This afternoon, my associate, Dr. Michele Gomez, spent over an hour
battling (so far without success) to get approval for an MRI for a
patient with new neurologic symptoms and a history of metastatic lung
cancer. The reason for this ridiculous waste of time? Three different
insurers each admitted that although she was insured, it was another
local branch which had to take responsibility for payment.
Though
written for physicians, I am sure that TPM readers will appreciate this
as well. The carefully researched links are definitely worth
exploring. This will be cross-posted at The Daily Kos on May 7. Please look for it and my other posts here.
Listening
to Dr. Gomez' crusade from across the room, I shook my head. Since our
President has started to move forward on health care reform I've heard
and agreed with his stark diagnosis: "The biggest driver of long-term
deficits are the huge health care costs," he warned in his March 24 press conference. "It is going to be an impossible task for us to balance our budget if we're not taking on rising health care costs."
Yet while I nod in agreement with President Obama's diagnosis, his treatment seems homeopathically weak and divorced from the reality I experience every day.....
Sione Alipate (name changed for privacy) has been
a patient of mine since I started practice nearly twenty years ago.
Before that he was a patient of my predecessor. His chart goes back
to 1970, at least.
cross-posted on The DailyKos at http://www.dailykos.com/story/2009/3/14/154550/702/88/705720
He is now seventy years old, a retired food handler for Sky Chefs,
who immigrated to the United States over forty years ago from the
island nation of Tonga. At my urging he recently became an American
citizen and voted, with great pride, in his first presidential election.
He is a strong but gentle and soft-spoken man. But last week he was near tears in my office as he and I discovered that the choices
he had been offered for his health insurance coverage meant he might no
longer be able to keep me as his primary care physician.
Saturday was a short day in the office. I came in to handle some paperwork and to see a few patients whom I couldn't manage to work in over the course of a busy week. It was an ordinary day with a typical, ordinary selection of patients....which is to say, that almost every one came with a story which cried out about how we desperately need change in our health care system.
Note: In the interest of developing diverse dialogue on this topic, this essay was first posted in slightly modified form at RedState.com where it was surprisingly well-received.... before it was removed and I was "banned"... for expressing a politically incorrect view? It has also been cross-posted on The Daily Kos, here, also in a slightly different form.
The first item on my plate was a patient who called to say that the asthma medication
he had been on for years and which had allowed him to control his
symptoms and stay out of the hospital was no longer covered by his
insurance.
I explained to him that there were likely alternatives that would
probably work as well and proceeded to compose an email to his
pharmacist, outlining the possibilities I wanted him to explore.
Shirley
Crandall (her name and circumstances have been altered slightly in the
interest of privacy) has been a patient in my office since late October
last year. She's a hard worker who's held a demanding job for many
years as the financial manager in a home improvement business. She's
survived a fair amount of hardship in recent years-- a divorce, pain
from gallstones and then surgery, a temporarily disabling knee
injury--but she's always bounced back. Note: This
Things changed, however, this summer when her boss went on a
rampage, violently slamming his fist on her desk, yelling to her face,
looking for a victim upon which to blame his own business failures.
She became frightened, unable to sleep, unable to eat properly. She
felt jumpy and was unable even to drive in the direction of her work
without developing feelings of intense anxiety. She had developed a
form of post-traumatic stress disorder.
No story today. I've got one in the works but taking care of family and patients is priority one for the next couple of days... (cross-posted at Daily Kos http://www.dailykos.com/story/2008/12/9/8172/04279/227/670987)
But there is some time pressure to consider what we've been asked to
do by the Obama Transition Team. We've been asked to contribute, not
just money and time (though these appeals do continue), but ideas. http://change.gov/
Sign up to host a health care community discussion over the holidays
Health care is a top priority for President-elect Obama, and he
wants your help in reforming the system to provide quality, affordable
health care for all Americans. That's why this holiday season, we're
asking you to give us the gift of your ideas and input.
Sign up to host a Health Care Community Discussion anytime from December 15th to 31st.
We'll provide all our hosts with special moderator kits that will
give you everything you need to get the discussion going. And Senator
Tom Daschle, the leader of the Transition's Health Policy Team, will
even choose one discussion to attend in person.
In my last post I admitted that I had thrown in the towel. Rather than go to bat again for my patient whose medication had been denied by his new insurance company, I gave in and prescribed an alternative that might not work as well.
Well, today the guilt got me going so I re-read the two page denial letter. Again I found the words explaining the reasons for the denial, two of which amounted to advocating for unscientific medicine, even malpractice. And I found the additional sentence, buried about two thirds of the way down page two, which said that I could call the "800" number on the page to talk with the doctor who had reviewed the case and denied my prescription request.
Today I attended a "pod group" meeting over lunch.Billed as meetings of primary care providers
hosted by our local medical group to allow us to get together and share items
of importance to our practice, the meetings instead have degenerated into
coaching sessions about how to "code" patient encounters in order to maximize
income, for the medical group and, secondarily, for us.
