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Every year in January we make new year’s resolutions.  We take a fresh look at what we are doing, and make a decision to do something better the next time round.  The Affordable Care Act (ACA) is our national resolution to improve health care, and this is the last year before it goes into effect. In this historic year, the way we  prepare for this change will affect its success and shape the future of medicine.

While most of  the changes included in the ACA will dramatically improve our medical care system, a few of its aspects feel like the same old slide downhill.  Our medical office has been receiving letters from various insurance plans asking if we intend to participate in the products they will offer on the insurance exchange, the new “marketplace” for buying and selling insurance plans.  One company sent us an invitation to contract differently for each of their tiered products:  gold, silver and bronze.  Their plan was to pass the cost differential directly on to us--we would receive more for seeing a gold plan patient, a medium amount for seeing the silver, and a small reimbursement for the bronze patient.  What are we supposed to do with this?  If someone has the bronze plan, give them shorter office visits?  Cut them off if they exceed their time allotment?  Maybe we should give the gold plan members premiere access, so when they show up they can move to the front of the appointment queue and be seen ahead of the lesser members, like the airlines do.  Same day appointments for the gold card holders; wait two weeks if you bought bronze?  The Disneyland Gold Pass for medicine!  We could have three check in windows in our offices, color coded --gold, silver, and bronze, so the medical care seekers are well aware of their status in the new hierarchy, and get attended to accordingly.

There are reasons this scenario seems seems so blatantly wrong:  medicine is not, and should never be, a commercial enterprise.  Health care is a need, not a want.  Getting sick is not a choice.  You just can’t opt in or out of having a body made of flesh and blood, susceptible to trauma and vulnerable  to illness.  The cost incurred for a serious illness exceeds the amount any average person could possibly be able to pay.  You can’t compare $180,000 for leukemia treatment to buying or skipping your not-fat caramel latte each morning.  When human beings are sick and in pain, they deserve to be treated fairly and with dignity.  Promoting the idea that healthcare is a “product” of which people can choose to buy a little or a lot is ludicrous.  Even the most cold hearted among us would not expect that an ill and dying tea party member be left out in the emergency room parking lot to slowly slip away because he or she opted out of purchasing an insurance exchange product.  We are all in this together whether we like it or not.

When I am in the airport and the passengers with premiere access get to go ahead in line, I am ok with that.  It’ not a life or death situation.  I know they paid extra for the privilege to board first or have more leg room, and I did not.  That is fair.  Ultimately we will all make the same flight on the same plane, to the same destination.  
In medicine, the only fair way to distribute services is for the sickest and most critically ill to go first.  All offices, emergency rooms, and hospitals operate with this as the basic tenant of triage.  Any other ordering of services would be absurd and inhumane.  Medicine will never fit the oft promoted business model where people’s lives and well-being are bought and sold like commodities.  However, there is one thing we can learn from the airline model:  even if we have contributed differently according to our circumstances, we can all end up on the same plane headed to the same destination.  

Comments

  1. April SousaJanuary 10, 2013 at 9:28 AM

    Thank you for these insights! As someone who tries to be educated in this way, but is really not close to the issue, i had no idea what the insurance companies ask of medical offices. I can see where medical offices are between a rock and a hard place. It shouldn't be all about the money, and yet, if a medical office doesn't get paid enough, they cannot survive.

    This model that the one company you described really reminds me of the classism in this society. I don't think I have any other comments for this, only that it makes me think. And my brain is wrestling with itself.

    ReplyDelete

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