Martin Young
Martin Young

Beware the angry ordinary man!

I took an unusual step two days ago. I started a petition against Discovery Health, the administrators of Discovery Medical Aid. I have good reason to be angry, but it seems being angry, as I and so many other doctors, dentists and other health professionals are, is not enough.

I am fighting for the right to control my own destiny in my own profession, not one that some outsider has decided for me. I fight also for my patients who pay high premiums to medical aids and who receive conditional benefits in return. I think their money has been misspent by administrators like Discovery, and I am asking all who have an interest to call them to task.

One would think, taking into consideration a summary of my career thus far as fairly typical of the average fifty year old South African doctor, that …

… after six years of intensive study, hundreds of hours of examinations, work experience in six hospitals, eight or so Christmas Days, and eight New Year’s Days and many special holidays on duty, missed childrens’ birthday parties and family celebrations, several hundred happy live baby deliveries, and sadly several stillborn babies, dozens of caesarean sections, thousands of stitches put into wounded people in busy casualties, being abused and spat on by drunk patients, seeing friends die from terrible diseases while powerless to intervene, performing post-mortems on people I knew and on complete strangers, going to homes to break tragic news to relatives, treating crocodile, leopard and snake bits, malaria, bubonic plague, giving medical testimony in court at least a dozen times, counselling marriages and drug addictions, five more years of trying to balance training, career and family, more examinations, hours of study, the staggering success of curing ill patients, and the bitter loss of losing them, hundreds of resuscitations, closed and open cardiac massage, two years of work experience on three continents, 20 000 surgical procedures, a million consultations, a million prescriptions, millions paid in malpractice insurance and a clean litigation record, the searing agony of serious complications and the thrill of a difficult surgery succeeding, after 10000 private patients and the setting up of a fine model of public-private participation … and doing what I do to the best of my ability…

… that medical advisers, technocrats and bureaucrats would give me the right to decide what is best to offer my own patients, and to determine for myself the value of those services. I think I’ve earned it.

Sadly not. Discovery (and many other medical administrators) certainly do not think so, and Discovery’s ‘staggering success’ (their own words) in the past financial year – during which things have become progressively harder for health service providers and consumers alike – is a bitter pill to swallow.

There is only one way to counter a company that sees no need to change a system which, although dysfunctional, is clearly working for them “staggeringly well”, and that is to challenge them and call them to account in a public manner.

And that is why I have started this petition. It could go both ways. There could be very little interest, whereupon I will shut my mouth, acknowledge defeat, and probably turn and swim with the tide just to survive. Or there could be a campaign that goes viral and demands that medical administrator executives be held accountable for the limitations they place on clients while enriching themselves.

The determinative factor is whether you, the reader, choose to sign the petition or not.

If not, please don’t complain to me about doctors or medical aids in the future. Having done my best and failed, I will no longer be interested.

Tags: , , ,

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    • EBRAHIM Ameer

      I support you and others like you. The ordinary man is powerless

    • Anne Coventry

      I’ve signed. Things like Discovery refusing to cover T3 tests because they don’t believe they will show anything, even though my specialist endocrynologist ordered them, because he DOES believe they will tell him something.

      I can’t get them to put my thyroid medication on chronic, because they want the original tests, which are lost in the mists of time, and the latest ones show that things are okay. The fact that these tests are done while I am on medication, and therefore should be normal, seems to escape them.

      If medical aids had their way, apparently we should just skip the expense of our doctors and go straight to our medical aids for diagnosis and treatment.

    • Barbra

      Where do I sign? I have been fighting Discivery for years to lift exclusions from a policy for a condition that I have been cured of for 11 years, and get fobbed off with ever increasingly pathetic reasons why it cannot be done every year!

    • michael

      Martin, you are on a hiding to nowhere.

    • Daniel Berti

      I don’t think you wrote this very well.
      Maybe you, with your list of things you’ve done and your ostensible good intentions, qualify for the freedom you desire – but it seems to me a logical jump to assume the same of other doctors.

