Monday, November 30, 2009


One of the primary claims made by opponents of the current medical reform initiatives pending in Congress is that we will all be robbed of our choice of doctors and freedom of choice in seeking medical care.  Nothing could be farther from the truth. Anyone who truly believes they have freedom of choice in medical care today must be living on another planet or receiving medical care from a different source than most all Americans.  The truth is choices of your medical doctors, treatment and source of care is almost always controlled by your insurance company, HMO, hospital or clinic.

To begin with, those of us on Medicare are limited in choice by limitations on costs.  There are a significant number of doctors who refuse to treat Medicare patients, let alone Medicaid patients.  We are further limited by caps on various procedures and by the fact we cannot go at our choice to see a specialist.  There first must be a referral from the approved family doctor or general practitioner.  

If you have private insurance, you are most certainly limited by those health care providers approved by your insurance carrier.  In the event you wanted to have a physician of your choice treat you at a particular hospital in a nearby city, forget it.  The hospital’s board of directors, many of whom may not even be physicians, control which doctors are allowed to practice in which hospitals.   Lawyers for hospitals will quickly tell you that choice of doctors practicing in their hospital has nothing to do with quality patient care but has to do with contractual matters and profitability.  If a cancer patient in Port Arthur wanted to have his or her doctor follow them to one of the larger hospitals in Houston, it would not be the choice of the patient, but the choice of the hospital the patient seeks to be admitted to.

Subsets of medical care such as blood testing, x-rays, CAT Scans, bone marrow tests, density tests and various exploratory procedures are seldom the choice of the patient.  As a matter of fact most patients wouldn’t know one from the other to begin with and usually they go where they are sent by their doctor.  Patients are never informed as to whether or not the doctor may have part ownership in the expensive equipment being used or what relationship he or she may have with the laboratory doing the various kinds of tests.  Most of us will simply go where we are told, never even attempting to ask for a choice.

Choice is almost as big a fallacy and bug-a-boo as Sarah Palin’s death panel which she claims but which does not exist in any of the legislation proposed by any member of Congress.

Recently, a health care expert was being interviewed on CNN and had done an extreme amount of research comparing the American health care plan to that of other nations of the world.  Although it is claimed by doctors, hospitals, pharmaceutical companies and others having a huge financial interest in our health that America has the best health care in the world, this statement does not hold up very well under a microscope. America does not even rank in the top 10 in longevity, mother survival rates in childbirth or availability of certain services to all people.  The United States does not compare well with many under-developed countries in infant survival.  While wonderful health care exists for the very rich and the United States leads in innovative technology, as many people die in the United States each year from lack of medical care as die in many of the third-world countries.

Contrary to many of my conservative friends, I do not hate insurance companies.  Lord knows they have made money available enough to make me a living for many years.  In most cases I have to resort to the courthouse to take it away from them, however.  Insurance companies have seen a huge change in the last 3-4 decades.

There was a time in the law when insurance was illegal.  It was considered gambling!  People who would issue insurance policies were held to be betting on whether or not someone would live longer than they expected, someone would be hit with some unexpected disaster or some other calamity.  They would bet some calamity would occur based on the odds they figured.  Insurance was then changed to become “risk managers.”  The theory being if a large number of people were insured, the insurance company could figure the odds on how many would survive with no claims made and what percentage would have claims.  

Homeowners’ insurance is a good example.  Most people’s homes are not going to burn down, so the premiums they pay make up for those of us who have the misfortune to lose our houses in a storm, fire or some other disaster.  The insurance companies have gone from being manager of risk to avoiders of risk.  This is why, if you have a homeowners’ claim for a leaky roof your rates are either tripled or your policy is canceled.  The same is even more true if it relates to health insurance.  Insurance companies will happily insure you while you are healthy, but the moment a physical problem arises, you are either rated out of the ability to pay for it, or your policy is canceled.

What President Obama and other reformers are maintaining is not being adequately explained.  We can save money.  If everyone were insured, there will be more healthy people paying premiums than there are sick people filing claims.  The whole thing would ultimately lead to savings of hospitals and other health care providers who would be assured of payment under a universal health care plan.

I am not without my concerns about some of the more popular proposals floating around Congress.  Most of them could be cured with a government option.  A prime example is the popular mandate of not denying insurance coverage because of pre-existing conditions.  This simply will not work without some government subsidy.  While I have great sympathy for people afflicted with diabetes, a history of heart disease or cancer, how do we know when it would be a reasonable amount of time to admit them and add them to an insurance policy?  Surely it is not fair for a person to wait until he or she had terminal cancer to then come and demand a policy to cover all of their future medical expenses.  

This is why we need a public option.  From a humanitarian standpoint and a practical standpoint there should be a government-funded plan so that people would not have to die needlessly because they had a pre-existing condition such as one of those mentioned above.  Without some limitations on forcing an insurance plan to accept people who are already sick, the very theory of insurance would not work well.

As I have said before, I am probably too old at this point to give good advice about insurance.  Those seeking reform should have asked me in 1962 while I was in my 20's and recently elected to the Legislature. At that point I knew everything that needed knowing about insurance.