Halloween 2008, candidate Obama eerily proclaimed “We are five days away from fundamentally transforming the United States of America.” Once sworn into office, President Obama immediately embarked on passing “The Manifesto” for his promised fundamental transformation, his signature legislation- Obamacare. This law passed against the will of the American people.
American medicine, once the pinnacle of innovative, individualized, cure-oriented, and life-extending care, is based on the sacred Hippocratic Oath which centers on the patient-physician relationship, with the single ultimate goal of doing what is best for the patient. Policies set forth in Obamacare fundamentally transform American medicine such that the central patient-physician relationship is replaced by the government-subject relationship via the insurance company-client relationship. The ultimate goal is now primarily doing what is best for the government and the collective good and secondarily profiting the insurance companies.
I have practiced medicine in the United States for over twenty years, and what my patients and I are now experiencing under Obamacare is oppressive and intolerable.
Last month I prescribed a routine medication to a patient. It is one of the most commonly prescribed medications in its class. I know the medication works for this patient, because I gave her a sample, and she told me it relieved all of her symptoms; nothing else we tried has helped.
She and I soon received letters from her insurance company denying coverage for this medication stating “the medication does not meet the criteria of “medical necessity” under your description of medical benefits.” The letter is shocking and effectively informs my patient and me that a higher power snooped into our private medical record, judged our treatment plan, and overruled it.
The insurance company tells us they have a medical director who will decide the “medical necessity” of what a doctor prescribes for a patient. The insurance company proclaims it has “put a process in place to send all information about the service to a clinical reviewer with appropriate credentials.” Based on this reviewer’s opinion, the insurance company will decide whether to deny or cover the medication. Wow.
Who are these clinical reviewers, and what qualifies them to pry into our personal medical records and decide what treatment will be covered? The private medical record has been hijacked and is being used as a means to deny care. Denial of patient care decreases expenses and increases profit for the insurance companies. Such perverse incentive is characteristic of intentionally tortuous Obamacare policy and works to impede actual patient care against the best interests of patients.
This particular clinical reviewer concluded I, the doctor, did not provide enough information to approve the request to cover the medication. (Since when did writing a prescription for a patient transform into a “request” to an insurance company?) The letter further states “documentation includes, but is not limited to; chart notes or prescription claims records or receipts.” In this case, the insurance company requires documentation including sending them actual receipts proving that the patient has purchased and tried two particular over the counter medications first.
In order to increase their bottom line, the insurance company places undue financial and physical burden on the patient and the over-stressed medical system as a whole. The patient is required to come out of pocket to purchase two additional medications and return for two additional examinations in the physician’s office to document that the medications do not work. This information, including actual receipts and personal medical information, must then be resubmitted to the company for consideration by their clinical reviewer. This is unbelievably inefficient and irrational. More patients end up being hurt as the waiting time for access to physicians is lengthened because of these burdensome insurance company requirements. If the patient is elderly, relatives may have to miss work to provide transportation to the physician’s office, further stressing our economic productivity.
This is the most appalling part of the letter: “This decision doesn’t mean that you can’t or shouldn’t receive this medication. Only you and your health care provider can decide whether you need it. But, this decision means that if you do receive the medication, it won’t be covered by your plan.”
So here we are, fundamentally transformed. The United States government forces its subjects to buy a healthcare product from its “qualified” companies. The qualified companies receive money from the government and its subjects. The government in collusion with its “qualified” companies thus determines what treatment will be covered and what won’t. Our government and its chosen insurance companies are now effectively practicing medicine without a license. They now have total control over our very lives. We must pay; they don’t have to provide. How does this help patients?
Insurance companies can’t lose as long as they do what our overbearing government says. We are forced to buy their increasingly expensive, restrictive product. They profit by denying our care. They get government bailouts if needed.
Not so for patients…
The premiums, deductibles, and fines set forth in Obamacare are so onerous and redistributive that only the very wealthy or politically connected will have money or favor to obtain the medical care they need and want. After “getting covered”, most Americans will have no money left to purchase what insurance companies refuse to cover.
Yes, we were five days away from fundamental transformation on Halloween 2008, and we are now beginning to experience the real life horrors of what is proving to be transformative, two-tiered, tyrannical Obamacare.
Obama publically admitted his intentions to Jane Sturm, an elderly patient’s daughter, at a 2009 town hall meeting: “We will let doctors know, and your mom know, that you know what, maybe this isn’t gonna help. Maybe it’s better not to have the surgery but to take the pain killer.” Now we know more, they’ll not only decide whether we can have the surgery, but whether we can even have the medication.
Patients with money or political clout can make their own medical decisions; the rest of us are left to the discretion of insurance company reviewers and partisan political hacks. Obamacare, the manifesto for fundamental change, must be repealed in full. Our elected officials must be held accountable.