Commentary - How It’s Done In America?

Lee F. Weisman, M.D.,
Charlotte Family Health Center

As a physician I feel obliged to respond to last week’s “Commentary” on (preventing) healthcare reform. This essay raised the same baseless, fear-mongering claims that have been shouted in Washington and across the country by those willing to say anything to stifle meaningful debate. The writer warns, “would you trust Washington” to decide whether your child or spouse can get cancer treatment? Of course not. But it has nothing to do with current proposals. It’s a sick sound bite used effectively to scare people, to protect the insurance industry (why?) and to prevent any real change from happening. “Danger,” they claim, healthcare rationing is on the way. Well guess what, it’s already here and has been for years.
Ask any physician you know how often we have to apply to the insurance company/Medicare for “prior authorization,” to get that MRI or referral to a certain specialist. My staff and I waste countless hours to convince some faceless insurance company shill that my patient meets the guidelines for this test, this drug, this referral. Some insurance companies make this process needlessly cumbersome and onerous (on phone hold for 20 minutes!), knowing they will save money. Yet, I hate to admit that it’s not all bad. Too many docs prescribe the expensive drugs, order too many tests, refer to too many specialists (of course I don’t). Done right and intelligently, guidelines can save wasting money on excessive testing, medications and treatments. Done wrong, it’s healthcare rationing at its worst. Regardless, it’s already here.
The writer references the “communist/socialist” systems at play in Britain and Canada, as if they’re being proposed for us (a lie by innuendo). In fact, those systems work pretty well. By independent standards their citizens are kept much healthier overall than U.S. patients (forget the occasional horror story; they happen here too). The tradeoff is higher taxes but much better cost control, as there is no company taking its profit “off the top,” no drug company forcing its noncompetative prices on individuals. No one is seriously considering that system for the U.S. but we can learn from these programs. Sadly, the fearmongers just want to scare you, to cut off any meaningful discussion of what works and doesn’t work.
The writer blames government control for our healthcare crisis. Well, who’s been in government control for the past eight years, ignoring the issue? Who blocked any attempt at healthcare reform under the Clinton era, using the same misinformation techniques? Who is subverting all attempts at meaningful reform now? The obstructionists basically want no change, legislative or otherwise, and have great financial support from you know who.
The defenders of the status quo don’t mention the huge profits that insurance companies garner by taking only the healthiest clients, refusing to cover preexisting conditions, constantly raising their premiums, and, yes, rationing healthcare. OK, we have Medicaid for the poorest, and Medicare for elderly, but who covers the growing population of uninsured or underinsured who can’t afford to self pay? Ask any ER doc what percentage of his or her patients have true emergencies (Dr. Bok at FAHC estimates less than 50%). Should we look to the insurance providers for solutions – let the foxes solve the poultry crisis? In this wealthy country, everyone should have access to good, local, affordable healthcare with a focus on prevention (and I should be adequately compensated for providing this care).
Can we trust Washington to get healthcare reform right? Well, probably not. Too many politicians are there to get reelected, with generous help from the lobbyists. Electoral reform should come first. But I do believe that the Obama administration is truly committed to searching for real solutions to the looming healthcare meltdown, to forcing reluctant politicians to stop ignoring this dangerous problem and do some meaningful problem solving. We should all support and contribute to this debate, whatever your view. But the blatant lies, inuendos, and misrepresentations aimed at shouting down any debate is fascism, not democracy. I guess that’s how it’s done in America now.