11 Reasons Why Our Healthcare System is So $&@%#! Up

by Jonathan Govette

Why healthcare is messed upPardon the expletives, I have been wanting to share some thoughts and frustrations about healthcare that I have seen arise over the last few years.

The United States healthcare system is completely broken; it has become a huge money pit, with insurance companies, pharmaceutical corporations and greedy lawyers at the bottom filling their pockets.  Mind you, I do not blame the practitioners or their staff, because they do an exceptional job, even when they are sleep deprived from working doubles.

Is our health a commodity?

Healthcare is a strange commodity. If you are starving, you can’t walk into a restaurant and demand a hamburger, and you certainly can’t walk into a steakhouse and demand a ribeye. If your water gets shut off, you can’t walk into a gym’s locker room and demand a shower and use of their shampoo.

If you can’t afford a cell phone, you can’t bust up into a Sprint store and demand to see Dan Hesse the CEO. But in healthcare, if you think you need care, regardless of actual physical acuity (severity), you can go to a hospital and they have to give you the best care they can provide, by law, and for FREE!.

Without making a value judgment on that fact, you have to admit that devising a system that both capably serves its clients and doesn’t bankrupt its providers is a tenuous ordeal, at best.

UPDATE:   Check out Part 2 – Another 11 Reasons Why Our Healthcare System is So $&@%#! Up, for the follow up story.


11 reasons why healthcare is broken 

Today I’m going to talk about 11 reasons why I think healthcare has been down in the gutter for so many years.

1.     Insurance companies - In a short-sighted view, insurance rates are a big problem. They cost so much that people outside of large business plans cannot get coverage unless they’re in perfect shape, under 40, and have no family history of medical problems. Which, given that last qualifier, discounts pretty much everyone. However, simply saying insurance rates are the problem is like saying inflation is the reason things cost so much; you’re actually only describing an effect of a larger system of problems, not the problem itself.

Just like the solution to keeping ice from melting isn’t inventing ice that stays frozen at a higher temperature, making insurance more affordable isn’t necessarily done by demanding insurance companies to lower their premiums.

The fix is to improving communications between providers and insurance companies that would result in less wasted tests, long wait times between care and approvals, (which result in health problems getting worse, which cost us more) Right now most insurance companies use paper fax to authorize treatments and sadly many of these are lost in transit or take many days or weeks to process.  Get with technology guys!

healthcare costs are high
Thanks to dailyinfographic.com for image.*See the full infographic here

With insurance premiums on the rise again, we seriously need to get our insurance companies on the right track so we can afford to die healthy.

2.     Excessive regulation - Not saying all regulation is bad, but, for example, the criteria for becoming a medical practitioner is way too strict. There is no reason why I should need eight years of schooling to say, “Hey, you have an ear infection. Take this for a week.”

Probably half the nurses at most hospitals could handle a lot of the GP work that gets done, but they can’t, because the government doesn’t allow them to. When it takes a couple hundred grand in education costs to become a doctor, doctors are going to demand a $%#! Ton of compensation for their services.

When doctors demand a %@#! Ton, it drives the cost of health care up. If we opened up certain branches of healthcare to people who can do the work even without all the schooling, it would drive costs down for at least some forms of healthcare. I mean, I can help design a bridge that, should it fail, will kill dozens of people without all that schooling, but I can’t tell someone he has a cold?

3.     Shortage of Doctors – Studies show that there will be a shortage of doctors for the American patient in the next 15 years according the Association of American Medical Colleagues.  But what they do not quote in the WSJ article is that number 2 above is the real reason why there is the lack of people wanting become doctors. If you have gone through the rigorous medical schooling, or know someone who has, you know how tough it can be.

4.     Medical advances - We’re learning how to treat more and more ailments, and these new treatments are pricey. Once upon a time, if you got a certain illness, you just sort of quietly died. Now medical advances are not a bad thing, they just cost a lot more during the first few years of their launch.

Now, you instead rack up a hundred grand in treatments that are paid for by your insurance provider. The insurance providers pay through the nose, and they pass the costs on to you in the form of higher premiums and co-pays.

