I was speaking with a client today about physician choice in the healthcare system in which he finds himself, and I could sense the frustration and desperation in his voice. He is hurting. He is in pain. He can’t work. He just wants to get “fixed.” He does not feel that his doctor is listening to him and the healthcare system governing his care does not allow him to change physicians.
Before we begin our descent into purgatory – for such is the descent into a healthcare system without choices or options and fraught with delays – let us ask ourselves: what is it that we so fear about “socialized medicine?” What is it that makes us cringe when we hear those words?
Well, apart from the cost and probable associated tax increase, there are things that are bad for the consumer/patient. I thought about it and, after reading a number of articles concerning the pros and cons of a socialized system (and spending a great deal of time in Europe, where such systems abound), I have concluded that there are three major things that keep most citizens from being in favor of it from the perspective of patient care. They are:
- Gatekeeper physicians that control your care;
- No physician choice (at all);
- Delays in medical care.
Let’s look at each of these objections individually. Here is how it works in most countries that have socialized medicine:
Gatekeepers. First, you are directed to go to a “gatekeeper” doctor in the form of a family practice, general practice, primary care physician. Once there, that physician determines whether or not you need to see a specialist. If they don’t refer you to one, you are stuck.
No physician choice. You do not get to choose this primary care physician, nor do you get to choose the specialist if the primary care does decide to refer you on. If you get there and that doctor tells you something you don’t like, no second opinion, or maybe you get a second opinion, but you don’t get to pick the physician who will give you that second opinion.
Delays in medical care. In the event you are referred to a specialist, that referral can take weeks or months. In many countries it takes several months to get an appointment with most specialists.
If you are a consumer, would you pay for such healthcare? Would you want your government to impose it upon you? We tried HMOs in the 1990s and they were a disaster. But even with HMOs you had some physician choice. What about a system where you have NO physician choice. Would you pay for that?
Guess what. If you are an employer in the State of Florida, that is exactly the type of healthcare you are paying for. If your employees are injured on the job, then they must file a workers’ compensation claim and enter a healthcare system that will provide them with all of the worst aspects of socialized medicine, and even add features that are WORSE.
Under the Florida Workers’ Compensation Law, injured workers do not get to select their primary care physician. The workers' compensation carrier tells you which primary care physician to go see. If that physician doesn’t think you need to see a specialist, you don’t get one. Second opinion? Forget it. Ain’t happenin’. You do get to change physicians ONCE in your claim, but the workers’ compensation insurance carrier gets to pick who you go see. If you don’t like that doctor, well, you may as well pound sand.
It gets even better. In most socialized systems, they monitor the healthcare being provided, but they are not trying to make a profit, as are workers’ compensation insurance companies. As a part of the Florida system, injured workers are REQUIRED to allow full, unrestricted access to their treating physicians to the insurance company AND its representatives. This means that insurance adjusters, case managers and defense attorneys representing the insurance companies can talk to your doctor whenever they want to, WITHOUT you being present.
So, people that have a serious interest in keeping the cost of your medical care down get to talk to your doc without you around. I can hear the conversations:
“Come on Doc, he doesn’t need physical therapy, does he? Won’t some home exercises be enough?”
“You aren’t really going to recommend surgery, are you Doc? Remember, we sent you 15 patients this week. Don’t forget who is feeding you.”
Where do I sign up for healthcare like that?! I can’t wait!
Over the past 10 years — when most of these limits were passed by the Florida legislature and made law by then Governer Jeb Bush — I have watched insurance companies become bolder and bolder in their denials and in delaying medical care. As I discussed last month, as time has passed, the Florida Workers' Compensation Law has been slowly chipped away at to the point that, in my humble opinion, it should have been declared unconstitutional long ago.
I have a client who was recommended to have a series of lumbar epidural steroid injections last Fall. The carrier refused to authorize the last one in November. They didn’t deny it. They just did not provide the “pre-authorization” required so that the doctor could perform the injection. They had no basis and gave no explanation. We filed a “Formal Grievance,” as we are required to in this case, then a petition for benefits, which will allow us to go in front of the judge for an order to make them authorize the injection. In MARCH, the defense attorney called me and said his client had authorized the injection and asked me to dismiss the petition. I said, “Give it to me in writing.” He did. This Tuesday my client informed me that he showed up to the doctor’s office last week for the injection, but didn’t get it because the carrier STILL had not provided the authorization for the injection. Yesterday, I filed my Motion to Enforce their agreement to authorize the injections. UNBELIEVABLE! And I deal with this EVERY DAY. Oh joy!
This is the healthcare delivery system that the State of Florida has imposed upon employers and their injured workers. It boggles my mind that with all of the negative press “socialized medicine” gets, that our government would enact a law which adopts all of the worst aspects of socialized medicine in a system where profit-driven insurance companies control everything. But then again, who has the bigger wallet? Injured workers or Insurance Companies? In Tallahassee, that is all that matters.