Medicine in the Era of Big Government
My wife is having surgery today. She’s chosen her doctors as best she can with the limited information available regarding their abilities, which is to say word-of-mouth, and we’ll soon be off to the relatively new facility in Bryan, Texas for her operation.
It’s a relatively minor procedure, but I have to admit to being a little afraid for her. There’s nothing like putting your life – or that of a loved one – in the hands of a stranger to make you appreciate a country in which one can choose who the man or woman holding the scalpel will be. That freedom is essential. But will it still exist if a national health care plan is implemented?
I don’t think continued freedom of choice is a given, although it certainly should be. No government-run medical plan can be considered legitimate if patients are forced to have their health care administered a small set of state-appointed doctors. Choice is mandatory if consumers are to avoid being forced into substandard treatment situations.
Fans of Tom Clancy will no doubt recall a chilling scene in a recent novel of his – I forget which one, sorry – in which Caroline Ryan becomes incensed after witnessing British surgeons drinking at lunch only hours before a scheduled operation.
I’m not saying that nationalized health care will lead to drunks in the operating room. I’m really not.
But I am saying is that a patient’s freedom to choose his or her own doctor is essential and must be preserved in a system in which medical malpractice will likely not be discouraged with the same vigor with which it’s pursued now.
Moreover, a national system will be motivated to cut costs in the same manner as the current regional HMOs have – by controlling doctors’ salaries, employing fewer doctors and keeping them “fully utilized”, and denying access to specialists by using general practitioners as gatekeepers.
Other national healthcare plans have been observed to create cost efficiencies in this manner with the inevitable result that access to non-rudimentary healthcare is delayed, often for months, with patients suffering as they move their way up the waiting list.
That’s a horrific outcome for a society in which we’ve had immediate access to the best healthcare system in the world. Yet it seems inevitable given the incompatible goals of national healthcare: universal access unfettered by economics and reduced costs.
There’s also a problem with the G.P.-as-gatekeeper strategy that may not have been taken into account: Almost half of U.S. primary care physicians would change professions if they had an alternative.
Some of the oft-cited reasons for this malaise are the over-abundance of government-mandated paperwork and low profit margins on an increasing number of government-funded patients.
Notice anything in common about these complaints?
Barack Obama claimed during the presidential campaign that he would not tamper with existing healthcare plans. Indeed, he stated quite clearly that we could all keep our existing coverages.
Unfortunately this is not true. While his plan, if it is passed, would probably not do away with existing employer-provided plans, it would remove the need for employers to provide healthcare coverage as an enticement to employees.
Employers compete for the best workers using a variety of tools, one of which is fringe benefits. Medical coverage could be considered one such, although at the rate of over $1000 per month for family coverage, it’s hardly a fringe issue.
Question: Which employers will continue to pay a 24% premium on the total compensation package for a typical $50K/year accountant or sales representative?
Answer: None that want to stay in business.
The inevitable outcome of a national healthcare plan is that it will absorb all but the most exclusive of existing health plans, making participation in it effectively mandatory. This brings us back around to the choice issue.
Patients and their families don’t care which bean-counters process their claims. We care only about whether we like and trust the doctors handling our cases and that we get needed healthcare in a timely fashion.
The architects of America’s proposed national healthcare plan would do well to remember that.
I don’t think continued freedom of choice is a given, although it certainly should be. No government-run medical plan can be considered legitimate if patients are forced to have their health care administered a small set of state-appointed doctors. Choice is mandatory if consumers are to avoid being forced into substandard treatment situations.
First and most important, Marc, please accept my sincere wishes for your wife’s health and for the best possible results from the surgery. It’s always scary when a loved one has to be in the hospital, and it’s perfectly understandable that you would be afraid.
I agree that freedom of choice is essential. I must point out, however, that true freedom of choice does not exist now. If you are one of the extremely fortunate Americans who has health insurance through an employer, you probably have to choose your doctor from a list of approved doctors provided by the insurance company. You probably cannot choose to go to a medical specialist without clearing it with the insurance company and/or getting a referral from your PCP. You probably cannot even get emergency medical care (and have it paid for) without calling your insurance provider within a certain period of time and getting approval for the care.
