Challenging the moral hazard with healthcare and insurance
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With the Affordable Care Act (ACA) enrollment period coming to a close, we have an opportunity to reflect upon present challenges in our healthcare system and look to make improvements in the New Year.

And there is much to improve upon. There are rising premiums sweeping the nation, particularly in Arizona, Alabama and Nebraska. The medical community has been confronted with a huge increase in regulations, slowing down doctors and staff while doing little to actually improve patient care.


Healthcare plans have become increasingly comprehensive, now covering a breadth of services ranging from obesity counseling to the morning-after pill. While some of these offerings can improve a patient’s health and quality of life, they present the problem of the moral hazard, a term describing how people behave when they are insured against losses.

In terms of healthcare, this has translated to people using their medical services and going to the doctor more often than necessary because they are not footing the cost. Unfortunately, the moral hazard has also inadvertently led to doctors themselves cashing in on the system, favoring volume over value and offering patients unnecessary treatments and procedures for their own financial gain.

I see it constantly. Healthy patients come in to visit me who have had spider veins treated with laser ablation, a process that essentially collapses the veins. On the surface, it sounds innocuous; doctors promising their patients that they can get rid of unsightly veins with a quick and painless procedure. But the problem is that this treatment rarely eliminates the unsightly veins that “required” it in the first place. Furthermore, it destroys the veins that are most commonly used for heart bypass surgeries, potentially robbing patients of a lifesaving procedure they may need down the road.

While laser ablation is at times medically necessary for those who suffer from varicose veins that weaken their legs or cause pain, it should not be used to achieve cosmetic results. Unfortunately for patients, it’s a real moneymaker, and the moral hazard is to blame.

Technology has led to some amazing advancements in the medical world: we are able to successfully treat cancer; vaccinate against a host of diseases; and life expectancy has risen to unprecedented levels. On the flip side, technology has also made some procedures so simple that any doctor can learn them. While on the surface this may sound like a positive, there is also a dark side. With laser ablation, for example, a family practitioner can take a weekend course on the procedure and call himself a vein doctor on Monday morning.

Doctors with distressingly low levels of training are able to open up their own vein clinics, pushing medically unnecessary procedures like laser ablation on patients who could get those results with a pair of compression stockings from Walgreens.                                                                                                  

For a quick 30-minute laser ablation treatment, doctors can make as much as $2,000. They do this by working the system, embellishing records to suggest that a procedure is medically necessary in order to justify insurance coverage. This, of course, is all happening at the expense of the patient, and the consequent conflict of interest has completely disrupted the doctor/patient relationship.

There has been a 6,000 percent increase in laser ablation treatments within the last 10 years. In my home state of Florida, unnecessary laser ablations have risen to abnormally high levels. The figures are staggering, and The Centers for Medicare & Medicaid Services (CMS) has never seen anything like it.

How do we fix this problem? Catastrophic events should undoubtedly be covered by insurance, but perhaps we need to move towards a value-based system, one in which doctors are not incentivized for pushing unnecessary treatments. In doing so, we can all work towards repairing the doctor/patient relationship while addressing abuse within the system.

Jose I. Almeida, MD, FACS, RPVI, RVT is the Founder and Medical Director of the Miami Vein Center. He has been practicing in the Miami area for over 20 years. Dr. Almeida is a highly accomplished vascular surgeon and is known as a pioneer in Endovascular Venous Surgery. He is the creator and course director of the International Vein Congress (IVC), the largest educational summit dedicated to venous disease, which is now in its second decade.

The views expressed by contributors are their own and not the views of The Hill.