Commentary on Managed Care
(licensed vs non-licensed de facto practice of medicine)



"Managed care is a social experiment involuntarily imposed upon a group of non-consenting subjects... the physician and his patient." Anon.

Saturday, January 7, 2006

Commentary by
Roger S Case, MD

(Health Officer, Island County & Commissioner, Whidbey General Hospital)


This is the sixth in a series of commentaries addressing the subject of the funding of (y)our medical care, and what we as wage earners (and businesses) can and must do to regain control of his/her/our healthcare dollar.

Friday, 18 April 1997

  Saturday, 26 April 1997

Saturday, 11 April 1998

Friday, February 15, 2002

Friday, 11 July 2003

Saturday, 7 January 2006

Friday, 10 November 2006

Sunday, 18 March 2007

Wednesday, 13 February 2008

Wednesday, 30 April 2008

Tuesday, 30 December 2008
Monday, 29 June 2009
Sunday, 16 August 2009

Monday, 26 April 2010

Monday, 15 November 2010
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I encourage readers to review my previous article written on this topic almost 3 years ago, 5th in a series that began in 1997 to bring to the attention of those interested in the growing dilemma of health insurance and access to care. It will provide the basis for this article, which will spell out what will be happening in health care over the coming years ...it is inevitable.

I reiterate, each person has a right to know everything about their managed care plan, and they can, with their physician’s counsel, select that program which best serves their needs. It is incumbent upon each person to inform him or herself — to learn all that they can about this very important factor in their life — and to select their medical insurance very carefully… very wisely.  This applies even more emphatically to those of us receiving Medicare benefits.

First, understand this: Insurance carriers are nothing more than a transfer agent for funds from your premium payments to those providing services to you — with a significant amount removed for their doing so (administrative overhead). While this may be convenient for you, it is an exceptionally inefficient (expensive) way of obtaining an increasingly difficult-to-obtain range of services from a rapidly diminishing pool of privately practicing physicians.

Why do the two most important individuals in any patient-physician relationship find themselves without a voice in this 'contract' for services? Because both parties have abdicated their roles in this fundamental of business negotiations. I'm speaking of you and your physician provider.

The time is already here where practitioners are considering no longer accepting insurance plans, demanding instead direct payment from the patient. Medicare and Medicaid recipients will increasingly find the only services available to them will be from the community clinics and emergency rooms, where they cannot be refused care. I am certain this will happen locally over the next several months.

Let me quote a physician in a nearby private practice:

"I am working a good deal in private practices now in a number of different settings, and am considering joining such a practice 4 days a week." 

"Right now the best doctors are barely making a living. The ones that practice to the present high standard of quality,  not rushing folks through, and who do all the preventive work and paper work that needs to be done ...and see Medicare and Medicaid patients ...make about the same salary as a school teacher but have a great deal  more liability and stress and went to school for even longer than the teachers."

"One practice that I work in has had a whole string of new graduates that in fact can't afford to stay in private medicine because they simply can't make enough money to pay off the student loans, buy into the practice and put food on the table. Really. Our system is totally broken and as the Medicare and Medicaid reimbursements fall in the next few years, no one is going to be able to afford to provide care to that population except the Federally Qualified Health Care centers that get dramatically higher reimbursements for these same patients."

"We are very quickly headed to a two tier health care system. More accurately, we are taking the blinders off and seeing the two “tears’ that have been there for years, but now the ‘underinsured’ are going to be a large number of folks and they will join the already very large number of uninsured, creating a huge gap in access to care. ...."

Health insurance as it is now structured siphons off far too much for the company's stock holders, administrators and executives. Most working families would be better served to place their health premiums into a Medical Savings Account where they could make direct payment for medical services with any provider of their choice. This would, of course, require prudence in seeking medical care, and of course more effort by patients to practice preventive care in order to reduce their need for medical services and medications.

An alternative opportunity would be for area physicians to collectively offer an insurance plan for the Island's residents.  There are about 48,000 non-military residents on Whidbey Island (22,000 households), enough to make it possible to do this. With every working family participating in a local plan, they – and even those not having insurance – would all be able to see any local physician or to receive care in one of the two local community clinics. No one could be refused care. 

This would of course require cooperation among the service providers, and organization and commitment by the Island's residents. Cooperation? Organization? Commitment? I realize this is asking far too much of either party, but perhaps necessity will be the impetus for accomplishing this.

Or, we could all continue on this downwardly spiraling medical care morass euphemistically called "health care" in America. The choice is really in the hands of the premium payer — the public (you and I). What are we to do? Doing nothing is unacceptable!

Remember. It is NOT the government's responsibility to provide for the individual's health care... so do not think for one minute that will happen.

Are you prepared for the coming crisis? You really think so?

Roger S Case, MD, FAAFP, retired Family Practitioner

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