5.     Paper – Please, stop using 50 year old FAX technology.

Did you know that providers need to fill out an average of 20,000 forms every year? And, 3 out of every 10 tests are reordered because the files are lost?
We also know that paper is the costly, killer of trees, hard to track, and easily misplaced, lost or misfiled…

So why most do doctors still use paper to communicate? Because till recently, it was really the only way for 2 doctors to communicate information, but thankfully that is finally changing with the advent of new applications that help manage the patient referral and insurance authorization process.  Sorry for the little plug – Check out referralMD, it will make you and your staff’s live so much easier.

physician referrals

Want more stats? Check out the full healthcare infographic about American’s broken referral system, the stats are shocking.

6.     Ignorance - Another branch of increased costs is ignorance, which I don’t mean in a derogatory fashion. Just the simple ignorance of patients or their parents not knowing how to treat something at home, or not even worrying about it and coming straight to the ER for care.

Ninety-five times out of a hundred (especially in children), the problem can be solved with medicine available at CVS for $6.99, but instead it now costs several hundred dollars in triage and physicians’ fees. As you can expect, many parents are more concerned with getting their children well than if they can actually pay for the service, and as a result do not pay the bill. They know they do not have to have money to be seen, and that’s all they need to know.

7.     Choice to Die - I feel that we, as a nation, spend entirely too much money on the care of irrecoverably indigent patients, and that euthanasia should be a legal option if granted in powers of attorney and a Living Will. I’ve seen too many middle-aged or older people spend their entire savings keeping elderly parents on life-support for years beyond the point when recovery was medically viable. People with strong feelings on healthcare should have to spend time in ICU wards and nursing homes, watching withered old people sit paralyzed in their own feces, fed by tubes because their vegetative minds can no longer operate their contracted and atrophied hands.

It’s a hard thing to look at, but it’s even harder, for me, to defend the right to keep someone in this cruel condition, especially at the cost of the taxpayer. I have notices in my Living Will dictating the removal of life support in that situation, as do most of the people I know. And I think that’s the biggest thing about people’s thoughts on healthcare: a volume of experience changes you, and the longer you’re in the field, the more pragmatic you become.

8.     McDonalds – Well any fast food for that matter.  Some of us eat it daily due to it being cheaper, faster to eat, and more easily consumed from any location.  The mentality of eating this type of food is slowly destroying our country. It causes American’s to gain weight, become stagnant, which in turn increases the risk for heart disease and other debilitating diseases. The overall effect is that these diseases are preventable and if kept in check, could lower the cost of healthcare premiums for everyone.

Will we change, probably not; will we get fatter and sicker? Yes….  So unless we make it illegal to eat badly, we will be drowning soon in our own disgust.

9.     Cluster $#@! Of EMR’s – You got me started now… EMR’s (Electronic Medical Record software) are necessary, we know this, the older paper filing system (See number 5 in the list to why paper is bad) was hard to manage, time consuming to use, and carried a huge liability if anything were to happen to the patient files.

Once the U.S. government got into the act of bribing doctors to use these newer systems, 1,000s of small under-capitalized EMR’s popped out of no where trying to get in on the modern gold rush that happened over the last few years.

Now the big issue with some of the largest EMR’s are that

  1. They are godly expensive, so most individual practitioners and small groups cannot afford them.  Current EPIC installs at a serveral local hospitals here in California were 100’s of million dollars, some up to 700M or or more. Crazy!
  2. Simply put, installation times are terrible. In some of the larger EMR’s it can take years to be fully integrated. What’s even worse is it usually requires the IT staff to help, which makes it even harder to implement.
  3. Systems are complex and way too hard to use. I have heard so many horror stories from EPIC, Meditech, and Cerner users that simple hate to use the system but are being forced to.  In some cases to use pieces of the software require you to click on 4 to 10 different areas to process a request.  Who designs these things? You would think that they would ask a focus group first or at least test out different graphic interfaces to make it more useable.
  4. Training is long, and unpleasant – We talked to a few nurses at Children’s Hospital about their Meditech installation and they were so unhappy with the process and how slow and laborious it was.

Developers need to be more caring to the needs of its users and take into account that they will be using this system every day; it needs to work and be simple.

10.     Healthcare Vs. Military – This is a controversial subject, my family/friends have both served in the military and also worked in the healthcare industry. Now I like the fact we help the world with it’s problems (be the police as it is), but you know what? If we save you, pay the bill.

