Unfortunately, this will be a repeating type of post, where I recount the horrors that my staff and I witness as we try to help patients get the care they need in the broken American healthcare system.
But let’s just get it out on the table—Obamacare is a failure. I know that the Obama administration points to the fact that many people today have health insurance today who once did not, and that young people can stay on their parents’ policies until age 26, and that people can’t be denied care due to pre-existing conditions. While all this is true, it does not mean that healthcare is fixed.
The reality is that we have just traded one set of problems for another. And while some people may be better off in some ways, many are not. Some are even worse off than before.
First of all, there are still 29 million people in this nation without health insurance. That is still a great many people. Second, for many who have insurance, it is incredibly expensive. While insurance premiums seemed to have leveled off during the early days of Obamacare, they are back on the rise. Many people will see their insurance costs go up by astronomic amounts in 2017. Many of my patients complain that they cannot afford their premiums, and consider foregoing insurance altogether now. For my healthy family of three, health insurance obtained through the West Virginia ACA marketplace (where we have all of one choice, so marketplace is not really an appropriate term) will cost $1,400 per month with a $13,000 annual deductible. The monthly cost is far more than our mortgage. It also means that we would pay the first $30,000 of any healthcare calamity that befalls us.
In addition to high premiums, many health insurance policies today come with steep deductibles and co-pays. The result is that many who have health insurance (and pay dearly for it) can’t afford to get care when they need it. It is not infrequent that my patients delay or refuse altogether important tests and treatments because of their deductibles.
While all of that is bad, maybe the worst and cruelest aspect of healthcare in the era of Obamacare is that even after the unaffordable premiums are paid, and if you can get past your high deductibles and co-pays, even then having insurance no longer guarantees you will have access to the care you need. Insurance companies have developed a number of other tactics to limit the care patients receive (and protect their profits), including requirements for prior authorization for tests and treatments, and narrow or incomplete coverage of care.
Prior authorization is used more and more frequently to block me from ordering tests or treatments that insurance companies feel might be too expensive. It means that decisions about a patient’s care may no longer be determined by doctors seeing patients, but insurance company staffers. Even when an insurance company ultimately agrees to cover care, it often takes me or my staff hours (and even days) to get through a maze of phone calls and questionnaires to reach that point.
This results in a devastating waste of our time, first of all. This is time we NEED desperately for patient care (not sitting on hold).
But twice recently, it meant that patients didn’t receive care they needed. I had an older gentleman with hip pain. The pain was most significant near the groin, and radiated down his inner thigh whenever he placed pressure on his leg. He had a history of smoking and an elevated PSA blood test, so a cancer diagnosis was something that was in the back of my mind. More to the point, I did not think that an x-ray was sufficient to reveal the cause of the patient’s pain. But after hours of being on the phone, my staff handed me the phone so that I could speak to an insurance company doctor. He was one snotty creep, and seemed a little happy in telling me that the MRI was being denied.
We ordered an x-ray, which showed arthritis in the hip, but that did not explain the patient’s symptoms, as I thought. The patient was back in my office a few weeks later, still complaining about the pain. We were faced with getting back on the phone for hours of fighting the insurer to get the real test we needed, the MRI!
I then had an elderly patient who complained of severe low back pain. Doctors are taught that there are certain red flags, rules that determine when back pain may be an indication of a more serious problem. Advanced age is one of them. The insurance company denied an MRI, saying that pain alone was not an adequate reason to get an MRI!!! Of course it is!!