The savvy american patient has many ways to cash in on his medical care. We discussed the "build-my-case" approach in the personal injury domain (auto accidents, workers' comp, slip and fall, etc) where the PI lawyer is usually the de facto HMO case manager and the chiropractor the gatekeeper of the case, bringing in the specialists in rotation to build-up the medical bill and enhance settlement. More surgeries = more monies usually. Lawyers greatly encourage those to increase their bottom line. After all they are not the ones putting their bodies and lives at risk.Patients are often proclaimed permanently disabled after these PI related surgeries and they are now cashing in on disability policies and/or Social Security Disability benefits (SSDI) at a relatively young age (usually in their forties). From the files I saw in Bethesda in the late 1980s, when I was awarded a grant by the Social Secutity Admnistration, about 40% of the people on SSDI were diagnosed with failed back syndromes and most of those were subsequent to MVA, WC or slip and fall injuries. The median age was mid-40s. The taxpayer will be supporting these "disabled" people for an average of 50 years! How could any economy afford that?
Following this all too common tableau, the now surgerized and disabled patient is very often in a lot of pain due to post-op morbidity, scar tissue, deconditioning and long periods of inactivity and convalescence, or at least claims to be. There is increased need or at least demand for narcotic medications. The more scars and hardware they show the more they can get providers to prescribe huge amounts of narcotics. These officially disabled patients, who have little official income left besides their SSDI, find it usually very tempting and lucrative to sell all or most of their narcotic medications on the street ($1 per 1mg for Oxycontin!), therefore cashing in in yet another way on their injury and medical care.
Such a multi-faceted and prosperous business bourgeons around a compensable injury in America unlike any other similarly advanced and civilized country. The incentives are too strong and too many parties profit form it. It is indeed one rare occurrence of lawyer-doctor complicity so Obamacare and Washington beware.
The Federal Government wants to save money by cracking down on fraud and abuse. The scenarios explained above are perfect examples of such except that there is no smoking gun. Surely one can say that a lot of these surgeries are unnecessary and that can be labeled as abuse, but you will always be able to find a doctor who says otherwise...for a fee! In a number of trauma-related related specialties, there are only two kinds of doctors, as in lawyers, defense doctors and plaintiff doctors, the difference being the payor.