      So for the case of patients – would we not just be trading one tyranny for another if we sign?

      I’ve read a bunch of your pieces, and among your comments about how you think your salary is not high enough, I get left with the impression that this is the fundamental, when-you-get-down-to-it reason you’re doing all this. It may not be the case, but I have had that impression. For example, when you wrote about calculating your worth by considering how much time you spent studying, etc., I found that silly and fundamentally not something a Doctor should be interested in.

      I’ll be interested to see how your petition goes. Are there not direct action alternatives? What about doctor unions? You sound anarchist at times in your piece – what about anarchist solutions?

    • Ula

      Well done Martin. That applies to all the self serving companies and government departments out there too.Let them be subject to public audits.

    • Martin Young

      Daniel and Michael

      From an earlier blog of mine:

      “Around 2006/2007 the Dept of Health asked for a series of practice cost studies among all medical groups to ascertain the ‘real’ value of a doctor’s services. These studies were done by actuaries over the next two years contracted by the doctor group representatives themselves at great expense, and the results showed to the Dept of Health’s dismay that the true values of doctors’ services were very close to the upper limits established by SAMA some years previously.

      The old ‘medical aid rates’ were simply not viable for an ethical medical practice. Not getting the results they wanted or expected the Department of Health did the obvious thing. They ignored the studies and took no action on the results.

      In the results of a case brought by SAPPF and others, acting Judge Ebersohn on 28th July 2010 declared the (‘medical aid rate’) RPL 2007 – RPL 2009 null and void. He found the process by which the RPL and rates were determined to be unfair, unlawful, unreasonable and irrational.

      The Judge also said that the process resulted in tariffs that were “unreasonably low ” and one of the reasons cited for the exodus of doctors from South Africa. Unfortunately all Schemes and Administrators still utilise the now “illegal” RPL structures to set their benefits and tariff structures, in doing so disregarding an order of the High Court.

    • Martin Young

      Daniel and Michael

      I am well aware of the risks and challenges here. I also realise that there are many people very happy with Discovery’s success. They are commonly known as “shareholders.”

      As doctors we have options. We can leave the country, and many do. Or we can try to find alternatives, other means of change. The public do not have that option. To some extent social media – blogging and petitions etc. – is anarchy of sorts. I’m not sure, Daniel, what to make of your suggestions otherwise. I’m not prepared to break the law.

      Just last week in my practice a medical aid refused to authorise a combined dental and ENT procedure on the same child on the basis that dental costs came out of another pool administered by another company. So the child needs to have two anaesthetics on different dates at twice the cost, twice the inconvenience to the family and double the risk.

      This is just one small example of the idiocy we as professionals put up with on a daily basis. Administrators demanding expensive scans before authorising surgery for problems we can see without special tests. It is endless wastage of time, energy and resources.

      One last comment on income – interestingly, provincial or state salaries for senior medical specialists are pretty good. I don’t come close to the same net income within my private practice. The work environment of state employ is the downside, and posts are not always available.

    • http://www.thoughtleader.co.za/martinyoung/2013/09/22/beware-the-angry-ordinary-man/ proactive

      Martin you are brave, but a pity- don’t you think your petition is muddled & not focused- why? Mixing up several issues like:

      *~50%?- lamenting about your own low fees & lack of freedom (own agenda- seek
      your own professional body & consult!)

      The balance of the other ~50%? consists of:

      * High “Medical Aid Admin costs” (are of Members- not doctors concern)
      * Medical Aid Scheme profit (untrue- differs from Discovery “Group’ profits)
      * Medical insurance (allowed profit)
      * Being spokesman of Medical Aid Members- as a none Member?
      * Free market- to choose doctors (negotiate fees), Medical Aid or Insurance freely!

      All SA “Medical Aids” fall under the Medical Schemes Act 131 of 1998 & are supposed to be “none profit”!
      All “Medical Insurances” fall under the Financial Services Board (FSB) & are profit orientated- like car, household insurance etc!