American’s and other countries that come and help should be compensated, Iraq anyone?  The Iraq war started March 20th, 2003 cost us almost 1 trillion dollars in direct costs and possibly another 1 trillion in future care for returning vets over the next 40 years.   So Iraq has all that oil money and they can’t pay America and our Allies back for the assistance?  Stats if you interested.

So what does that mean for healthcare? Well, if we had that money, we could offer better healthcare services and not be in such a huge hole that will only get bigger as American’s population ages.

11.     Pharmaceutical companies – Now I am not the one to hinder capitalism, it’s great that you can make billions, pay your executives top dollar, and live the good life, but do not release drugs knowingly that are unhealthy for consumers or can cause health problems. This causes massive litigation and increased costs that pharma passes along to consumers and it’s bad business. Say no to drugs! or at least try to…

A great example of a Big Pharma company not doing the right thing is the drug Risperdal. The U.S. Food and Drug Administration (FDA) told the J&J to stop the false and misleading marketing claims not once, not twice, but three times from 1994-2004, but the company reportedly continued to include marketing the drug for unapproved uses right in their business plan.

In 2006, research showed that up to two-thirds of prescriptions for Risperdal were for unapproved uses that had little or no scientific support. Worse yet, elderly dementia patients who were prescribed Risperdal for off-label uses were found to increase their chances of death by 54 percent within the first 12 weeks of taking it!
Read more here.

Top 10 CEO Salaries for Big Pharma in 2011
1. William Weldon – Johnson & Johnson – $26.7M
2. Ian Read – Pfizer – 25M
3. Miles White – Abbott Laboratories -24M
4. Robert Coury – Mylan – 21.3M
5. Kevin Sharer – Amgen – 18.9M
6. John Lechleiter – Eli Lilly – 16.4M
7. Joseph Jimenez – Novartis – 15.7M
8. John Martin – Gilead – 15.6M
9. Lamberto Andreotti – Bristol-Myers Squibb – 14.9M
10. Robert Parkinson – Baxter – 14.1M

Read more: Top 10 Pharma CEO salaries of 2011 – FiercePharma

Access to drugs from other countries.
Another issue. Our esteemed congress people are about to pass legislation that would make it illegal to purchase drugs from other countries (even with a prescription) under the guise of both internet safety and public health. Unsurprisingly, the drug companies and health insurance companies are the ones pushing this legislation. Here is a link to the legislation

Check out the survey of what others think of healthcare

Surv it

Click to retweet


My rant has ended – Let’s discuss.

Did I miss anything? Have some ideas to fix the problem? Let us hear your thoughts

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Jonathan Govette is the Co-Founder and CEO of ReferralMD, a trusted HIPAA-compliant referral network for providers, caregivers, imaging, labs, & hospitals to coordinate care across organizations, locations, & departments. Jonathan is a content marketer & social media specialist with an engineering, design, and business background. Jonathan has been featured on many of the top healthcare websites such as Forbes, HIT Consultant, HealthWorks Collective, MedCity News, VentureBeat and more...

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  • Mark Sims

    Thanks for the great post, very informative. I do have a point to add as well. I think you are correct in your views, and feel that it will take many years, maybe even 10 to 15 years before we fully fix our issues. The system is completely broken as you put it and will take some time and great minds to fix it.

    • http://getreferralmd.com/ Jonathan Govette

      Thanks for the comment Mark. I agree its going to take a long time and trillions of dollars before we fix it. Here’s to waiting!

  • pndr

    2 under recognized points. 1) United Healthcare’s CEO was paid $102 million in compensation for 2011 and he’s not even allowed to give a flu shot. They gained 13% increase in profits in 2009 and 21% increase in profits in the first quater alone of 2010. Meanwhile, physician reimbursement has DECREASED for the last 5 years straight while the amount of work (paperwork etc) has increaded. So, premiums go up and reimbursements go down…where is all of the public’s money going? This is just one example of the many insurance companies out there and they are all doing it. There are just way too many people between me and my patient.
    2) Top heavy administrative costs to keep up with constantly changing and increasingly confusing “reform”. It takes an average of 5-7 office staff per physician. Many efficiently run offices have to have a full time staff member just to make phone calls to insurance companies to ask permission to perform a procedure from someone with zero clinical training. There are plenty of jobs to be had in healthcare with the shortage that is out there so I am not talking about reducing the job force. I am talking about having a higher percentage of the job force providing improved patient care services. THE ANSWER IS TO SIMPLIFY NOT COMPLICATE. When was the last time a lawyer or politician got involved in something and that something got better and less expensive? What would people say if a physician tried a court case or started doing people’s taxes for profit? The same reaction should happen when people who don’t understand what is being treated are allowed to dictate how and by whom treatment is rendered. And I don’t want to hear the “corruption” card. The corruption in healthcare and insurance fraud has followed the trend of increased non-clinical people making money off of healthcare…coincidence? All of these politcal people want to point the finger at doctors…we should start chasing the dollar trail and get back to patient focused care.

