Aaron Carroll is a pediatrician and wrote an article in the NY Times called Trapped in the System: A Sick Doctor’s Story. He tells a tale of how much work it is to get his ulcerative colitis medicine. Let’s use his testimonial to see if my CatastrophicCare plan would work.
- He mentions poor access. (If he had a Direct Primary Care doctor like me then this would not be an issue)
- The medicine is old and it’s generic. It costs about $80 for three months even though I haven’t met my deductible. But this story isn’t about money. This is about the nightmare of how hard it is for me to get the drug. (If he just pays cash and doesn’t tell his insurance then he could get his medicine easier).
- Every three months, I run out of my medication. In order to get more, I need a new prescription. In order to get the prescription, I need to have lab testing to prove to my doctor that I don’t have anemia. (Once again, without insurance involvement and a DPC doc onboard, he is all set).
- Let’s start with the lab testing. At various times, my insurance plan (which is excellent, by the way) changes which laboratory facilities it will cover fully. Often, these are not labs that are housed in the huge health care system for which I work. I often have to go elsewhere to have my blood drawn. If I change facilities, I have to get a new prescription for the labs, since they can’t share with one another. (A CBC for my patients is $10. End of sob story.)
- Further, even though my lab orders are good for a year — and I need to have them drawn basically forever — the labs recognize them for only six months. So sometimes I have to get in touch with my doctor and get a new lab order. (This takes an email to get set up the next day in my office)
- But because the laboratory and my doctor are in completely different health care systems, the lab results won’t show up in my doctor’s electronic database. I have to beg the lab to remember to fax over the results — using paper — which it often fails to do. (I get the results the next day and tell the patient)
- My next step is to check if the pharmacy I use is still under contract with my insurance plan. The medication I use needs to be ordered at a mail-order pharmacy, because my insurance won’t cover it at a local facility. My insurance plan has changed its mail-order pharmacy of choice more than once in the last few years, which necessitates that I inform my physician about the change. (Pay cash and all of this is irrelevant)
- It’s at this point that I try to get in touch with my doctor, previously through a phone message, and more recently through an online site. If I’m lucky, which usually isn’t the case, the doctor will already have the lab results. If not, I have to go back to the lab and beg it again to fax over the results. If the doctor has the lab results, and they’re normal (they always are), a nurse will then call in the prescription. This usually takes a few days. (I only have 600 patients. This scenario does not happen)
Can you see how the insurance company gets in the way? This author’s physician sees too many patients. It doesn’t have to be that way but since he bills insurance companies it changes the equation. That is why he is hard to get in touch with. Once the insurer is removed, he can do DPC and real patient engagement occurs. Once the insurer is removed, cash becomes king and prices come down. Bureaucratic red tape is also removed and these articles do not get written.
Let’s replace Obamacare with CatastrophicCare.