COMMENTARY: Local doctor says patients could be in for suffering

As a physician, people expect me to use facts to provide the best care. Consider these two patients: they both have diabetic foot infections, a risk for amputation if not treated aggressively. They’ve both had surgery to remove infection, and a wound vacuum applied to the healing surgical site — a device that improves recovery. At hospital discharge, though both patients’ wounds are identical, the device is removed from one patient, while the other is sent home with it.

Now, a quiz. One of these patients had private insurance and the other was government-insured. Which insurance do you think approved the device recommended by his doctor? Which patient paid for his plan through work-place deductions, and which was unemployed? Which patient was satisfied?

Here’s what the patient, whose wound vac was refused by his private company, said: “I paid for insurance all my life, and the government gave that bum a wound vac!”

I am never upset when patients get proper treatment, and always upset when they don’t, so I completely understand this patient’s frustration. What I don’t understand is who he was upset with — the entity providing the appropriate care — the government! In my world, where the goal is excellence for every patient, the government (Medicare, Medicaid, Veterans Administration) is usually my ally, and private insurers, as this patient found to his shock, often my adversaries.

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I have never had to argue with Medicare for a service I have recommended, but I duke it out regularly with private insurers: for refusing skilled rehabilitation, a special drug, or treatments. I have only one complaint with Medicare — they don’t negotiate drug or device prices, which would lower costs for us taxpayers. But they will. And, if we want the best bang for our insurance buck, it’s just as inevitable we’ll (eventually) hire government to manage health care. A few facts:

Insurance costs continue to rise. Despite having insurance, 20 to 70 percent of Americans are unable to pay medical bills, or cut back on food and basic needs to do so, or forego needed care/medication.

Private insurance bureaucracy costs more than public — 12 percent versus 2 percent.

Eliminating multiple insurers cuts hospital and physician administrative costs in half.

Independent organizations forecast Medicare-for-all can insure all Americans at lower cost than what we spend now.

Healthcare costs (private plus public) gobble 18 percent of our domestic spending, and continue to rise.

Most citizens and doctors favor providing basic care for all.

Patient satisfaction with single-payer plans (Medicare, Veterans, Medicaid) is higher than with private insurance.

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As for my opinion, fiscal responsibility suggests we tame expenses, starting with the bloated private insurance bureaucracy and profit, every dollar of which subtracts a dollar from patient service. We can do this while improving care, providing service to all, and restoring the freedom to choose our providers that private insurance networks now deny us.

I went into medicine to help people. I am in favor of policies that improve patient care, even more if they also reduce cost and paperwork. Congress is holding hearings on healthcare. If you believe, as I do, that facts matter more than politics, there is no better time to let your representatives know that you’re watching. And if you don’t think facts matter, I’ll still be there to take care of you, because I believe that’s everyone’s right.

Dr. Mary Jo Groves is a hospitalist at Springfield Regional Medical Center.

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