    • http://getreferralmd.com/ Jonathan Govette

      Great addition to the thread, I agree with the insurance authorizations, its a nightmare. I have a friend that works at Concentra and 90 percent of their time is spent with insurance authorizations that are still being sent back and forth with faxes. Really? All I can say is I can’t wait till we change this.

  • BooksatBeach

    Interesting article. I tend to put more stock in articles that avoid $#!*)0 and phrases like “…installation times suck.” Consider paring it down and focusing on the three big things you’re trying to say; review it for professionalism; and then republish.

    • http://getreferralmd.com/ Jonathan Govette

      Well the expletives got your attention and helped you find our blog, so it worked. I could not find a better way to share my feelings about the healthcare system then to just say what I thought. Sometimes just saying how it is, is the best way to tell the story.

      The reason why the article is long is because it’s a massive problem. If you notice our blog has short and long articles based on the content we write about. Healthcare has so many problems right now we decided to put them all together in one post for everyone to read and discuss.

      Thanks again for coming to read it!

      • Jamie Inman

        My only comment on your expletives is that you misspelled them. My twitter profile @ibeatcancrtwice has the correct spelling: !@#$%! NOT $&@%#!
        Love this article!

        • http://getreferralmd.com Jonathan Govette

          Glad you enjoyed it, feel free to leave any feedback on future articles that would be helpful, and we write them for you. Thanks!

        • http://getreferralmd.com/ Jonathan Govette

          Thanks Jamie! Glad you enjoyed it. We are working on our next massive post, stay tuned.

  • david

    It is all the same around the world. If you go over health cares you easily realise that for every first line assistance team you find a pyramid structure which tip is made by a physician, the nurses, porters, etc but the pyramid’ s large base above is made by a lot of other “powerful” professionals that have a clumsy or even no idea at all about the aspects of their activities they are dealing with,
    I mean, people, efficiency criteria, correct resources’ use but, anyway, they try to do their best to fill their pockets with very few restraints. We lack of a consistent ethical frame to develop our daily work And it is not only a USA’ s way of providing health assistance: it is a overall world tragedy we are too far to sort out-Welcome to the real world.

    • http://getreferralmd.com/ Jonathan Govette

      Thanks David, I agree with the current framework is completely broken. I know how to fix it but it will take over 100M in investment and many years to properly employ it. For now I am happy to fix just one aspect of the system, which I feel is one of the most important for both the patient and the doctors that refer them.

      If you have any thoughts on the matter, I would enjoy hearing more about the solutions and how we may be able to assist each other with our end goal.

  • getthegummintout

    In almost every item you listed above, behind it is 45+ years of draconian Federal/State Mandates and the additional over-regulation from other sundry bureaucrats who all have to put their “next big idea” in place on an industry that needs fewer hurdles placed upon the practitioners and clients. This problem only got bigger when the Fed got involved – and it has spiraled out of control since it became a “political club”. Most of the costs in healthcare are directly related to the BS introduced by each level of Government.

    • http://getreferralmd.com/ Jonathan Govette

      I agree, and unfortuanlty it only continues with subsidizing doctors when they upgrade their systems to an electronic format. Without these subsidies many of these poorer quality software companies would not be in existence due the the inferior products they produce. Its time to cut the fat, and help education and healthcare, two of the most broken systems in America.

  • http://twitter.com/dalecoymd Dale Coy

    Only in medicine can the customer tells you how much he will pay you. That’s because quality has NO relation to cost.

    • http://getreferralmd.com/ Jonathan Govette

      You are correct, it seems like some customers treat their health as a commodity that they can bargain with. There will always be doctors that charged higher fees, if they are worth the cost then patients will continue to go to them. If they are not, then overtime the practice will go under, or the the doctor will have to adjust his pricing model in relation to competition. Let the market sort it out.

