The Practice of Medicine -- Personalized

Posted: Dec 05, 2012 7:52 PM

 Today, I lived two contrasting approaches to the practice of medicine in the United States.  If ObamaCare becomes the law of the land, the contrast will grow even more marked.  Anyone who doesn't yet understand why the ObamaCare approach to medicine -- ie, centalizing control in government and insurance bureaucracies rather than in patients, the consumers -- is so terrible should read this post. 

Here's what happened: One of my small children fell and had an ugly, jagged cut beneath an eye.  It bled and looked ugly enough that I thought a physician should see it, so we made an appointment with our pediatrician, who accepts our health insurance.  Along with the cost of our insurance, I was asked for just a $10 copay, and then . . . we waited for 40 minutes as my child's discomfort grew, along with the ugliness and swelling of the cut.  When the doctor finally arrived, she was in the examination room with us for literally 20 seconds before taking a call.  She left the room and a few minutes later, a nurse came in to hustle us out with the name and number of another doctor (presumably a plastic surgeon we could contact?).  There was no opportunity to ask questions -- including whether a plastic surgeon was necessary, how likely scarring was, how quickly the wound needed to be sutured, if it did. 

Perhaps this doctor just had a bad day -- she is well-credentialed and in our limited exposure to her since signing on with her practice we have been reasonably pleased.  But it was a dramatic reminder that how she treats us, and whether we are pleased (or not), has no real impact on her livelihood.  To the extent she must please anyone in our doctor/patient/insurance relationship, it is the insurance company. My child may be her patient, but they are her clients -- the real source of her income.  She cares much more about losing our insurance company than losing us.

After this disgraceful conduct, I contacted my husband's general practicioner in Manhattan (like many doctors there, he accepts no insurance).  I had never spoken with him before, but my husband was on a plane, and he had told my husband that if any of us ever needed anything, we should call him.  I did.  He knew who I was, heard my account of what had happened, and immediately called a plastic surgeon's office for us.  He then called me back -- himself -- to tell me with whom he had spoken, and assured me that they were expecting my call.  Indeed they were. They told us that they would see us whenever we got there, the doctor examined my little one carefully, and then my child received excellent care.  It was a happy ending.

But it was a happy ending because we were fortunate enough to be able to pay for this limited type of care out of pocket.  Dr. Cohen is a wonderful, caring physician (my husband has said he reminds him of my late father, which is the highest praise a doctor can get in this house) and he doubtless would have helped no matter what.  But not every doctor is like Dr. Cohen (and certainly not like my dad!).  And that's why it's important that the patient -- not the government, not the insurance company -- is ALSO the client . . . the person whom the doctor needs to please in order to see his practice prosper.

One of the many pernicious effects of ObamaCare is to de-link a physician's success and the quality of his/her patients' experience with him/her.  It makes doctors even less accountable to patients for their care.  And it will only exacerbate the trend we saw today.  Those who can pay for private care, out of the system, will do so (as do many in the UK).  Those who are not able to afford such out-of-pocket expenses will be stuck in a system where they will have less and less choice and control over the quality of the care and treatment they actually receive, even as their premiums increase.  It will be a little like the public education system (and we all know what a smashing success that is) . . . those who can, will pay extra and go private.  The rest of us will pay ever higher insurance premiums for ever less personal, caring care, in which following government guidelines and holding down costs are the only real imperatives.

We are able to pay for a couple of stitches from a good plastic surgeon, but it wasn't cheap.  There are many other things that would simply be beyond our reach, and we'd be trapped putting up with whatever care our insurance-covered doctor chose to provide.  And that's before ObamaCare.

Today, I saw the future of American medicine if ObamaCare isn't stopped.  How ironic that a President who claims to care so deeply for the non-rich has created a system where the ultra-rich (way beyond any normal person's means) will end up getting cared for like royalty, while anyone whose income doesn't place them within those rarified ranks will end up with a remarkably diminished standard of care, mediated by a faceless bureaucracy.

As I've said before, we'll end up with a system that combines the efficiency of the Post Office with the compassion of the IRS.  A success on par with America's government-run education system.

Good going, ObamaCare.