      Any “Discovery Member” of “Medical Aid Schemes” can freely lodge objections at the yearly AGM. Any such Member or Members could follow a documented complaints procedure as laid down in Act131/98 or take legal actions against breaches of the Act.

      We as consumers would only have one objective: reduce premium costs of “Medical Aids” by economizing the whole system without loosing on quality and free choices!
      It includes you to charge a reasonable fee as well! All this is a huge task!

      Choices of “Medical Insurance” products are available on the national and international markets.

      Good luck!

    • Tofolux

      @Martin, I totally get this and cannot understand why Discovery is allowed to do what they do with impunity. I was diagnosed with a life threatening disease two years ago this after much diagnosis and a lack of understanding of the disease. My experiece at Groote Schuur was absolutely wonderful and with the competence of a specialist, my disease became manageable. That was under public health.Since moving to Jozi, I was once again misdiagnosed (by a professor) ended up in a bad way, was hospitalised twice and am now in a bad financial position this because has Discovery has failed me completely. I can only go to hospitals under their contract which charges enormous fees, have a doctor allocated (this without being in a position to make a choice), have all kinds of tests(ad nauseam) and prescribed tablets some which are completely unnecessary and then after having medical aid, some if not all doctors bills are NOT SETTLED in full by Discovery. This situation has left me in a precarious position because despite having a permanent disease which needs to be managed with pills, consultation etc etc Discovery refuses to foot this bill because I have no funds due to me. This notwithstanding that I am allocated a mere pittance of my yearly contribution. So as a young adult, a medical aid has the potential to ruin my credibility. Whatever decision Discovery makes in my interest, I have no say. All I do is pay and hope for the best. It is a total sham and misrepresented on all fronts

    • Old Wallet

      Dear Martin,
      Good idea.
      Let’s unpack it.
      You want freedom of choice in prescribing meds.
      I think most of us agree with you. Temptation becomes greed – incentives to prescribe + others.
      You sell time; what happens when you can increase your income with the same patient in the same time frame.
      When open schemes were started in the sixties, it was about doctors’ cash flow and access to health care.
      hen, the medical profession treated each other & others vastly differently to the way they do these days.
      here bad apples where ever we go.
      How does an industry cater for the good and control the bad?
      That my friend, is the magic.

    • Geoff Brown

      Would you mind saying how Discovery is preventing you from advancing your career in a manner you see fit? It wasn’t clear from the article. I’m not saying they’re a wonderful and pure organisation – just that you didn’t exactly express yourself very clearly.

    • Tofolux

      @Martin, is there no way you are able to compile a presentation get a mandate from concerned doctors and members of Discovery and ask to present this to the Portfolio Committee on Health in Parliament. As part of parliament’s consultative process you are able to do this, in fact the Secretary of the Portfolio Committee can advise you. I am of the opinion that the Minister of Health, the Council of Medical Aid Schemes are well aware of these practises and I have heard that there has been proposed legislatation to curb these practises. The problem is that these issues must be kept on the radar screen and the only way to do this is through citizen activism.

    • http://www.thoughtleader.co.za/martinyoung Martin Young

      Dear Proactive

      We doctors are the people who have to deal with the disappointment and financial stresses placed upon our patients by their own medical aids, and have to try to work within those limitations. It’s very very difficult.

      Medical aids are by law ‘not for profit’ but what happens is the administrators cream their admin cut from the MA’s – formerly as high as 17% – at no risk to themselves, and only then manage the balance by limiting benefits to members. It’s not illegal but certainly unethical in my view.

      Our professional bodies have been fighting this for 20 years to no avail – I’m using disruptive social media tactics by necessity – invoking the power of the crowd. As I say, it may not work. All other avenues have been tried and have not led to any improvements – none that I am aware of anyway.

      My other posts at least do give suggestions. The only alternatives seem to be killing private practice – which appears to be the goal of our Minister of Health, or running the whole system dry and taking as much profit out of it as possible – at which stage there will be other business avenues to pursue. And this seems to be what Discovery is doing.

