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Can you really choose your own doctor?

Intelligent people differ on whether the new Affordable Health Care Act, also called “Obamacare,” is good for our country. In this posting I hope to address one of the criticisms of Obamacare, namely, that somehow the government will have a say in deciding the medical care you receive and will prevent your doctor from doing what s/he believes is in your best interest. Those same people in essence argue that private insurance somehow does not interfere with the doctor-patient relationship that currently exists.

For years, critics of universal health care programs have argued that the government will come between you and your doctor. The argument is that the government will somehow have a say in what tests the doctor can order, what medicines the doctor can prescribe, what procedures should be performed. The best way to test those claims is to examine how the how the two government-sponsored health care programs, Medicare and Medicaid, actually work.

Everyone over 65 years of age is covered by Medicare Part A which covers hospital bills. Medicare Part B, which is voluntary but which almost everyone takes, covers doctor bills. What Medicare does not do is prevent a patient from going to the doctor of his/her choice. As long as the doctor registers with Medicare, which all doctors can do, Medicare will pay for the doctor’s services. Further, Medicare does not restrict the types of tests, treatments, etc. that the doctor performs. That is between you and your doctor. Medicaid, which covers the indigent, works in a similar fashion.

There is a major problem with Medicare, however. Medicare pays doctors based on services rendered. The reimbursement rates have been going down steadily, so that doctors are receiving less than they used to. As a result, many doctors are refusing to accept new Medicare patients.

On the other hand, those of us with private health insurance often find that our insurance companies refuse to pay for prescriptions, tests and procedures ordered by our doctors. People who work for insurance companies decide whether a test or treatment is necessary. In other words, it doesn’t matter that your doctor thinks a test or procedure is necessary, it is a stranger who holds the purse strings who effectively makes the decision.

Insurance companies also restrict you to seeing certain doctors. Every insurance plan has “in-network” doctors who have contracts with the insurance company setting forth the amount that the insurance company will pay for any particular office visit, test or procedure. If your insurance plan changes, your doctor may no longer be “in-network”. In that situation, you would have to either change doctors or pay most if not all of the doctor’s bills. Unlike with Medicare, private health insurers force you to use their doctors, whether they are good or bad, whether you like them or not, and it doesn’t matter if you’ve been seeing the same doctor for 20 years whom you trust and with whom you have a great relationship.

Similarly, insurance companies limit the medications you can get. The insurance company decides if there is a cheaper medication for what ails you, and if there is they will likely refuse to pay for the drug ordered by your doctor. Once again, it is the insurance company that is making medical decisions that impact your life.

There are valid criticisms of Obamacare, but interference in the doctor-patient relationship is not one of them.