By Dr. Jane Orient
July 13, 2012
As soon as the Supreme Court upheld Obamacare, people started celebrating that their worries soon would be over.
The front page of my local newspaper reported on a 31-year-old with metastatic colon cancer who had hit the $300,000 maximum payout on his insurance. This possibility had not occurred to him when he bought his insurance plan.
Did he get care? Well, yes, but he had to raise money between chemotherapy treatments. This was exhausting and very difficult for a person who was so weak and sick. Now all Obama-compliant health insurance will have to provide coverage with no lifetime maximum, so everyone will have to pay higher premiums.
A caller to a talk-radio show rejoiced that he could now get insurance for his baby, who was born with a rare heart defect called tetralogy of Fallot. Open-heart surgery to correct this defect is widely available, and this baby almost certainly will be able to receive a state-of-the-art procedure.
The catch is that the family will have to pay for it. Charity, high-risk pools and special programs for congenital heart disease are some ways to help. The Obamacare way is to force all insurance subscribers to pay higher premiums.
Under Obamacare, all “necessary” and “appropriate” treatment will be “covered.” Before we shout “Hallelujah!” let’s ask, “What does this mean?”
Those words are even harder to define than “tax.” They will be defined by bureaucrats with one eye on the budget and the other on population health statistics. The actual decisions will be iplemented by puppet physicians with divided loyalties. Giving too much care may jeopardize their “bonus,” their ability to meet payroll or even their jobs.
The reformers who will be in the 150-plus federal agencies write scholarly papers on how we “waste” too much money on patients in the last six months of life. Realistically, a young person with aggressive cancer has a very dim outlook. Out of love or compassion, you might be willing to spend your money to give that patient a chance. But you might not want the insurer to take money out of care that you might need yourself. The bureaucrats who are responsible for society’s money also have to protect their own their lavish salary and perks.
As for babies with disabilities, the reformers’ Complete Lives System gives them a very low priority. They cost a lot, and society hasn’t invested too much in them yet, so why not give them “comfort care”? Or why not “prevent” the problem with prenatal diagnosis and abortion? Almost 90 percent of babies with Down syndrome are culled out in this way already, drastically reducing the demand for pediatric heart surgery. Innovation is not to be expected with the new taxes on medical devices and the new focus on “wellness” research.
Nevertheless, you may ask, aren’t we still better off with more coverage?
You may be shocked to learn that the answer is no. The price of coverage is not just sending the insurer money that you otherwise might devote to your own or your family’s care.
You may unknowingly relinquish your right to get more care, or more timely care, than your insurer allows. If the insurer covers a certain treatment but denies payment in your case for lack of medical necessity” or sufficient benefit (say your cancer is too advanced or you are too old) you may not be permitted to pay for it yourself.
The same is true if the insurer only allows a payment too low to induce anyone to perform the needed treatment.
A doctor who is enrolled in Medicare or Medicaid can go to prison for accepting more than the government-determined fee or for doing what the government determines to be too many procedures, even at the allowed fee. Managed care contracts, though not yet bound by the threat of prison terms, also restrict your doctor’s ability to care for you.
“Coverage” may make you feel more secure, but it also can mean less care and poorer care despite higher cost.
Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons (aapsonline.org).