Why I Don't Like President Obama's Health Plan

Let me tell a story, a story that happened to me, to explain why I don’t like President Obama’s healthcare plan.

Most of the stories one reads about what is wrong with various health care systems, whether the stories are complaining about the system we have in the United States or the government-run system in another country, talk about horrible problems. People in the United States who have serious diseases or conditions and who cannot get treated because they do not have insurance or enough money to pay for care. People in England who can’t get certain medicines that are available in the United States because some government authority has decided that the drug is too expensive. People in Canada who come to the United States to get an operation or to see a specialist because the waiting lists are too long back home.

My story is not one of those. There is no sad ending; no terrible thing happened. In fact, I am very pleased how everything turned out. The story not only has a happy ending, but it wasn’t bad during the middle. But this may make my story more normal. It certainly shows, in my opinion, how President Obama’s health plan could affect any of us, in our every day medical care.

First, though, I will admit that the title of this post is a little misleading when it talks about why I don’t like "President Obama’s healthcare plan". I’m actually not sure if President Obama has a healthcare plan. I know he had one during the campaign, but now it seems that he is deferring to the Democrats in Congress to come up with a plan. I am not sure he cares what the details are as long as something passes. So when I talk about "President Obama’s healthcare plan," I am talking about plans being developed by Democrats in Congress. It is all we have to go on so far.

One of the complaints President Obama has about healthcare in the United States, and one of the reasons he says we have a healthcare crisis in the United States, is because we are spending too much money on healthcare. Other countries are spending much less money, we are told, and we are no healthier. (There are a lot of things that can be said about that statement, but I do not want to get sidetracked on those issues right now. I am just going to accept that this is what President Obama says and believes.)

Well, if we are spending too much on healthcare, then one of the parts of a solution to the problem must be to cut down on how much is spent. We are told, by President Obama, that our current fee-for-service system encourages over-use of medical care. If so, then part of the solution has to be a change in that system and/or in the incentives that are allegedly encouraging this over-use of medical care.

The approach of the Senate bill is to create something called a "medical home" and to provide that people would get their medical care through their "medical home." (The House bill provides for pilot programs with the same idea.) The idea is that your medical home would be your primary care doctor, and he or she would send you to a specialist when you needed to see one. It sort of sounds like the way some HMOs work.

I am familiar with HMOs because our family belonged to a HMO for over ten years. We had some really great doctors with the two different HMOs we belonged to. (In the middle of the period I changed jobs so we had to switch HMOs.) Also, there was no paperwork and few, if any, extra costs. When our daughter was born, the only cost we had to pay was something like $25 for parking. Everything else was covered, and there were no forms to fill out or anything. It was amazing.

But then a problem came up. My family has a history of glaucoma. My mother had it. Also, I am (or at least I was, before my cataract surgery) very nearsighted, which makes glaucoma a bigger risk for me. (My extreme nearsightedness was the reason I had to have cataract surgery when I was only 53 years old.)

Because of my mother’s problems with glaucoma, I always made sure to annual eye exams. With the HMO that meant that first I had to go to the eye doctor on staff at the HMO. To check my eye pressure, he would use something call a "puff test." It was quick and easy and not too accurate. (I learned the last point from accompanying my mother to some of her eye doctor’s visits.) It also did not require any expensive equipment. But after jumping through that hoop each year, I would get to go to the specialist, so it was okay. It was a waste of time, but the key was that I got to see the specialist I needed to see. Also, I started to develop a history with the specialist, which is important because, at least from I have been able to tell from eye care, trends are almost as important as where you are on any particular day.

It was important to me to see a specialist because my mother had not gone to a specialist initially. She knew about a good place to go, because my grandmother had gone there, but it was a long way from her home, so she went to one of the two ophthalmologists where she lived. The trouble was that she did not get good care. They were taking pressure readings, but they were somehow getting them wrong. The pressure in one of her eyes got so high, she wound up losing the sight in it. At that point she switched to the specialists my grandmother had gone to, and they kept her other eye working the rest of her life. It wasn’t easy, but they did it.

But back to my story. I went in for my annual eye test at the HMO, and once again they realized I needed to see a specialist. But when I got the referral, it was to a different doctor. Why, I asked. Because the HMO had switched its contract for specialist eye services to another set of doctors. I learned that the contracts that HMO had with groups of specialists would come up for renewal every year or two, and they would change who they used. Which meant my doctor changed. Instead of the specialist who had been seeing me for several years, who was beginning to know and understand my history, I had to go someplace else. And it seemed like this could happen again – and again.

Given my family history of glaucoma, I was really upset. Instead of going to the new specialist that the HMO now had a contract with, I made an appointment to see the specialist I had seen before and paid for it myself. When I went there, I learned that the pressure in my eyes was up.

That is when I realized that I could not rely on the HMO for my eye care. I did not want to go through any more of those silly "puff tests" or have my specialist change every couple of years because the HMO switched from one group of doctors to another. My eyes were too important to me, and because of my mother’s experiences, I knew which doctors I wanted to see.

So the next time I could change my health plan at work, I did. I left the HMO for a PPO (Preferred Provider Option) where I could pick the specialist I wanted to go to. The monthly premium for the PPO was higher than the HMO. Also, there were deductibles and co-pays. It was definitely going to cost me more money.* But I didn’t care. I was willing to more pay to get the medical care I wanted. I knew a little about glaucoma, and I knew a lot about the specialists who were helping my mother. There was no question that I wanted them to take care of my eyes, too.

The concern I have about what President Obama wants to do to our healthcare system is that we are going to get forced into some kind of HMO – or something very similar to it. He says that if I like my doctor and my insurance, I can keep them. But I don’t believe him. He doesn’t have a plan of his own. How does he know what is going to be in the final plan?

More importantly, if President Obama really thinks our country is spending too much money for healthcare, then he has to figure out some way to cut healthcare spending. He claims he can do that by just cutting waste. We don’t need to cut services, he says. We’ll just cut the waste, and we will all get the healthcare services we need for less money. That theory concerns me. The HMO thought they were providing me the healthcare I needed. Experts could say it was a waste of money for me to leave the HMO and then pay more money to go to the specialist I wanted to go to. I worry President Obama sees that extra money as the kind of waste he wants to cut out of our healthcare system; the kind of thing that the Democrats' new plan won't allow people to do.

I know about my eyes, and I know about good eye doctors. I want to go where I know I will get the care I want, even if some government expert thinks I am wasting money. Because spending money to protect my eyes is not a waste to me.

And that is why I am against President Obama’s health plan.

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* It also cost my employer more money, too.

Comments

[Jennie]

Good post.

love, Jennie