06 Jul 2012
- Written by Ken Alpern
ALPERN AT LARGE - All physicians are trained to usually be verbally soothing and tactful, but at times to be honest, in speaking with patients. With a sick healthcare system and/or a sick economy, and with so much of America in denial, this is one of those times for honesty: Republicans are reaping what they have sewn for decades of inaction, and Democrats really should hold back on their exuberance, and don’t know as much as they think they do about the risks posed by the Affordable Health Care Act.
To begin with, I need to throw out a few talking points and/or disclaimers—I work 5-6 days a week doing medical and surgical dermatology, and prefer that professional satisfaction to the more lucrative alternative of cosmetic dermatology, which is fee-for-service and often an escape from the limits of health insurance rules ... and also provides an escape from patients who increasingly want non-medically necessary services for free.
I work in a multi-specialty medical group that rewards productivity and not mere billing, and while my nurses and front office staff are all encouraged to limit-set with unreasonable patients, they’re also encouraged to ensure that patients who need affordable care can get it promptly and effectively.
Everyone works together in the same building in my group, so if any doctor or nurse or staff is a loser, then he/she is gone.
And I also work in a dermatology-only private practice clinic to keep myself rounded and grounded. I see HMO, PPO, private, Medicare, Medicaid, cash and uninsured every day of my career, and I see both folks who abuse their insurance, fear losing their insurance, or who are without insurance.
I’m also a medical reviewer who has seen enough mischief, misperceptions, inappropriate demands and cost-ineffective treatment approaches from physicians, healthcare insurers and (especially) the patients to recognize that health care is NOT something that one can just “fix”, and with every solution comes a sad-but-unavoidable new problem that is created as a result.
File this all under “human nature” and “reality”, because people normally want things their way, and with all the trimmings.
But both political parties have shown a lack of coherent leadership on this issue, and have ignored both “human nature” and “reality” despite all the true believers adhering to libertarianism, capitalism, socialism, wanting to be just like Europe or Canada “we’re the only industrialized country, blah, blah, blah), or wanting to NOT be just like Europe or Canada (we have the world’s greatest health-care system, blah, blah, blah).
The only solid and good thing that has come about from “Obamacare” (which really should be described as Pelosi/Reid care, and which invited severe blowback in the 2010 elections and is likely to cause more blowback in the upcoming November elections—no matter much in denial a Democratic cultist one might be) is the following:
The festering sore that is our healthcare crisis cannot be ignored any longer, and while every physician I have spoken to on this despises the way the Affordable Health Care Act was implemented, and fear its consequences, we all seem to agree that perhaps now we can get to the root of our problems:
The greatest concern—and it IS valid, despite the assertions of any presidential apologist out there, because it’s ALREADY HAPPENING—is that the fines (or penalties, or taxes, or whatever stupid title you want to throw at the monetary figure Americans will have to pay if they don’t pay for health insurance) are so low, and the opportunities for employers to drop their employees’ healthcare benefits are now easier, that private insurers will likely lose many (perhaps most) of their patients from employer-based health plans.
Which sounds really good if you really hate health plans and insurers…until you start wondering what life will be like if everyone—including you—were on Medicaid (which is called Medi-Cal in this state).
I have patients that ALREADY choose not to spend lots of money on commercial plans that their employer offers, and choose to go on a Medi-Cal managed care plan that also has low-cost commercial insurance but with the same limitations as do Medi-Cal patients.
Most of them are content with this, but do YOU want to get that letter from your employer explaining that they’ll no longer subsidize your health insurance, either in total or in part?
Insurers like Blue Cross/Shield, Cigna, HealthNet, Pacificare/United, etc. are kind of like our banks—they are often led and run by some of the slimiest and most conscienceless people in existence—but, like our banks, if they’re gone then life becomes a living hell. Opportunities are lost except for the very, very rich, and everyone’s quality of life plummets.
So if Aetna gets sued by doctors claiming they’re not getting paid for services rendered, and Aetna fights back by saying these doctors are self-referring patients to their own surgicenters at inflated prices that drive up premiums, who’s truly representing the best interest of the patients? Isn’t it best to make sure both sides are able to report their side of the story?
And if Blue Shield is prevented by the state from closing some of its health policies to new patients by California Insurance Commissioner Dave Jones, isn’t that proof that we DO need government intervention on vital issues such as health care?
And what appeal process would an insurance commissioner have at his/her disposal if large numbers of Americans were on Medicaid, and that it was deemed that Medicaid needed more money from the taxpayers and/or would reimburse medical providers a rate that they deemed unacceptable?
With private health insurance, there IS an appeal process that is government-mandated. With government-provided health insurance, there is little to no appeals process for either coverage of a given treatment or waiting to see a doctor for a given procedure. Oh, there’s the official paperwork for an appeal…but it’s much less frequently authorized than with private health insurance.
Our healthcare crisis isn’t going away, and Medicaid and Medicare are destroying state and federal budgeting efforts to a degree that dwarfs the impacts of defense, education, welfare and Social Security.
The very poor and sick WILL be forced into Medi-Cal/Medicaid and the trend for employers to dump their workers in that system is very likely to increase.
The Republican mantra of “let the private sector handle it” has not proven relevant or successful, and the Democratic mantra of “we’ve got to be more like Europe or Canada” might just fall under a new mantra of being careful of what one wishes for…lest he/she actually get it.
For the thorny problem of healthcare to be resolved, the era of partisanship (on BOTH sides!) needs to end, and an era of pragmatism needs to begin. It’s just not healthy to approach this crisis in any other way.
Tags: Ken Alpern, Alpern at Large, healthcare, HMO, PPO, Medicare, Medicaid
Vol 10 Issue 54
Pub: July 6, 2012