I have a new pediatrician for my children. She is an excellent doctor who loves her job and has a lot of experience. She is thorough, meticulous and not ‘on a clock’ to see as many patients possible in one day to maximize her income. My new pediatrician doesn’t accept insurance policies purchased on the Exchange (Obamacare) nor does she accept Medi-Cal. She has created an affordable cash patient scheme for parents who do not have health insurance, have inadequate health insurance or on Medi-Cal. She charges only the ‘cost’ for vaccinations, meaning the cost for her to purchase and her examination fees are only $35 (as opposed to the average of $75-100 for cash patients). Her practice is in a very well off part of town and she comes highly recommended. She is open and upfront about the insurance policies she accepts and her cash patient fees and she even gave me a list of free health clinics that give free vaccines to children who do not have health insurance and recommends that we go there for vaccines if that’s all we needed to see her for and save the vaccine cost and examination fee. And we got to discussing the bureaucratic mess that is Obamacare, why the cost of health care and services are so high despite the reforms and the special interests that are driving them. I talk a lot about health insurance and health care on my blog. It’s something that matters a lot to me, because like millions of families, we do not have endless budget to devote to health insurance and health care costs and it’s my job to find the best policy for the budget we have.
I’ve never discussed at length with a doctor, especially a pediatrician or family practitioner about the ramifications of Obamacare and today I got the opportunity to. The reason why this doctor chose to opt out of the Obamacare exchanges and Medi-Cal is because it’s unsustainable and it doesn’t serve the best interests of her patients. With Medi-Cal she is very restricted on what she can do to treat her patients and the same goes for the Exchanges. Another requirement of Obamacare is the ‘transparency’ part on the part of doctors. Doctors are required to fill out pages and pages of cumbersome forms in the name of transparency under the new Obamacare law and if they don’t have the time to do it, they have to hire more staff to do it but at the same time her claims compensation are capped by the same law. But to her the most egregious is, a law, written by Harvard graduates, who live in an “ivory tower”, most of whom aren’t Medical Doctors, but are dictating public health policy from a business model (i.e. profit and loss) standpoint.
My pediatrician attends a lot of public health policy conferences and she sees these “ivory tower” folks often, and when she brings up the glaring fact that they are not in the trenches practicing medicine with one hand tied behind their back; they get offended and taken aback – typical neoliberal response. When I bring up the common trope that it’s the doctors and practitioners who are driving up the price of health care by practicing defensive medicine to avoid malpractice claims and demanding higher salaries – which is addressed with higher claim amounts, she says that the insurance company only pays her $60 for every trip to the hospital to exam a newborn and this can be any time day or night, any day of the week (depending on when the baby is born). And depending on where the hospital is, that $60 may not even cover the gas to travel to and from the hospital. But she must take this potential ‘loss’ and go because every newborn and their potential siblings are her potential new patients.
We spoke at length at the monstrosity that is Obamacare, she said the law did away catastrophic insurance, which is high deductible and covers only catastrophic events such as car accident, cancer, heart disease; and this insurance is usually favored by those who are young, healthy and are self-employed. These plans keeps monthly premiums low and this is done by design as it’s meeting a demand by users. Right now these plans have been outlawed, every single plan now must be a normal insurance plan which covers for all events, but the premiums are still high and deductible is still high and essentially “all plans now are catastrophic plans”. As a medical professional, she enlightened me to the fact that the reason health services are so high, and why it costs over $10,000 for a 2 day hospital stay to have a healthy, uncomplicated childbirth and why an MRI costs $3000 is because the huge bureaucracies involved in these companies and how everyone needs a piece of the pie and they are also charging for people who can’t pay for them by inflating the cost for every person counting on the insurance company to pay 50-80% of it. My pediatrician keeps her costs by sourcing private labs and CT and MRI scanning places who are out of the networks of insurance providers, who work on a cash basis only; they do not bill the insurance and through those facilities the true cost of services are revealed to be reasonable. You can get an MRI for $300, a CT scan for $150 or $200 and blood tests can be processed without going through a huge, messy and expensive bureaucracy. She also chose to opt out of the Exchange because she believes, due to the unsustainability of Obamacare, it will come to a natural end, without needing the Republicans to repeal it.
We discussed the single-payer system, and she said that’s not the panacea either, it can help in some situations, but for those with complicated medical histories or unusual diseases, single-payer system can be terribly restrictive. Single-payer only works if government doesn’t dictate what kind of care for what kind of diseases in order to control costs; basically a free for all. Every patient is unique and as a result the services they need for diagnoses and treatment are unique; and it’s this simple concept that those in “ivory towers” can’t understand. Single-payer system works best in routine illnesses which protocols and treatments have already been established. Those with illnesses which require more creative methods or experimental methods of treatment, the single-payer system doesn’t address that concern very well, you spend half of your time trying to get approval for treatment versus getting the treatment. In the end, we ran out of time discussing this subject but she did say, with all of our resources and innovations, we should be able to work something out where a viable, affordable, good health care system can benefit most people. There is no perfect system where every single person can be taken care of, but we should aim for getting the majority of the people covered without creating so much anxiety for average families.
The doctor spent nearly 2 hours on my daughter, she was due for her annual wellness check and new patient assessment. She also got a vaccine shot, and my total cost for her services rendered was $275 (I didn’t have her in-network insurance and I chose to forgo the agony of arguing with my current insurance and paid the cash). She had a lovely and kind nurse work with my daughter for her assessments, not once did we feel hurried or rushed. It was the first time a doctor spent so much time with any of my children and in the end, it was $275 well spent. I came away with all of my questions answered and feeling confident that my daughter’s clean bill of health was the result of thorough examination.