Posts Tagged ‘rural medicine’

A Frustrated Physician Speaks Out on on Town Halls, the Legislative Process, and the Urgent Need for Reform

August 18th, 2009 1 comment

An old college friend with whom I’ve recently reconnected sent me a long, thoughtful comment on my recent writings on health care. Since few read the comments (unless they are commenting themselves),  I’m posting Dr. James J. Ledwith’s thoughts on the need for health care reform here. Jim’s insights are informed by his years of practice in rural  Virginia and now in Boston. Wherever you stand on HC reform, this is a must read:

The Tea Party disruptions of public discussion of the health care reform probably won’t keep Congress from moving forward on this essential task, but it will compromise the quality of the final product by obstructing the open dialogue on the issues with our representatives. As a teaching family physician, I thought it was a good idea to send a medical student to a nearby town hall meeting with two of our congressmen. My student entered with a strong interest in the issues and concern for the impact on her plan to become a family physician, but left with a sense of frustration and embarrassment after Tea Party activists disrupted debate. Our Massachusetts representatives learned nothing to guide the shape of the new legislation.

Concerned by the hyperbole about rationing or pulling the plug? I suggest simply asking your physician how he or she would provide care for you. Concerned about unnecessary tests, or that your primary care specialist has no incentive to promptly read an ER report and talk to the limited-practice urologist who may need to perform a procedure to relieve the pain of a kidney stone? The physician practicing in a “Patient-Centered Medical Home” would do this but the service lacks funding outside of concierge practices for the elite. My prescription is to push Congress to begin reform of our health care system and build incentives to produce more family physicians, and that you hurry to establish care with one if you haven’t yet (Massachusetts has taught us that there are not enough primary care doctors to do the job).

The free market of private insurance simply doesn’t work in health care. There is no viable option for the low income worker, the individual with a pre-existing condition, or the guy who is laid off with COBRA premiums exceeding the unemployment check. There is no incentive for the young healthy worker to give up part of his income to insure himself until unexpected illness makes him a burden on public plans.

We all pay for the costs of the uncovered care and the travesty of having neighbors suffer rather than ask for assistance. A few years ago, nearly 1/5 of my patients in private practice in rural Virginia had no insurance to aid them with my bills, their medications, and consultations, let alone hospital care. Now in Massachusetts, it is a real pleasure, a relief actually, that due to Universal Coverage each visitor to my current office can afford to get the care I recommend.

We will have to make all insurance plans accountable to officials who answer to voting Americans. During nearly twenty years of small town family medicine, I was confronted by the need to push beyond standard procedures to appeal for coverage of necessary care with an insurer. At least a dozen or more times, my patients were fortunate to have a state rep on the state insurance commission. Minutes after calls to his office the coverage for the denied treatment was assured. By the way, this was necessary only with private insurers, not the public Medicaid or Medicare programs.

Private insurance plans have their place in the market with public plans, which are essential to offer help to those who need it. But should physicians spend valuable time sorting through varying coverage rules and limits for each individual patient? Care will be delivered efficiently to all with basic coverage for all, with uniform rules for all plans.

Remember, if a small minority obstructs sound civil debate, Americans who want to express views can still call and write to representatives individually or support lobbying groups who will rationally express those views.

How frustrating to have all of that experience drowned out by ignorance. A consequence of the First Amendment, I guess, but I think there’s a reasonable argument that shouting the other side down isn’t the kind of robust “debate” that the Founders had in mind. What’s the line between protected speech — however coarse — and destructive disruption? A few seem to be testing that line.