October E-Letter

People have asked me about my thoughts regarding health care reform.  Here is my physician-oriented perspective:

As the debate over health care reform continues, I am struck by the strong emotions that have been stirred on all sides of the debate.  One area of agreement, however, is the desire to ensure that choice over physician, hospital and treatment options be maintained.

Yet, how much freedom of choice exists in our current health care system?  Every year, around this time, the “open enrollment” process forces people to change physicians and hospitals.  So much for promoting continuity of care or maintaining the patient-physician relationship.

If you need an individual policy and unfortunately have a chronic illness like diabetes, heart disease or cancer, good luck finding any plan that will cover you at any premium level.  Your best option is to hope and pray to be “alive by age sixty-five.”

With over 300 companies offering health insurance, why don’t we have more choice?  Part of the answer is the clout exerted by large national companies (Humana, Aetna, Blue Cross, United Health Care) that limit competition and choice.   In January,  the AMA reported that 94% of the 314 metropolitan areas surveyed are dominated by one or two carriers.  “Without rivalry to compete against, a large health insurance company can take advantage of patients by raising premiums and dictating important aspects of patient care without fear of losing business.”

What are the aspects of patient care that insurance companies now dictate?  Upon my return to practice, I have experienced their intrusion into every aspect of patient care.  Insurance companies and
their pharmacy management partners dictate what meds I may prescribe,  what tests I may order, what diagnostic codes are acceptable, and where our patients may be admitted.

I don’t know where health care reform will lead, but re-establishing real patient and physician choice is a key feature I hope to see.