Medicare and Medicaid Are the Original Sins of U.S. Healthcare

Profit motives aren’t the root cause of our broken U.S. healthcare system, as purported in Aaron Rothstein’s review of Wendy Dean and Simon Talbot’s “If I Betray These Words” (“First, Do No Harm,” Bookshelf, April 4). The original sin in healthcare is the highly complex and bureaucratic Medicare and Medicaid programs, which drive reimbursement methodologies for all payers of healthcare.

As a former hospital CFO, I learned that government-funded healthcare reimburses providers using arcane codes that the public and even many providers fail to understand. Commercial insurers largely follow this methodology in their payment arrangements with physicians and hospitals. As a result, providers have an incentive to document care to optimize reimbursements rather than provide care to the patient in exchange for an easily understood price. One reason your provider is glued to his computer, laptop or tablet during your visit is that documenting care appropriately to be reimbursed is complex.