      They are abusing their market position in a dysfunctional system that suits their own business model to the detriment of all other players. If that is not the case, they have to convince me otherwise in an open and transparent manner with evidence thereof.

    • http://www.thoughtleader.co.za/martinyoung Martin Young

      Tofolux – I agree with you 100%

      Geoff – my career is established and for the moment I have no need to develop it. The same cannot be said for those doctors much younger than me that will be faced with a choice of either working in an underfunded and under equipped state system, or going overseas. With the current climate and uncertainty over our futures I cannot blame new specialists for leaving the country. As a skilled professional, I expect to be treated as such by the organisations I have to deal with to see my patients given the treatment they need. The medical administrators ignore this completely in ways to numerous to detail here. In essence under qualified people with a vested interest in a company make the decisions that go against doctors trying to help their patients.

      Michael Moore’s documentary “Sicko” portrays this situation very well – worth taking out of the video store. the same situation is happening here.

    • Brent

      Martin I am an old ‘pale male’ a science graduate and have many friends plus family in the medical profession. My medical needs due to old age are increasing in spite of living very healthy (a lot sponsored/pushed by Discovery) and since being on Discovery for ± 10 years have not had one serious complaint. I stick to the rules and they respond 100% correct. They paid (100%) for two serious operations in 2009 (cost somewhere in the150 thousand level) promply to the hospital/medical professionals without me having do anything. So whatever your complaint please do not mess it up for thousands of members who are happy. The socialists in Govt are probably clapping their hands in glee, more complaints makes it easier to clump everything into one Govt system, be careful for what you wish could come about. Perhaps tweaking the system is what is needed but putting a spanner in the spokes smacks of disgruntled egoism. Brent
      PS – most of my medical friends and GP are no fans of Discovery so perhaps they bend more to the patient than the docter, again some tweaking is necessary not trying to scupper the whole system.

    • Isabella van der Westhuizen

      Martin private practice is over. You should position yourself to come back to the state. Private practice is a victim of it’s own financial success and has now been taken over by large corporations. The state has a lot of problems but increasingly it seems to be a better option than the grind of private.

    • Martin Young

      Brent

      I’m glad your experiences are so positive. That’s the way every client experience should be. You after all have paid for a service. It should be no surprise that you have received it. The fact that not all client experiences are as positive is the real problem. I’m pretty sure the same doctors who treated you have contrary stories to tell.

      I want private practice to remain just as much as you do. It is where I make most of my living. Some medical aids like GEMS keep their admin costs down to 5%. Why can’t Discovery? Where is the economy of scale?

      It does not exist.

    • http://www.thoughtleader.co.za/martinyoung/2013/09/22/beware-the-angry-ordinary-man/ proactive

      Dear Martin,

      if you could divorce your personal earnings agenda- which “consumers” will hardly support- from the real issue of high & unfair “Medical Aid Administration” costs, would win you much more support!

      Why not follow procedure & formulate a complaint according to Chapter 12 section 61(1) of Act 131/98 and lodge at it the next Discovery AGM and to the Registrar &
      Minister? It reads in part:

      “Notwithstanding the provision of any other law, the Registrar may, with the concurrence of the Council and the Minister, by notice in the Gazette, declare a particular business practice as undesirable for-

      a medical Aid scheme to award a contract for administration services without engaging in a fair and reasonable process of evaluating a range of potential administrators to select an administrator best suited to the needs of that medical scheme, taking into account considerations of, among others: cost, capacity, experience in administration and financial soundness;”

      Many suffer similar or greater financial & other stresses you describe within our unbalanced, threatened and political manipulated economy due to the past and present BEE, EE….. etc!

      Yours is not unique- in the end the outcome should bring lower costs to consumers and not only higher fees for doctors by a trade off in Admin costs! Was section 61(1) ever contemplated, done & rejected at an AGM or the Minister?- if yes, please explain & give details!

    • http://www.vulamehlo.co.za Carl Muller

      I support this…..it is time that greed for profit stop these guys in their tracks..

