In the confusion of the United States Medical system, a lot of time and money is invested in negotiating payments with insurance companies, billing, collections, and other matters. I am convinced that most medical practices and hospitals do not have an accurate cost/benefit analysis of their billing and collection practices. To begin with, there is no obvious connection between services rendered and charges made. No one that i’ve spoken to in the health care system can explain why things cost what they do. I will hear phrases such as “standard practice,” or “allowable billing,” but how they arrive at the wild numbers that appear on invoices is not understood by anyone. Those numbers, however, are quickly revised in negotiations with insurance companies. It is not at all uncommon to see the initial charges adjusted by more than 50% as insurance payments are made. I’ve tried to reconcile insurance company “explanation of benefits” statements with health care provider statements, and it is clear that often the two are using entirely different numbers.

I don’t know what it costs a medical practice to engage in all of those negotiations. I don’t know how much they pay for accountants and billing clerks to constantly adjust statements. But it can’t be without expense.

So I was struck as I examined a statement from a health care provider that we recently received to find the watermark on the paper to say “We take care.” “Take care” is an idiomatic phrase that is often used to express good wishes when parting or at the end of a message. I know I’ve said to folks, “take care” as they climb into their cars to depart from our home or head home from church. I think that it is offered as advice to exercise caution. The meaning is similar to “be careful.” But when used in that manner, it is offered to the other. Take care is something the speaker wishes for the hearer. But the statement doesn’t say, “You take care.” I says, “We take care.”

I guess it might mean “We are careful or watchful,” or “We give particular attention to something.” I assume that it is the slogan of the medical practice. It is printed beneath the name of the practice and next to their logo. Its generality, however, leaves me wondering what care they take. They don’t seem to be particularly concerned with timeliness in their billing practices. They don’t seem to even be overly careful about accuracy in accounting. A bill seems to be a strange place to make comments about the quality of care and even if it is, there is a certain arrogance to the fact that the judgment about the quality of care is made by the provider and not the patients.

Shouldn’t “We take care,” be something that is demonstrated by practices, not declared in an advertisement. If the quote were attributed to others it might make sense: “They take care.” As a self-proclaimed statement it is as meaningless as the numbers on the bill.

A recent academic study found that 66.5 percent of all bankruptcies were tied to medical issues. High costs for care combine with time lost from work to create a worst-case scenario for too many people in our communities. No other reason is cited as much as medical costs in bankruptcy filing. Similar studies have shown that the insurance that is available and affordable to most working people is not adequate protection from catastrophic medical costs.

Since it is their slogan, I guess we should take them up on it. Since they say, “We take care,” perhaps we should remind them of some areas where we’d like to see them take care.

Take care, medical providers, to be honest and upfront with explanations of the total costs of visiting your facility.

Take care to provide only the care that is necessary, avoiding the upsell of additional diagnostic tests that serve only to protect providers and do little to help patients.

Take care to base treatment decisions on compassion, not expectation of profit.

Take care to spend enough time with each patient to truly listen to their concerns.

Take care to look at the big picture and not just a set of symptoms.

Take care to have real people who answer your phone in real time instead of a series of automated messages with multiple menus to select.

Take care to make appointments available in a reasonable time frame. When patients come to the clinic, take care to avoid having them wait for care.

Instead of proclaiming what you take, think a bit about what you might give.

I suppose I could go on and on with my list, but you get the picture. There is very little trust in the US medical system in large part because the system has done little to earn trust. This does not mean that individual physicians and nurses can’t be trusted. It means that they are working in a system that consistently provides worse outcomes at a higher price than health care systems in all other developed countries.

The system won’t be fixed by changing slogans or revising billing practices. Major policy changes will be required and it is unclear whether or not Congress has the ability to make major policy changes in the hyper partisan political climate of Washington DC. I guess we should ask our representatives to take care.

Take care to remove excessive profit from health care. Insurance companies should exist to serve people in need of health care, not produce profits for investors.

Take care to invest in public health and preventive care so that people can afford to remain healthy.

Take care to offer every citizen the level of health insurance protection that members of congress enjoy.

Take care to regulate excessive profits from the sale of health care practices and facilities.

Take care to limit profits from government-funded research in the pharmaceutical industry.

No matter how I try to use the phrase, however, it seems to only work for me as a greeting or advice given to others, not a phrase one applies to oneself. I remain unconvinced that the slogan “We take care,” means anything when printed on the statement from the clinic. Of course, I don’t expect the clinic to listen to my advise anyway.

As for the readers of my journal, “You all take care now!”