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OPINION
Letters to the Editor - July 3, 2000.
The uninsured? There aren't enough of them - Proposed legislation would provide defibrillators for rural areas - Complex forces cause IPA failures - A threat to get the state involved helps in getting claims paid
The uninsured? There aren't enough of them
I keep hearing about the uninsured. It seems as if every day there is a new story, another editorial, another cry of despair about "the uninsured," as if these 44 million were a plague of locusts visited upon this nation and the health care community. Even more amazing to me, many of these seemingly heartfelt cries of woe come from physicians themselves.
It seems to me that somewhere along the line a serious error in logic has been made. Health insurance is somehow equated with medical care. Nothing could be farther from the truth. Health insurance is not care -- it is a voluntary method for distributing financial risk. No health insurance policy ever diagnosed or treated anything. Health professionals do that.
I would like to say that I don't care how many uninsured there are, but I can't. I wish there were more. I have a primary care practice with a number of uninsured patients. They pay full price, in cash, in a timely manner, and are extremely grateful for the quality of care and high level of customer service we provide.
We don't have to waste time and effort coding, on the phone for pre-cert, verifying benefits, peering over explanations of benefits, or defending ourselves to patients after being demonized to them by the insurers for exceeding "reasonable and customary." They pay for both inpatient and outpatient services without complaint. Furthermore, they never have that annoying sense of entitlement so pervasive elsewhere in the health care marketplace. In short, they are my very best customers. Why would I want fewer of them?
From their perspective, they receive top-notch customer service from our office. They don't have to navigate phone trees, they can have walk-in visits, and can reach me personally by phone with any concerns, 24/7.
For those who feel medical services are unaffordable without insurance, I might suggest that this says more about the inflated prices of specialized procedures than the health care system as a whole. However, I heartily endorse "major medical" policies with or without a combined medical savings account to reduce the risk of catastrophic financial loss in case of severe health problems that could require prolonged hospitalization or expensive interventions. Remember, it wasn't that long ago that such policies were the norm, and they make great sense. Current first-dollar coverage including routine care is like an auto insurance policy that includes oil changes or a homeowner's policy that covers cleaning the gutters.
So before bemoaning the "uninsured," give it a little thought. Most of the true plagues visited upon the medical community were called down by insurers, and an uninsured patient base on a cash basis sounds a lot like the promised land to this primary care physician.
Proposed legislation would provide defibrillators for rural areas
I was pleased to see the article "Defibrillators increasingly available -- and being used" (AMNews, May 15), which describes the life-saving benefits of increasing access to defibrillators.
Every two minutes, someone in the United States falls into sudden cardiac arrest. Cardiac arrest victims are in a race against time; the sooner the emergency medical services team arrives, the better the victim's chance of survival.
In rural areas, however, it's much tougher for even the most outstanding EMS teams to reach a victim in a short response time.
But there is a simple, effective way to improve the chances for victims of cardiac arrest in rural areas. We can increase access to defibrillators, which play a key role in the "chain of survival" for cardiac arrest victims. In fact, the American Heart Assn. estimates that more than 50,000 lives could be saved each year if automated external defibrillators were more easily accessible.
Fortunately, because of recent advancements in AED technology, it is now practical to train and equip fire department personnel, police officers and other community organizations -- and that's exactly what my new legislation would do.
I have introduced the Rural Access to Emergency Devices Act to provide rural communities with the defibrillators they need to help save lives.
My legislation works to strengthen the chain of survival by providing $25 million to expand access to AEDs, and providing for grants to give people the training they need to learn how to operate defibrillators.
I hope my legislation's simple, common-sense approach can give rural communities the training and equipment they need to give rural victims of cardiac arrest a fighting chance at survival.
Complex forces cause IPA failures
Regarding "The irony of IPAs" (AMNews, June 19): As an attorney who has assisted independent practice associations in the development of the organizational model and in implementing risk and nonrisk contracting, I am concerned that the burden of failure is almost always placed on the physicians themselves.
Physicians naturally are interested in making a living, and too often IPAs are sold by "consultants" (some who actually are working for payers) in various capacities as the next holy grail. Physicians are a captive audience for people who are not, in the end, required to bear the risk of strategic failure.
Moreover, IPAs eventually, as shown by the California experience, become averse to their own members. In order to capture market share, the IPA absorbs the revenue without worrying about the individual practice expenses.
Medicine is a profession and it is not appropriate for physicians to blame one another for the failure of IPAs. Rather, it is important to appreciate the complexity of market forces at work.
A threat to get the state involved helps in getting claims paid
Regarding "Regulators cracking down on late payments of claims" (AMNews, April 17): I have been working as an accounts manager for 23 years, and your article on late payments really hit close to my office. Sometimes you feel that delays of claims are unique to your own specialty. I have found that recent second and third inquiries to claims with the statement, "If claim is not paid within 30 days of this follow-up, it will be forwarded to the Insurance Commissioner's Office for review," is getting a response.
It's encouraging to know that something is being done to make the insurance carrier pay for services rendered. Isn't that the way it's supposed to work anyway?