    • Peter Jansen

      Martin
      You do not have patients, you have customers, who wish to purchase your labour (medical expertise) at market related prices.
      The customer is liable for settling the account, not the medical aid.
      The clearing price for these services is what a willing buyer of your services is prepared to pay and a willing seller of the services – you – is prepared to accept.
      The laws of supply and demand should determine what you should be able to charge, which has nothing to do with the hours you spent obtaining your qualifications.

      It is also unfortunately not true that Doctors – especially GP’s always know what is best for their patients and will always prescribe the most appropriate and cost effective course of treatment.
      Medical aids and suppliers of medical insurance products have the same right to query the service providers costs and recommended course of action as do insurance companies dealing with builders, loss asessors dealing with major claims etc.
      Doctors are human beings and subject to the same temptations and failings as the rest of us, such as the temptation to over service, the temptation to order very expensive and unneccesary tests just to rule out the possibility of highly unlikely causes (at the same time reducing to close to zero the possibility of malpractice litigation).

      The practice of hospitals giving Doctors rooms in their facilities at zero or close to zero rentals is also arguably unethical and not in the customer’s best interests.

    • Martin Young

      Brent

      The ‘100%’ you refer to is actually 30%. The public perception of 100% being fair remuneration is a carefully crafted deception perpetuated by the medical aids.

      I’m not trying to kill private practice by any means. I’m asking a company to ditch the hypocrisy of demanding financial ‘restraint’ from the professionals who give their product a market and their own members while enriching themselves heavily in the process.

      To reiterate – Discovery pays themselves as much to administer the medical aid as they pay out to all consulting doctors to provide treatment to their members. That assumption of value is ridiculous, incomprehensible, and in a struggling economy just plain obscene.

      The public has no idea of this situation, and in my opinion should be.

      You may not be aware that Discovery’s top plans pay most doctors fees in full – “300%.” To the best of my knowledge these plans do not cover their own costs, and are subsidised by the lower plans. So many of the lower plan limitations and extra payments are to a large extent to cover the deficit of, dare I say it, the cover for the rich. Another example of the ‘poor’ subsidising the ‘rich.’

      My earlier posts do offer suggestions for changing the status quo. The problem is that there is little incentive to do it by the primary power holders – the medical aids like Discovery. We doctors cannot change that because we are not Discovery’s clients. Guys like you are.

    • http://www.thoughtleader.co.za/martinyoung/2013/09/22/beware-the-angry-ordinary-man/ Andrew

      On 24th July 2009 my mother was diagnosed with a Lymphatic Occlusion in her left lung. Discovery Health approved the treatment on 9/11 2009.

      It took them 57 days to approve her treatment for non-hodgekins lymphoma.
      She died shortly after that.

      THIS is what we pay them for.

    • Martin Young

      Proactive

      I don’t know everything that has to date been done in direct opposition to Discovery. What I can tell you is that organisations that represent doctors have been in “talks, discussions, meetings etc etc” for as long as Discovery has been around, and there is pretty little evidence of any change in approach. Things have become worse for the consumer, not better.

      I have openly and publicly opposed Discovery for the past ten years. Their most senior execs have sat at my desk trying to explain themselves. I have met them at their offices with potential solutions. Initially I believed their efforts to redress the situation were genuine, but time has proven me wrong.

      I have no intention of altering my fees – I charge what I do anyway. So please don’t mistake this as an ‘appeal’ for more money. It’s nothing of the sort. Your assumption that it is just shows the effectiveness of the general anti-doctor propaganda out there in the market place. Why can’t a professional set his or her own fees? Lawyers do it. Accountants do it. Architects do it.

      In effect I’m trying to stop patients having to pay in on top of their monthly premiums by having Discovery raise THEIR own rates. I also want to draw attention to Discovery’s blackmail and coercive tactics that pit patient against doctor and vice versa.

      Old tactics have been tried. This is a new tactic, using the power of petition and of social media.