  • http://www.facebook.com/survcast Oliver Nguyen

    A survey on this article has been posted to Survcast:
    http://survcast.com/11-Reasons-Why-Our-Healthcare-System-is-So-Up-referralMD#_=_ – Question #2:
    Are you for, or against the Patient Protection and Affordable Care Act?

    Click to vote and see the results.

    • http://getreferralmd.com/ Jonathan Govette

      Thanks Oliver, Love your website

  • http://twitter.com/painspeaks Liz Hall

    Lots of interesting food for thought and I agree with many of your assertions! Thank you for this article!

    • http://getreferralmd.com/ Jonathan Govette

      Thanks Liz, I took a look at your blog, and read more about you http://painsufferersspeak.blogspot.com/p/my-story-diagnosis.html. My mother has been in the same situation for many years after getting hit by a car at a early age, and now deals with Parkinson’s. Let’s set up some time to talk more and see if a collaboration may be in order to get the word out.

  • http://twitter.com/ReferralMD/status/238398758218510337/ Jonathan Govette (@ReferralMD)

    11 Reasons Why Our Healthcare System is So $&@%#! Up http://t.co/wafQr2ia #emr #ehr #HCIT #healthtech #digitalhealth #hcsm #hcr

  • http://twitter.com/ShimCode/status/238701135005880320/ @ShimCode

    RT @ReferralMD: “11 Reasons Why Our Healthcare System is So $&@%#* Up http://t.co/6dSWLcvT <= Right on! #hcsm #hcr #ACA

  • http://twitter.com/ReferralMD/status/239083797906333697/ Jonathan Govette (@ReferralMD)

    11 Reasons Why Our Healthcare System is So $&@%#! Up http://t.co/tNndhbFA via @referralmd #HealthReform #Healthcosts #occupyhealthcare

  • fadler

    Healthcare is “no fault” everywhere else in the world but the U.S. Why? Its #()#$)(@#$& COMPLICATED! There are so many differnent moving parts that it is impossible to not have risk benefit assessments at most points. Stop the ability to sue.

    • http://getreferralmd.com/ Jonathan Govette

      Legal is a big issue in healthcare. Do you have any recommendations on how to simplify it?

      • http://militaryhealthmatters.com/ Milhealth

        Torte reform, … frivolous lawsuits. I’ve known/know (personally) excellent Doctors who have been or are currently being sued for what? $ That’s a big reason for the over abundance of tests being ordered … For all types of frivolous lawsuits (all, not just medical), I really think the British system is good. That would probably cut out at least 50% of the abuse … allowing legitimate lawsuits to move through the court system faster. On the other hand, insurance companies (the non-clinical decision-maker) denies an important test/DX procedure … thus, leaving the doctor open for … a lawsuit if something should happen to the patient (I’ve seen this personally too).

        Re: ER’s … what I don’t understand is if a patient presents with a non-critical issue, why are they being treated? Wasn’t the intent of the law to make sure the hospital couldn’t turn away someone needing ‘emergency care’ for such things as a heart attack, stroke, appendicitis stitches, a cast, or bone reset.. etc? Here in Miami, Jackson-Memorial hospital is a quasi-hospital/homeless shelter. Literally, ‘patients’ come in nightly, the medical personnel ask “what’s wrong tonight?” Reply: “I have a headache.” They get a bed to sleep overnight. Don’t get me wrong, I’m not cruel or against homeless people having a safe place to sleep but the ER is a very expensive ‘shelter’ …

  • http://twitter.com/ladyhank959/status/256833989065723904/ @ladyhank959
  • Kate Kalthoff

    Great post. You bring to light all the things that are messing up the system. I think there’s a real solution out there – – http://savingprivatehealthcare.com

  • AMF

    What about the fact that we don’t address basic resources when we treat patients? Doctors – (especially in emergency rooms, where a lot of people get their health “care”) – are writing prescription after prescription for asthma, heart disease, etc when patients have no food at home to even comply with medication treatments, ghastly housing situations – cockroaches, lead paint, no heat – and other basic-resource deficiencies. We’re treating so far down the line we’re barely providing a band-aid for a chronic-sized bleed out. Fixing our health care system isn’t just about shedding unnecessary costs and looking into holes – it’s about realizing that we’ve got to start working for better and healthier communities, families and individuals by working on social determinants. Interesting poll here of doctors who say they wish they could do just that, but our broken system doesn’t allow them – http://www.rwjf.org/content/rwjf/en/research-publications/find-rwjf-research/2011/12/health-care-s-blind-side.html?cid=xpr_pp_001

