Dr. Emily's Blog

A father stands anxiously at the window to our reception desk, shifting his weight from side to side, clutching at a piece of paper.  “ My son can’t play football unless this form is signed, and practice starts this afternoon.  Can’t you help me?”   “Unfortunately,” explains my receptionist, “We are booking out 6 to 8 weeks for a well check up.  Our same day appointments are set aside for patients with serious, acute illnesses, and besides, sport physicals are not covered by insurances.”   “What am I supposed to do?”  asks the distraught parent.  The receptionist gives him a sympathetic look and hurries to answer the persistently ringing phone.  Some desperate families actually go to the emergency room to get their sport physical forms filled out.  Thus the insanity of the sport physical season plays out. Typically, the required paperwork is handed out to families in late July, and the school system expects physician offices to to s...

We are coming to the end of the first year of the Affordable Care Act (ACA).  Although the ACA ushered in an era of improvements, we still have a long way to go.   Devin Miller, Washington correspondent for the American Academy of Pediatrics, optimistically reports that more children that ever are currently insured, thanks to the ACA, Medicaid, and the Children’s Health Insurance Program. 1 He reports a 25% reduction in the number of uninsured Americans, which should be great news.    My question is, what does “being insured” mean?  In my experience, the new Covered California plans generally have a large deductibles, sizable co-pays, restrictive formularies accompanied by many exclusions.  If you can still go bankrupt from medical bills while insured, how much good has this done?   We are happy that many more people have insurance now, but that needs to translate into good medical care for policy-holders.  If the insurance indu...

Hi.  My name is Emily Dalton. I am a local pediatrician and  I have had the misfortune of dealing with the health insurance system from 3 different perspectives:   that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts with and gets paid by various insurance companies.  Our system is profoundly dysfunctional, and we need to completely rethink how we deliver healthcare to the nation’s population.  Previously I spoke about my experiences as a patient and an employer.  Today I will share my opinion as a physician.   I have had no end of problems dealing with the 9 different insurance companies with which our office contracts.  After one of our doctors has seen a patient, we submit a claim to that patient’s insurance plan requesting payment.  Three full time employees work to make sure the claims we submit get paid correctly....

Hi.  my name is Emily Dalton, and I am a local pediatrician.  I have had the misfortune of dealing with the health insurance system from 3 different perspectives:  that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts and gets paid by various insurance companies.  I am here to tell you that the system is broken, and that what is going on today in medicine is so dysfunctional that we need to completely rethink health care in our country.   Previously I spoke about some of my experiences as a patient, struggling to get medical expenses covered by my insurer.   Today I am going to talk about what I deal with as a small business owner who provides insurance for the 30-odd employees of my medical practice.   Over the past decade, our medical office dreads the arrival of each new year because the insurance plans offered previously are c...

Hi.  my name is Emily Dalton, and I am a local pediatrician.  I have had the unfortunate experience of dealing with the health insurance system from 3 different perspectives:   that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts and gets paid by various insurance companies.  I am here to tell you that the system is broken.  What is going on today in medicine is so ineffective that we need to reinvent our nation’s healthcare system from the ground up. As a patient, I am tricked by the insurance plan I bought.  Even though the plan is called “HSA 2000”, the deductible for my family is actually $4000.  When we bought the plan we were told the insurance would cover 80% of the charges after the deductible, but after signing up that percentage was changed to 70%.   Despite the deception, I am stuck with this costly plan for t...

GODZILLA HAS RISEN:   THE INSURANCE INDUSTRY UNDER THE AFFORDABLE CARE ACT When inquired if Godzilla was "good or bad", producer Shogo Tomiyama likened it to a Shinto "God of Destruction" which lacks moral agency and cannot be held to human standards of good and evil. "He totally destroys everything and then there is a rebirth. Something new and fresh can begin.”  (Godzilla, Wikipedia)   Despite all the hopes many of us had for the Affordable Care Act, the current system of medical insurance is a twisted and dysfunctional nightmare.   I should know, because I am in the unique position of experiencing it from three perspectives simultaneously:  that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts with and gets paid by insurance.   As a patient, I am tricked by the insurance plan I bought.  Even though the card says “HSA 2000”,...

PRESERVE POLIO SOCIETY Whenever one of my patients refuses vaccines for their child, I cringe.  Why turn down one of the best medical protections available?  Vaccines have prevented massive numbers of deaths and uncountable lives of anguish.  Refusing them makes as much sense as refusing clean water or sanitation systems.  For those of us with basic medical and scientific knowledge, this decision is incomprehensible.     However, for the average parent, vaccines may seem incomprehensible.  Medical science has advanced to the point where many people can’t understand how vaccines work, and don’t appreciate the benefits they have brought about.  Most parents don’t have a scientific education, so in decision-making they rely on the loudest voices that jive with their inner sense of values.  The collective memory of children in iron lungs or infants coughing themselves to death from pertussis is gone, so fear of disease has been remove...