Conton Letter - 07/29/09
Sensible Health care

I am a health care provider in Rockdale County. One of my patient groups is children with developmental delays. Treatment is paid for by Georgia Medicaid. A few years ago, the state had the brilliant idea of transferring the management of Medicaid to private insurance companies. They touted greater efficiency and reduced costs. The effect on my practice for this group of patients was dramatic. My administrative costs doubled through needless denials, resubmissions and certification processes. The time to get paid increased from a week to several months. My bad debt write-offs quadrupled. The money per unit of treatment, when it is eventually paid, was squeezed to 75 percent of what it was under the government run Medicaid. Basically, the cost of providing care went up while the reimbursement for the service went down. I was left with three choices to ensure the survival of my practice.

1) Spend less time with my patients, in most cases reducing the quality of care.

2) Increase the cost of treatment and hope that other payers and individuals pick up the difference

3) Drop this vulnerable patient group from my practice altogether

It is always strange to hear individuals talking from the insurance company playbook. "I don't want the government telling my health-care provider how I should be treated." What do you think happens now? Just that it is a profit-driven insurance company instead of government. And, frankly, I might trust the motives of government a bit more. Or, "Government does not know how to do anything right." Well health care is not one of the things that private insurance does right, either. Better still, "Government-run health care is going to create wait times for treatment like in Canada." Check out the wait time for the uninsured right here in the U.S. While you're at it, ask the underinsured how long they had to wait for approval for a procedure. Additionally, verify that they eventually get what the doctor asks for. It is usually some compromise that would save the insurance a few cents, not what is best for the patient. Besides, the examples of delays in Canada stem mainly from a shortage of providers. We have far more providers per capita than the Canadians. We will thus be coming from a far better place in terms of health-care providers than they ever got to. We are capable of learning from their problems if we design the system to be strong and effective rather than weak and accommodating to opposing philosophies.

In my practice, I could charge my patients much less for service if verification, resubmission and reimbursement procedures imposed by private insurance companies are simplified. I would gladly take a cut in payments to focus on my patients and be guaranteed a known fee in a predictable timeframe. This is one thing government has shown that it knows how to do, that private insurance companies proved they do very inefficiently.

Just to compare, how ridiculous would it be in hindsight to claim that government's involvement in education has put private schools out of business? Or that it has driven up the cost of education? Or that it has lowered quality? Let us just stop to think for a minute what it would be like not to have a public option in education. How many children would truly get left behind?

Access to a certain minimum of health care should be a right not a privilege, especially in the richest country in the world. That minimum is what should be provided by the public option just as in education. If anyone wants more they should be allowed to pay for it through parallel or supplemental private insurance. The systems coexists well in education, so why all the hoopla about it in healthcare? If anything, health care, like education, might just be a domain that should not exist without a public option.

Dr. Brian Conton