  • MJ

    Point #10 – you’re an idiot. As if Iraq even wanted us to go over there and “help” them in the first place. Of course they should pay us for it. /sarcasm

    Your analogy would be like if I came and burned down your house to “help you” get rid of a small termite problem that I heard you had in your attic, and then I sent you a bill because I tripped on something in your backyard and broke my ankle while I was setting the fire, so obviously YOU are responsible for my medical bills AMIRIGHT? lol

    • MJ

      Actually a better analogy: It’s like the guy in the intersection who washes your windshield without your permission demanding that you compensate him for it… only if instead of washing your windshield he smashes it with a rock and shoots your wife.

      • http://getreferralmd.com/ Jonathan Govette

        The countries that we help, ask for our help, so we go there to fix their problems in most cases. So your analogy is flawed. But I do appreciate your comments.

    • http://getreferralmd.com/ Jonathan Govette

      Unfortunately you missed the point with number 10. Wasteful spending in one area of the country directly effects other areas. We as a country need to be compensated (And most likely we (or someone) are secretly), but they goal is to make these types of transactions public so we know where our money is going.

      If a country needs our help, they should foot the bill for our services either directly or indirectly. We can not be the police for everyone without diving deeper in debt.

  • http://twitter.com/mphprogramslist/status/278812900381057024/ @mphprogramslist

    11 Reasons Why Our Healthcare System is So $&@%#! Up – A True #publichealth crisis http://t.co/Z06Rwp0K via @referralmd

  • http://www.facebook.com/daniel.maynez.52 Daniel Maynez

    I had to share this article with the Fresno State Student Policy Healthcare Consortium to get them to start a discussion on the topic! I’ve have been pointing out some of the problems you have described on here to explain why the healthcare system is so fragmented. I’m hoping I can mold some of these students into thought leaders to be open to new ideas and create solutions.

    • http://getreferralmd.com/ Jonathan Govette

      Hello Daniel,

      Thanks for the share, please let me know if you have any questions, I would be happy to help in anyway.

  • Frank

    I think we have no right to borrow to fund our health care. As about half our costs are now to be paid for by our children, we need to cut our health care in half or double our taxes, premiums, etc. Or a bit of both.

    • http://getreferralmd.com/ Jonathan Govette

      You are correct Frank, times are going to be very tough, and the outcomes are not clear. Currently the main issue is over 40 million Americans do not seek regular care which makes it more expensive when a big issue arises that could have been treated for a smaller cost. Regular appointments are key to a healthy life, that and not eating half the food that is available to us.

  • David Wishnew, MD

    It just seems to me that if you wanna make the rules, you must be a player. That said, I never see Physicians being asked what they want (other than the white tower, University based physicians. For the rest of us, regulations, rules, paperwork, unfunded mandates etc are imposed without any good science to show that these are effective.

    • http://getreferralmd.com/ Jonathan Govette

      I agree, everything seems like its forced down the throats without much thought. Not a good way to run a business or the country.

    • jk RN

      I never see RNs being asked either. I think we have enormous amounts of suggestions of how the system could be run more efficiently, but why ask us?

  • http://twitter.com/drcredentialing Physician Practice

    Hi Jonathan,

    Great article. I am still recovering after reading that. I need a guest to call in for a radio show tomorrow at 5pm est to discuss trends in healthcare. Would you be interested or can you recommend anyone?

    We will be discussing the recent article in Time magazine in addition to just covering how things are changing in healthcare. Show is from 5pm-6pm and is on the most listened to network in Florida. Free press never hurts. You will receive a digital copy of the show and it is transcribed for use on the web. It is wokv which is the most listened to radio network in Florida.

    Let me know if interested or if you know anyone.


    • http://getreferralmd.com/ Jonathan Govette

      Hello Andrew, I would be happy to help you tomorrow.

      Feel free to call me today to chat 650-241-0720

  • Aaron Spooner

    All due respect, I couldn’t disagree more with number 9. EMR’s are the future of healthcare and practices who believe paper is “just fine” are stifling growth in the industry.

