Medical school didn’t teach me about the intricacies of health insurance. My family medicine residency program took pride in caring for all patients regardless of insurance status. When I worked in New Zealand and Canada it was a relief to not worry about which diabetic test strips were on formulary or whether a patient’s insurance would cover their birth control.
In my current position as a primary care physician at an urban academic health center and as the debate around the Affordable Care Act continues, I feel it is crucial to make a concerted effort toward simplifying our complicated health insurance system.
As a family physician, I treasure my relationships with patients, and I’m proud when patients recommend me to their friends and families. I appreciate that the health care system within which I work accepts most insurance plans, but when my patients change jobs, lose their jobs, move, become eligible for Medicare, or their insurance plan switches networks, they are forced to get new doctors and establish care within a new system.
Many critics of universal health care argue that it limits patient choice, however in my experience there are overlooked negative consequences of having too many health insurance options.
This past year, my patient with a previous miscarriage was elated to be pregnant again. I saw her monthly for routine prenatal visits up until December when she was five months along. During our last visit she mentioned her employer-based insurance was changing networks in the new year. I haven’t seen her since.
Another patient, a mother with an autoimmune illness that causes debilitating back pain, sees me regularly for most medical concerns. She also sees a rheumatologist with whom she’s built trust as they’ve discussed treatment options with significant side effects. She lives near my office, so the location is convenient. However, her family recently decided to move 10 miles south, which puts them in a new county. She’d be happy to drive the extra few minutes and keep her same doctors, but because her insurance is through the county system she is forced to re-establish care elsewhere.
Insurance changes can carry considerable costs as well as impacting continuity of care. I have an elderly patient who spent decades receiving medical care within a large managed care network. Over the years he had imaging studies and surgeries, tried various combinations of medications to control his blood pressure, was referred to specialists, and visited his primary care physician quarterly. A few years ago he transferred care. He arrived at my office with a vague history of his chronic medical conditions and some pill bottles. The clerical staff dutifully obtained prior medical records and presented me with a 300-page fax that took hours to sift through and sort out what was pertinent. I had to refer him to new specialists within our network and repeat many of the previous studies. The time and money spent obtaining and reviewing old records and repeating consults and tests are just some of the overlooked costs of a seemingly simple change in health care coverage.
It is evident that our current health insurance system is too complicated. Cryptic booklets comparing and contrasting insurance plans with varying coverage limits and deductibles are confusing for health care providers and patients alike and result in fragmented medical care and increased costs. Treating health care as a commodity and putting the burden on a sick and overwhelmed patient to shop around for medical insurance just doesn’t make sense.
I am concerned that any version of Trumpcare will add to the health insurance kerfuffle and obstruct access to care under the guise of creating more patient choice. I urge us all as health care consumers to consider the impacts of an overabundance of health insurance options and advocate for simplifying our system.