Over the last few weeks, I have seen many dissatisfied consumers of the new health insurance exchanges. Patients were promised that they would be able to keep their own doctors. Yet, many were unexpectantly dropped from their health insurance plans. In order to avoid tax penalties, they enrolled under new plans. I have seen several new patients transferring from their previous physicians because their earlier doctors were not enrolled in their new plan. Similar to patients being suddenly left without coverage, doctors were notified that they were no longer in network. Some of these patients had been with their prior doctor for a decade or longer. The doctor- patient relationship is not a bond that can be fostered overnight. In addition to the cost of their insurance premium, there is an emotional one as well.
Another concerning phenomena I am seeing is that patients are being denied their medications that they have been taking for years. They go to pick it up at the pharmacy and are informed that their medication is no longer covered and they either have to pay out-of-pocket or change to a different one. I recently had an asthmatic come quite wheezing because it took her a week going back and forth with her insurance to cover her inhaler. She had been on others in the past which had failed. And it is increasingly difficult to reach a live person at the insurance company by telephone to request an urgent authorization.
We hear much in the news about how patients should be empowered consumers. And that is because many of them are now footing a large part of healthcare costs. Many are feeling forced to pay premiums which they may not necessarily easily afford. And then they are hit with huge deductibles. I am finding many patients don’t want to come just because of the burden of the large deductible. After paying out their premiums, they don’t have much left over to pay yet more for another deductible. I have seen a patient put off their own medical care because they couldn’t afford the deductible for both themselves and their child.
While some of the goals of the ACA may be good, such as eliminating the pre-existing clause exclusions from insurance coverage and getting the uninsured covered, its roll-out has placed a heavy burden on some. Those who already qualify for Medicaid can still sign up for Medicaid plans. They have not been asked to pay anything so are not being asked to step up to foot the bill. The main squeeze is being placed on the middle class. These are the same who have already been heavily affected by economic forces over the last several years. A system truly needs to be set in place that works for them and not adding to their strain.
It is time to re-evaluate whether this is the solution to the perceived healthcare crisis in this country. When only a certain class of people are being the most heavily laden, the solution is not a fair one. A true solution would not be one that exacerbates the already developing physician shortage making access more difficult for sick patients. It would not mandate which doctors a patient is free to receive care from or even which medication they should be taking, based on cost. A real solution would focus on quality healthcare and open access with free choices for all its members. Perhaps the time has come to explore other areas of the healthcare system that may be in need of repair.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