  • Pinak Bhattacharjee

    Quite a research Jonathan! However, the market scenario looks much better as compared to few of the emerging markets like India, where 80% of the hospitals are yet to have an EMR and a long way to go for Stage 7 Clinical Transformation. They seem to be just learning about HIS now. Other than the top hospital chains, rest consider IT as a burden rather than an enabler. Although, the medical insurance industry is yet to emulate the US, healthcare IT unfolds an altogether different story in SE Asia.

  • George Swan

    Very good article, Jonathon. I’m a hospital admin, now ‘semi-retired’. I’m thinking that doctors should not be corralled by insurance companies in the ‘negotiation’ process, promising doctors how many patients they will deliver, so cut a bigger discount. Instead, insurance company premiums should be based on a ‘modified community rating’ with a rebate based on healthy outcomes (correlated to lower utilization/costs). We already have a master list of all services (the charge master) with RVUs assigned. A doctor should have the freedom to charge whatever percentage of the chargemaster they want. That would immediately clarify what services cost in a community, and the community would have incentives to adjust behaviors to become healthier. Billing would be much easier/more efficient (reducing costs). Combined with an ‘all payer claims’ database, we could transform our healthcare system in less than a year. This should be done by county or state, NOT by Washington DC. I think this could be done as an ‘ACO’ (Accountable Care Organization). Anyone who would like to ‘just do it’, please contact me (iplus007@gmail.com)

  • Someone

    This is one of the most naive posts I have ever read. The reasons you stated are obvious at best, wrong the other times. America should be compensated for the Iraq war? That’s ridiculous.

  • Austin Chiang, MD

    Agree with many points on this post but must point out that re: #7, withdrawal of care and DNR/DNI is very different from euthanasia. There’s obviously no right or wrong answer with regards to the legality/ethicality of euthanasia, but just wanted to highlight the differences in withdrawal of care vs. DNR vs. euthanasia. “Removal of life support” implies that patients were resuscitated to begin with. I agree many patients would not want to endure the pain and suffering of undergoing CPR and defibrillation shocks, and this would be a DNR. Some may choose to be resuscitated with hopes of getting off “life support” (meaning pressors and ventilators for the most part) if their condition can be reversed. But among those, some may state in their advance directives that they would not want to be maintained on “life support,” at which point their surrogate/healthcare proxy can corroborate and withdraw care. Euthanasia is obviously a highly debated topic, as it is practitioner-assisted death. Obviously much of the problem is where to draw the line. It may seem obvious that a 25 year old seeking euthanasia who is otherwise well would not be ethically appropriate. However things may be difficult in a 85 year old who is incontinent and bedbound, when they do not require life support and are otherwise capable of making their own decisions. Some would argue that clinical depression may be confounding the situation and that this would warrant treatment prior to consideration of euthanasia.

  • Emily Moses

    I have recently left the healthcare field and I don’t plan on returning. I agree 100% with everything you say here, and being from the Northeast, that’s not common for me. It’s just so frustrating that everyone agrees about the woes of the healthcare field, but nobody can agree on what can be done to fix it. I’m just glad I’ll never have to use a fax machine again :)

    • http://getreferralmd.com/ Jonathan Govette

      I agree on the fax machine, terrible tech to still use in an office. Where type of work are you doing now?

      • Emily Moses

        I’m currently unemployed with a degree in journalism and 5 years of experience in the medical field. I’m considering either starting my own business or going back to journalism – possibly writing with emphasis on the medical field.

        • Nate

          Maybe we can work together to solve these problems.


    Jonathan, I have read with interest your article. I propose another debate. It is our necessary health or is not required?. Who should provide health, Government or citizens?. Who should control the good health, Government or citizens?. If you answer these questions, you’ll have the answer to your 11 reasons.

    • http://getreferralmd.com/ Jonathan Govette

      Your questions are open for debate, I would enjoy hearing your thoughts if you would like to publish them on our website. Government rarely creates what users actually want, and capitalism sometimes fails, as it has with healthcare. So there is no right answer unfortunately.

  • Eduardo Mahiques

    Jonathan has done a good diagnosis of the health situation, now lack a good treatment, which must be based on lot of training physicians and lots of information for patients. they will need good teams, led by good leaders to propose appropriate protocols to improve health care. You can do, only does lack will and energy to do so. Without leaders, training and information, you you will continue denouncing the health deterioration by the centuries of centuries.