by Dr. Marc Siegel
‘It is as painful perhaps to be awakened from a vision as to be born,” James Joyce wrote famously in his masterpiece “Ulysses.” I recently had such an experience when my office manager—who protects me from the daily insurance grind of referrals and approvals and pre-certifications and blood drawing—was out sick. Thus the veil was lifted from my eyes, and I awoke to the harsh realities of our medical future.
One patient was severely depressed and needed medication and a referral to a psychiatrist. Another was having trouble breathing from asthma that requires inhalers. A third had a faded rash on her arm that she was ready to call a spider bite until she showed me a two-day-old iPhone photo. It was the angry red rash of Lyme disease. Each problem had an effective treatment but each visit took over half an hour to carefully complete.
The appointments were gratifying, in an old-fashioned way. Patients still have the expectation that their doctor will be patient and listen carefully, but one by one doctors and patients are awakening from that comforting vision of the past to the rushed, restricted world of the ObamaCare future. Thanks to that eye-opening week without my office manager, when I ran hours behind, I was forced to forfeit the vision I had of myself as an old country doctor practicing in a big city.
For me and many of my colleagues, the real practice of medicine is supposed to involve an intimate encounter with each patient and a diagnosis of illness leading to a potential cure. In the future, however, a diagnosis of Lyme disease or the severity of a patient’s depression may be missed because showing the photo or taking an extensive mental-health history doesn’t fit squarely into the 10-minute visit authorized by insurance, along with mandatory computer documentation, insurance verifications and appointment scheduling.
These problems predate ObamaCare, but the new law brings more regulations and low-quality insurance at a time when we are already struggling to comply with the electronic health-record mandate.
Supporters of health reform will say that the Affordable Care Act didn’t cause all these problems, that President Obama shouldn’t be blamed for wanting to make sure that everyone has health insurance. Unfortunately, the kind of insurance that is growing under ObamaCare’s fertilizer is the exact kind that was jeopardizing the quality of health care in the first place: the kind that pays for seeing a doctor when you are well, but where guidelines and regulations predominate and choice is restricted when you are seriously ill.
How can quality of care not be affected if the antibiotic or statin drug or MRI scan I feel you need isn’t covered under your plan? How can ObamaCare be labeled a success when it adds layers of bureaucracy to an already overburdened system?
This month, even as Health and Human Services struggles to fix the health-exchange websites, the Obama administration announced that errors are occurring on the back end between the government and insurers at a rate of one out of four enrollees. This means that when you come to see me in January, assuming I actually participate in your narrow new ObamaCare network, there is a substantial chance you will never make it past the front desk because your new insurance will not be active.
Since insurers are being compelled to cover more folks with pre-existing conditions, with no lifetime limits, and to cover everyone in a family plan at least up to the age of 26—all popular provisions of the ACA—they reduce costs by cutting fees to vulnerable doctors while restricting the tests they can order. This makes the practice of quality medicine almost impossible, but it helps preserve an insurance company’s bottom line while complying with a government mandate.
That copay that you no longer have to pay for colonoscopies or mammograms may have been the one bit of steady cash keeping in business many physicians and providers who perform them but work on very thin profit margins.
What should have been done? If the government felt that a significant segment of the population was underserved, they should have hired the doctors to serve them and built the clinics to serve them in—and mandated the scaled back, affordable insurance that covers severe illness only.
What ObamaCare gave us instead is a hybrid that should make both Democrats and Republicans, doctors and patients unhappy: big business combined with big government.
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Dr. Marc Siegel is a professor of medicine and medical director of Doctor Radio at New York University’s Langone Medical Center.