Oh, and if you don’t have health insurance, as close to 50 million Americans don’t, then you cannot choose any doctor or hospital at all, because you can’t pay for it.
That doesn’t seem like meaningful choice to me at all.
A national health insurance program does not remove choice; it adds access.
Last word, as well as the first word: My prayers and positive thoughts are with you and your wife. That is a sincere, heartfelt wish, not lip service. I hope everything goes well.
Well, what Kathy said.
Locally, we have a very sad malpractice case in play. One endoscopy center has been linked to at least 85 cases of hepatitis, and more cases are almost certain to be found as people get tested. Many of these people used the facility in question because it was the only one approved by their insurance company.
Death by insurance assignment.
But wait! There’s more! At least one woman is suing her insurance company for insisting that her hepatitis be treated by the same medical group that gave it to her in the first place!
So enough with “continued” freedom of choice. I’d just like to have freedom of choice.
Thank you, Kathy and ShortWoman, for your prayers and good wishes.
You both make good points about the sad state of affairs in some parts of America’s health care system. It’s not an ideal system by any means, unless you’re part of the truly upper class. My concern is that it gets worse under a government-run plan. And it can certainly get worse.
Envision SW’s example on a nation-wide basis. Patients locked in to doctors who aren’t motivated or interested or competent. No thanks!
When my wife’s was talking this AM I was thinking to myself, “I don’t like this guy. I wish we were in Houston at MD Anderson instead. But she’s OK with him and here we are.” Let’s just say it was good to at least have had a choice.
While I am generally a free-market supporter, I have to agree with other commenters that you are overstating to amount of choice we have.
I have a son with a chronic allergic disease. Due to the nature of his disease, allergy testing is very difficult. There is one means of testing that is relatively new that we received approval for our insurance company to try. We had our allergist perform the test, which he had never done before. Because of our persistence we were able to get the insurance company to approve a visit to a specialist who looked at the results of those test and said he was “confused” by the report from the allergist. Clearly, he did not know what he was doing. After months of back and forth from the insurance company, we were finally able to get them to approve a visit to an allergist that specializing in the disease my son has. We were fortunate to have one of the best insurance companies in the country, and even at that we had to fight hard to have the option of seeing an allergist with the experience we were looking for.
That’s an anecdotal account I know, but from what I understand that sort of thing is not very uncommon.
If you want to read more on how my son’s condition has influenced my view of health care, you can go here: http://sovereignmind.wordpress.com/2008/10/14/our-little-pre-existing-condition/
Rather than arguing the point of the choices we do and don’t have, I would like to direct a little attention to the final line here.
“The architects of America’s proposed national healthcare plan would do well to remember that.”
What people need to understand is that right now, the push for “universal” health care is very strong, in fact even the insurance companies are giddy about the idea. As we sit here debating, members of Congress are collaborating with their insurance buddies about the future of America’s health care. They are not discussing “national health care”, it’s a mandate that’s got them all excited. I don’t see any freedom there, or a choice, except to make our voices heard loud and clear. So, back to “The architects of America’s proposed national healthcare plan”.
What do you want? This is our country, and what I was promised is a government of the people, by the people, and for the people.
I support HR 676 single payer health care. All Americans would be covered, have full choice of care (including natural health), with no requirements other than a small tax increase. An easy trade for those who currently pay $500/mo. premiums. It would be best if you read the bill yourself, and compare it to your wants and concerns.
If it works for you, write to your Senators and your Representative, and if something is lacking, ask that it be corrected.
Neither of these is “true” anymore. The old “gatekeeper” concept has gone by the wayside. IMHO, the concept behind it (consult your primary care doctor first since about 90% of medical issues can be managed by your PCP) was and still is, sound. The most appealing health plans now for employers and employees alike are the “open access” plans.
As far as ER visits, I know of no insurance company that requires “prior authorization” for emergency care. Now your co-pay may be higher than an office visit. In addition, EMTALA prevents ER’s from not providing care based on your ability to pay (or the type of insurance you have).
I would agree with the gist of the post. No one has absolute “choice”. And why? Because there are not unlimited resources.