The care provided by family practitioners, pediatricians,
and general internists--primary care providers-- is known to be the most cost
effective in medicine.We know our
patients.We understand where they are
coming from.We can use this knowledge
to tell, often, when a belly ache is a sign of serious disease, when a serious
investigation is needed, or when reassurance and a little "tincture of time" is
all that is needed.
I arrived this morning in the
office at 8:50 a.m. to find Glenda, my
office manager, buried in charts.She
had been there since 6:30, simultaneously arranging referrals that had been
requested the day before, making sure that we had properly completed the
detailed forms required by the Child Health and Disability Prevention Program
that helps pay for the preventive care provided to some of our poorer patients,
and listening to the voice mail from pharmacies to get the medication refill
requests in order for me before the day begins in earnest.
How Obama Can Fix The Economy and The
Health Care System At The Same Time
Aaron M. Roland, M.D.
In the face of an economic crisis unprecedented
in more than half a century, pundits are asking how President-elect Obama will alter
his ambitious proposals.The implication
is that economic hardship must lead to scaling back or even abandonment of the
change upon which he had based his campaign.
Certainly,
in the face of changing conditions, the new President will have to reconsider
his plans.But in the case of health
care, the crisis may have an unexpected effect. It may allow Obama move beyond
his modest proposals to something far more comprehensive.
Washington
policymakers love to compartmentalize problems and their solutions.
There is a bank bailout, a mortgage aid plan, an automaker
rescue, a healthcare access proposal.
But
sometimes the solutions may be better conceived through a unified approach.
The near
bankruptcy of the automakers which has alarmed us in recent days points to the
nexus between multiple problems and their solutions.While Washington
insiders have proposed emergency funding for loan guarantees or retooling of
the auto industry, another tack could address not just the Detroit's
woes, but those of the nation as a whole.
Of the
various economic burdens faced by the automakers none is larger or more ongoing
than that presented by health care costs.This has become the focus of ongoing conflict with labor unions as
workers face economic and health insecurity.Health care cost add nearly $2000 to the price of each automobile,
making competition with foreign automakers increasingly problematic.
For
individuals, health care costs are the number one reason for lack of insurance,
contribute to the majority of bankruptcies, and are a factor in over one
quarter of home foreclosures.
Although
President-elect Obama has proposed to include health care finance reform as a
central part of his domestic agenda, his proposals so far offer nothing to cash
strapped businesses.Indeed, the
employer mandate he has offered will only add to the cost of doing business.
The
solution to this problem lies in linking health care reform to economic
incentive and providing truly universal coverage while reducing our national
expenditures for health care.
The current private insurance based
health care system has become a bureaucratic nightmare of buck-passing and
profiteering.It is rife with waste that
has nothing to do with providing quality comprehensive health care.Indeed, only some 65% of health insurance
premiums are spent on health care. Instead, insurance company executives earn
hundreds of millions of dollars while corporate marketing departments spend
fortunes selling insurance to the healthy just as their utilization departments
resist paying for the care of those who become ill.
Rather than inviting a mandate that
business pay to expand this wasteful system, the economic crisis offers the new
President the opportunity most other reformers have not had--the chance to begin
from scratch.The American people have
voiced an overwhelming desire for change.We have come to understand that business as usual isn't always good
business and that the business models that private systems create don't always
work in the public interest.
Turning to Medicare, the second
pillar of our current national health financing system, the President and
Americans can envision another alternative.With centralized funding and near universal enrollment of the population
it serves, Medicare provides better quality care and higher satisfaction at a
substantially lower cost than the private health system. Paling before the
bloated bureaucracy of its private cousin, Medicare's administrative costs are
only 3% of its funding.No surprise, as
there are no resources spent on avoiding care for the sick, marketing, investor
relations, or corporate profits.
Abandoning a private health
insurance system for an improved Medicare For All would immediately result in
dramatic savings to our nation's health care bill.But to truly help the struggling business
sector the financing of this system, ideally with a new and progressive tax,
could be phased in over a several year period as an economic stimulus.
Businesses which now fund health
care as a cost on their bottom line could immediately eliminate that cost, with
the bill being paid through a combination of temporary deficit spending and a
widely distributed low tax levied on consumption or as part of a revised and
simplified income tax reform.
Eliminating the a multitude of
public and private programs which currently pay for segmented components of
health care, eliminating our national sense of insecurity about paying for health
care, eliminating all parts of the health care bureaucracy that don't directly
relate to providing care, a move towards Medicare for All provides a way to
solve our automakers' crisis, and our own.
Dr. Roland is a family physician whose work within a private practice of broad economic and ethnic diversity has melded with his experience and training in politics and public policy to nurture a unique perspective on and commitment to fundamental health care reform.
