The Doctor is In

Damon Raskin, MD | Special to the Palisadian-Post

Q: How will the current health system upheaval affect us in the Palisades?

Well, yes indeed, there truly is a large elephant in the room. Not just any room, mind you—it’s right in the middle of my exam room, and I’m not sure exactly what to do with it. I can’t just leave it there or there will not be enough space for me to examine patients. So, we really have to figure this out.

The “elephant,” so to speak, is our health system and the proposals of the new Republican plan versus the Affordable Care Act. Not a day goes by when my patients don’t have questions about what procedures and exams are covered, if they get a yearly physical “for free” with their plan or why they still get a bill for services that they thought were covered.

Mr. Jones (not his real name) came to see me last week for a check-up. At 63 years old, he needed a plethora of preventive lab tests for his cholesterol, blood sugar, and kidney and liver function. He had an electrocardiogram to check his heart, as well as vaccines to prevent pneumonia and shingles.

“What is going to be my final bill?” he asked with a skeptical look of concern.

“I really don’t have a clue,” I responded with all sincerity.

And that is really the crux of the problem. As physicians, we are trained to help the sick and prevent and cure disease, to offer helpful advice and support our patients through hard times. But navigating the maze of insurance coverage was not a course offered in my medical school.

When the Affordable Care Act was passed, I saw more and more young people come to my office for check-ups because they were able to get on their parents’ insurance plans. I have also helped more people than ever with drug and alcohol addiction who never had insurance benefits before because they now had coverage for mental health and drug treatment.

The new proposal may be even more difficult to shop for insurance. Individual plans may offer skimpier benefits and patients who expect more from their doctors may end up getting a bigger bill in the mail at the end of their visit. Since out-of-pocket costs may rise, this may impact my senior patients on fixed incomes. They may choose to come to see me less often. This is quite concerning, as prevention is really the key to longevity.

If fewer people have coverage or are priced out of the market, I will see sicker patients who need more care, or these patients may end up getting care in the emergency room. Both scenarios are very concerning.

Taking politics out of this, we, as a society, need to look at the big picture. We are the only industrialized nation, the most powerful nation on Earth, without universal health care for our citizens. The ones who seem to reap the rewards in this system are not the doctors but the insurance and the pharmaceutical companies.

Let’s try to get it right this time by getting informed and learning. We have to stop hiding behind the elephant and stand up and make ourselves heard. Our health depends on it.