    • Xsanga

      We need do to this against the white economy who makes billions from the black masses and cheap labour, a white doctors pains are nothing compared to a black workers. Lets boycott coke, and Sanlam and Old Mutual and PnP, they making 100’s of billions pa while the blacks get poorer ans are starving in white abundance. There is a much bigger struggle out their, the growing poverty and the growing rich through exploitation and apartheid dividends

    • Curt

      Considering that the D of H has proven that the entry level plan for families is no longer affordable, I asked a health journalist why the medical aid industry in South Africa should not be considered to be a massive legal ponzi scheme?
      I have not had a reply yet and I am not expecting one.

    • http://www.thoughtleader.co.za/martinyoung/2013/09/22/beware-the-angry-ordinary-man/ proactive
    • Jorge

      Martin – great..glad to see I’m not the only one. I’m fighting with Discovery over an international claim that they refuse to pay – all based misinformation. The truth is I actually saved them potentially more money by getting treatment overseas. After being told it would be covered now they are refusing coverage so I’ve had to fight!

    • https://www.facebook.com/groups/295741530532679/491090200997810/?notif_t=group_activity Cheryl Narunsky

      Thank you for speaking out, and definitely consider this a signature – I invite you to take a look at a facebook group that I created, following my daughter suffering a Traumatic Brain Injury, and being subjected to the Discovery MEDICAL PANELS ARROGANT OVER-RIDING OF THE RECOMMENDATIONS OF HER MEDICAL TEAM – A TEAM WHICH INCLUDED 2 NEURO-SURGEONS, A NEUROLOGIST, A GP WHO IS A REHABILITATION SPECIALIST, 2 SPEECH AND LANGUAGE THERAPISTS, 2 OCCUPATIONAL THERAPISTS, A NEURO-PSYCHOLOGIST, AND A NEURO-PHYSIOTHERAPIST all of whom wrote appeals on her behalf. As a clinical psychologist myself, I believe we should be questioning the ethics of our fellow medical practitioners who are employed on Discovery’s medical panel and make decisions regarding patients that they have never examined in any way. The facebook page address is https://www.facebook.com/groups/295741530532679/491090200997810/?notif_t=group_activity Let’s join forces??

    • http://www.giveadogabone.co.za Chris Davidson

      My (Step) daughter had a major car accident in July 2012 and had brain damage (TBI)
      we are still struggling with discovery to live up to their promises.
      Delay tactics is their company policy. We as a family have had to settle all doctors,therapists, treatments medications etc.
      We have laid a complaint with the medical association, so now we wait, once again.
      I think it’s so important that the medical profession as a whole should stand alongside you in a concerned effort to confront Discovery and make them live up to the standards set by law.

    • Shane

      Discovery Health is nothing but a lifestyle program aimed at getting you a few bucks off vegetables… When it comes to them actually doing what we pay hard earned money for there is always an issue, something goes wrong or they wont pay for this or for that. Soon when going into surgery we will have to make sure that they use the brand of surgical gloves that discovery pays for…. Not once has there been a pleasant experience with them

      You have my full support

    • Martin Young

      Hi Cheryl

      I’ll certainly take a look. Please consider posting a link to this article and the petition on your Facebook page.

      We need a clear idea of how many angry people there are out there. So does Discovery.

    • http://theeasylife.co.za MisterJingles

      One thing that I would like to add…I would not have a problem to pay R4000 a month for my medical, although its ridiculously high for 2 people, if I knew that no matter what my claims would be covered without question.

      Nobody WANTS to be sick, and would therefor really take quite some effort to try and defraud the system. When I go to a doctor/dentist/hospital it’s because I’m sick…sick to the point that self medicating doesn’t help anymore and I need help from a professional.

      I dont want to go to the dentist for the first time in 3 years and be told sorry your medical doesn’t cover this because you have run out of funds….even though my dental benefit is untouched at R19k but my “medical savings account” is depleted and everything has to come out of there….basically saying that I pay R48 000 a year to have R12 000 of cover for the year, for 2 people, does that make sense or does it sound fair?

    • Matt

      Yes – my employment contract says I must belong to Discovery – so not only am I an unhappy member, but I’m a trapped member!