardiologists are known within the fraternity as plumbers. Things were good, but the real winners were the plumbers . . . and the big time losers were the cardiovascular surgeons, those who specialised in chopping up your chest. He knew a guy whose father was a top ophthalmologist. He had an amazing practice. He begged his son to specialise in ophthalmology -- the practice would eventually be his, on a silver platter. But the new doctor had his heart set on cardiovascular surgery. The work was satisfying, the money was fantastic and the market was growing rapidly -- there was a shortage of good practitioners. Eye work was boring, monotonous, not for me. Years later, by the time this guy was finally in the "market", after years of intense study and practice, he had no work. He was crying. His father was on his way to retirement and the eye practice was great. What had happened? What went wrong? Simply, technology had changed the scene. Medical specialists were now able to provide the same and even better service than surgeons. In one word, the "new" development was the stent, a slender tube or spring inserted into the cardiac artery to hold it open allowing blood once again to flow freely into and out of the heart. Very, very simple technology.
When a patient presented to his cardiologist and was diagnosed with blocked cardiac arteries, instead of sending her off to the surgery boys and girls, the doctor would say something like, well I could send you off for surgery. The surgeon will take a circular saw and hack open your rib cage. Don't worry, you'll be asleep so you won't feel much. They'll connect you to heart-lung machine because your heart must be temporarily non functional during this maneuver. They'll cut some arteries out of your leg to connect to your heart, bypassing the blocked cardiac blood vessels. Now you'll have to walk for an hour every day, after you recover, for the next year or two to keep your legs from atrophying (walking is probably a good idea -- you ought to exercise given the condition your must be in in order to have reached this stage -- or maybe you believe it's the fault of your genes). The surgeons can do this in about three months time, so please take it easy, your ticker's not too good and we want you to still be alive when the appointed time arrives. You'll be in hospital for about ten days and then you'll recuperate at home for at least a couple of weeks . . . I guess a month all together away from work. The chest pains will last a little longer, but now from the thoracic shop. They'll give you plenty of morphine to quell the pain. You'll have a zipper scar on your chest for the rest of your life. Da-de-da! And by the way, you'll need to do this every ten, twelve years or saw . . . . Or tomorrow morning you can come by the hospital -- I run a clinic on Tuesdays and Thursdays. I'll stick a tube up your leg artery towards your heart. No anesthetic, just a little local. We'll drop this little thing, called a stent, into the arteries leading to your heart. Your blood will flow easily, immediately no more angina or discomfort. And you can go home in the afternoon, back to work tomorrow. And if it doesn't work, well, we can easily replace it at any time. Which method would you prefer? Of course the cardiologist does a financial interest in your selection, but the cost to you or to your medical insurer is a fraction of the cost of surgery and an extended hospital stay. Now, ten years later you don't even get to choose. It's obvious. The surgeons only get the difficult cases, and, though the cardiologists don't tell you this, the few stent cases that are botched up. But you're already in the hospital, and the surgeons are just hanging around the coffee shop, waiting.
So I was a little more than angry when Errol, my friendly insurance man, called me last week with a new offering. To be fair, Errol is a good friend (probably because he is really an engineer that went off the tracks -- it happens when you come and live in Israel -- not everyone can do what he did before, even if he wanted to) and has helped me extricate money out of the insurance companies in some tight situations. Thanks Errol. :-) We have a policy which provides cover for surgery. We've had it for the past ten years and have yet to make a claim, thank God. The policy even covers laser surgery for eyesight correction, allows me to select any doctor, anaesthetist, hospital, etc that my little heart desires, and do it anywhere in the world. Like all normal human beings, I have never read the policy in full, so I am not sure what it really does cover, and what are the [many] exceptions and exemptions. I hope it does ensure, if I need to make a claim, that I get a surgeon who is good at what he does. Though, as an aside to contradict myself, while my brother-in-law was still studying anaesthetics and intensive care medicine, Israel's then Prime Minister, Menachem Begin, slipped in the shower one evening, breaking his hip. They rushed him to Hadassah Medical School's Hospital in Ein Kerem, and brought in all the top practitioners as befitting the premier of a major world power. The anaesthesiologist was my brother-in-law's professor . . . but, now being an academic, she was a bit rusty on the practicals -- she didn't do this kind of work too often. So Jeff did the work and she got the glory Errol was offering me, for a mere 10% additional cost, cover for "medical alternatives to surgery". Get it -- they will now also cover me for a stent in place of cardiovascular surgery. I have to pay now them extra to get a service that costs them a fraction of the cost of surgery. I wouldn't expect these leeches to take into account the cost to the economy of the absence to the workforce for a month of a key player such as me. It's not a direct cost, so the actuaries are encouraged to ignore it. The direction medicine is taking today, is increasingly towards medical rather than surgical solutions. I related to Errol my brother's anecdote above. He started to give me examples which they presented him at a special seminar called for the purpose -- to teach agents how to sell this junk product. Varicose veins was one example. I said B.S. Get me the numbers. My guess is there are probably no examples, but if there are, by next year, when the practitioner has paid off his initial equipment investment, he'll be racking it in, in partnership with the blood-suckers. Policies prices are going up -- and cost to them for services is going down. But as I said to Errol, you have me by the short and curly -- take the money.
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