Anonymous Doctor

Just got back from health care orientation. You would think as doctors we'd have an awesome health care plan, but we get the same thing anyone else does. Choice between an HMO and a PPO and just because I'm a doctor doesn't mean I really know the difference. Co-pays, deductibles, I'm sure pretty soon I'll know how to game the system and all the tricks, but right now I'm assuming I'm not going to need much major medical care and I'm going with the low plan. Besides, how would it look if a doctor got sick and the hospital where he works wouldn't treat him? Hey, there's an idea for a movie. Or an instructional video.

My dentist double-bills the insurance company. I questioned my statement after I got it-- thought it was a mistake and I'd be charged more money. Called him up and he got on the line and said he just does it to save the patients the deductible and co-payment. And it's true he hadn't charged me-- I figured he would send a bill. He didn't. He wins and we win. Everyone wins but the insurance company. And who wants insurance companies to win? Well, at least until they go bankrupt or raise their premiums. I don't know what we're supposed to do as doctors, how far we're supposed to go for our patients, where the line is between using the system and misusing the system. As a med student I heard residents on the phone negotiating with insurers, figuring out with the phone representatives how to structure a diagnosis so that it's covered, figuring out that if you give 10 pills now and 20 pills later, they'll be covered but 30 up front won't be. It doesn't make sense. It's too complicated, it serves no one, it's pointless.

Yet at the same time I don't want to reflexively just say we should have government-run national health care without seeing that system in action. For the people who can get care, the care here is pretty darn good. We save people. We do amazing things. That they aren't always able to do everywhere else in the world. Yes, everyone deserves the best care we can give them. And, no, it's not right for one class of people to get "more" medicine than another class. But how to administer a system like that-- I don't know enough yet to know. And how to draw the line between necessary medicine and optional medicine-- well, that's easier, but on the margins it's not always so clear. Gastric bypass? Dermatological procedures? Fertility treatments?

And as far as figuring out how doctors are going to get paid... there's already such a disparity between generalists and specialists, a disparity not always particularly justified by the work we do, that I'd hate to see a new system come in that would make that problem worse instead of better.

But all of this is far enough from being well-informed that I shouldn't even be sharing. Once I'm in the system, I trust it'll at least be easier to feel like I know what I'm talking about. For now, I need to make what's sure to be twelve phone calls in order to get a pager that actually works.