TMJSurgeon.com…An Editorial. The difficulties of obtaining TMJ surgical care in the United States, Part I
Over the past year, I have received many emails expressing interest in insurance issues and difficulties that patients have in obtaining care. In all of healthcare, this is one of the more bizarre areas to have to deal with relative to healthcare financing whether it is through employer funded insurance coverage, or the federal government payers (Medicare/Medicaid). The current state of affairs in the United States impacts us all. Frankly, in talking with my surgical colleagues from other countries, my perception is that patients in other countries have much less difficulties than do Americans in this area of healthcare.
This and the next blogs are ”Editorial Comments” which I hope will help with understanding of the problems providers and patients face with obtaining help with this very common human ailment. The underlying theme here is that Americans have the mistaken perception that they do not live in a country that has socialized health care…..they are wrong as they misinterpret the word “socialized”. When government directs,funds, pays, authorizes, and controls the delivery of healthcare (Medicare/Medicaid) it is socialized and easier to understand as a “socialized” concept. When corporate America self funds healthcare as an employee benefit, hires an insurance company as a fiduciary to write coverages of benefits (like choosing food in a cafeteria…what’s covered, what’s not…) this is corporate employee benefit socialization….albeit in a smaller group context but a group socialization nevertheless. A patient is still not free to choose an insurer or product, or even sometimes their choice of doctor, that fits their needs and there are layers of review and authorizaton to go through. It’s not a governmental or publically acknowledged socialization, but regardless, is a cultural capitalistic socialization of work compensation benefits. Abuses of this system have created the need for government to step back in to police this part of the process with multiple layers of complicated bureaucracy for providers and the healthcare “industry” ….laws like (HIPPA and many others) to protect the public from abuses from HMO behaviors etc. So regardless of perception, we are socialized, just to different degrees and disguises. The agents of socialization are just identified and interpreted differently for some reason. Make no mistake, if there was no money to be made by insurance companies in American Healthcare administration…..there would not be the emotional debate and defensiveness concerning mechnaisms of payment by third parties, be they governmental or corporate insurance based….and hence the debates that enrage the public such as “single payer” concepts and the emotions that are created.
People somehow believe there is freedom and fairness in this process….there is not. It is ironic in the country that science, research and development has created much of the modern world’s healthcare discoveries and advancement….that its own people contend with such a dysfunctional product for their own healthcare financing.
If one were to choose a healthcare specialty to study the bizarre system and consequences that have evolved to create the healthcare system of the US, a good starting point would be the specialty of oral and maxillofacial surgery……which is the surgical specialty which will manage “TMJ Surgery”.
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