You Call This 'Choice of Doctors?'

I was a panelist on a forum on health care tonight up in Harlem at Hue-Man Bookstore and Café.  I always feel like I get a lot more out of hearing people’s questions on health care than they could possibly get from me answering them.  While listening tonight, I was stuck by the realization that the single scariest line from the anti-reform fear mongers is the false notion that you wouldn’t be able to choose or keep your own doctor.  But perhaps, just perhaps, that scary line won’t work this time – because so many don’t get to see the doctors they want under our current broken system.

The concern I heard over and over again tonight was, “How do I get to keep my doctor?”  It makes sense that this was so strong a focus.  One attendee talked about his doctor being his partner in care.  One of the other panelists, Dr. Virgie Ellington, author of What Your Doctor Wants You to Know But Doesn’t Have the Time to Tell You, pointed out, “The single-best preventative care you can give yourself is to have a strong relationship with a primary care doctor who knows you.”  You would think this would be a ripe audience for the scare tactic, “You won’t be able to have the doctor you want under government-run health care, and even if you do, bureaucrats will overrule your decisions.”

But those seeking to scare the public should have stayed to hear the rest of the story, though.  One woman related how she was laid off after 9/11, got a new job with minimal benefits, was told she couldn’t go on her husband’s plan, and only just now was able to get a job with insurance that covered the two doctors she trusts the most.  As she said to me, “I’ve had two check-ups in seven years.”  Another participant talked about how often the insurance companies and HMOs overruled the treatments her doctor prescribed her, and how each time she had to fight her way into getting the coverage she needed.  There was some talk about how most of us who get insurance from our employer have no options at all with the plan.  The benefits are decided upon and the networks of providers is established with absolutely no concern for who your doctor is before you take the job.  Your option is take it or leave it.  There’s no alternative – individual plans are prohibitively expensive for most of us, and we don’t have a public competitor plan, similar to Medicare and with a similar reservoir of providers, that we can sign up for if we don’t like what’s offered by our employer.  We get no choice at all.

Giving the flip-side of the argument, the primary care doctors on the panel shared exactly how difficult it was to give patients the quality time they needed, pay for nutritionists out of pocket to teach at-risk patients about health living, and yet see enough patients in a day to be solvent.  This is the same financial pressure that drives doctors out of primary care – another limit on the patient’s choice.  And of course, let's not forget those who lose their coverage when they lose their job -- and with it, the ability to pay for the doctor they want.

It’s fascinating to see how little the arguments of the critics of reform – those who claim to be defending the relationship between a doctor and a patient, and the sacrosanct ability to choose your own doctor – actually match up to the experience of real people.  We’ve got denial of provider and denial of service now, but it’s based on the bottom line for an insurance company.  You cannot be afraid to lose what you don’t have.

(Photo credit:  Arbitrary.Marks on Flickr.)