The myth of choosing your own doctor
One of the anti- universal health care tropes is that “you wouldn’t get to choose your doctor” under single-payer medicine. Presumably this means you DO get to choose your doctor under the private insurance schemes that we Freedom-loving Americans favor. My estimation is that “doctor choice” is probably limited under any system.
Health-care events sometimes span years. I had an accident a few years ago and fortunately my health insurance covered most of it except the four broken teeth, which they excluded as “dentistry”, and which was excluded as “reconstructive” dentistry by my dental plan. So I paid for most of those crowns myself.
One of the teeth in my upper jaw had cracked lengthwise – perhaps – or maybe the root canal made it brittle over time but in any case it eventually became a conduit for an upper-jaw infection. And I didn’t feel that infection because one of the first things the infection did, apparently, was destroy the relevant nerve. Maybe there were a few days of toothache; I don’t remember. Sinus infections give me toothaches too so it’s possible I missed it.
Anyway, there was this painless infection chewing away at my upper jaw. It was so high up in the jaw that it didn’t quite register on routine dental x-rays. By the time we could detect it, enough bone had been destroyed to make the adjacent teeth wobbly.
My dentist referred me to an oral and maxillofacial surgeon, who took one look at my new x-rays and said; “Nuh-Uh!” and sent me to the only guy in town who would tackle it. And somewhere in all that referring and bouncing back between the fussy definition of “dental” and non-dental, I slipped “out-of-network” unawares. (Your choice of doctor, you see, is very much tied to your insurance network. One wonders if a continent-spanning single-payer network might not, in fact, result in more choice.)
Finally the big day came, and they took out one of my front teeth, excavated “about twice as much bone as we expected” and packed in synthetic bone matrix in hopes my osteoblasts would know to move in and make a foundation for the remaining teeth, and someday hopefully, a titanium anchor.
The dental insurance company doesn’t want to pay for the anesthesia; apparently Andrew Jackson or somebody would just have taken a few hits of whiskey and said “Do it!” And today my health insurance company flatly denied my claim on the rest of the charges. So it’s all on me.
I’m incredibly fortunate to have a job and some money saved up. In spite of these bills I should still be able to replace the leaky roof on my house this year. Not everyone is so lucky.
Your health insurance company, if you are so lucky as to have one, doesn’t have a “Whatever happens, make sure you receive care” ethic. They want your monthly payment, but denying (your) claim is what they call “containing costs”. They have entire departments full of people who do nothing but try to deny care. If they can pin it on Workman’s Comp, or another insurance company, or if there’s somebody who can be sued (your task, if so), or if they can re-define it as being some part of your body they don’t cover, or if the medicine that worked for you seems just a bit too luxurious to them, it will pretty up their annual report. But it certainly won’t improve your annual report.
The result is that every doctor you know must employ an entire staff of qualified people who do nothing but navigate that minefield in hopes of getting paid. They don’t want to (but will if they have to) send collection companies after you.
And that’s just for people who have insurance. If I lost my insurance – for instance if I lost my job – no company would touch me. I’d be totally screwed. I wouldn’t get to “choose” any doctor.
Somehow this bureaucratic death-match is supposed to be more efficient than single-payer – and deliver better care in the bargain. But it doesn’t. We spend WAY more per person on health care but we get worse results from it. I would just dearly love to tell members of Congress that we won’t give them government health insurance, but we’ll give them an allowance to go buy it for themselves on their precious free market – if they can. Since the majority are older males, many of them would be in for a rude surprise. It might not change their minds, but it would make a damn good reality TV show.
- I do wish someone would explain to me why teeth are not considered part of your body for health purposes. The connection between periodontal disease and heart disease, for example, is well-known. The same bugs that live in the ligature space between teeth and jaw are just as happy munching on a heart valve or starting an arterial plaque collection. Given the cost of a heart attack, you’d think health insurance companies would be more proactive about dental health. Maybe they think adding “See your dentist twice a year” in their newsletter is being proactive.
- Your eyes are not part of your body either, apparently. Except my eye doctor does a number of general health screening tests when he looks at my retina. It’s very complicated, I guess we can’t be expected to understand.
- Although I dislike pain as much as the next person, I’m not a wimp when it comes to most dental care. I had all four wisdom teeth out using local anesthesia, and one of them needed to be split with a chisel and taken out in pieces. Afterward, I drove myself home. But I had major abdominal surgery just eighteen months ago. It was quite traumatic and as a result I went into this procedure suffering extreme anxiety. Being knocked out for this recent procedure meant the surgeon could take his time and be methodical. In removing infected bone, it’s important to be thorough.
- An entirely separate issue is whether “doctor choice” is as critical as we think. Beyond avoiding the obviously incompetent, it might not matter all that much. Do you need Marcus Welby to tell you to eat better food, exercise and lose weight? And in the more specific cases like the one detailed here, any competent doctor will refer you to one who can handle the case.