If you have insurance, you've probably had this experience. Your doctor recommends a course of treatment and a claims adjustor denies the coverage. Maybe you fought the battle and won, maybe the doctor fought it for you, or maybe you did without and suffered the consequences.
The I-Team invited five local doctors, Dr. Richard Chudacoff, Dr. Carl Heard, Dr. Joe Hardy, Dr. Beverly Neyland and Dr. Frank Memec, to share a physician's perspective of the overhaul debate.
The five physicians say they see patients everyday who they cannot give the care they think they should have.
"It's gotten worse with the recent economy as well. Multiple patients who've had surgeries scheduled either lost their jobs or they just simply can't afford the deductible to pay the hospital bill," said Dr. Richard Chudacoff, gynecologist.
The physicians identify health insurance as the dividing line between the haves and the have nots. Recent estimates put the number of uninsured Nevadans at around 400,000.
"What we're doing is we're rationing immediate, upfront, cost effective interventions early in a chronic disease process, waiting until they deteriorate to the point of an emergency room visit, spend $8,000 in the emergency room and end up saying, ‘Hey, what's the matter? Our costs are out of control," said Dr. Carl Heard with Nevada Health Centers.
A recent review by the Kaiser Commission on Medicaid and the Uninsured determined taxpayers fund the bulk of nearly $56 billion per year in uncompensated care, much of it in hospitals.
Health care reform supporters contend universal coverage may reduce that expense long term by enhancing preventive care and increasing early diagnoses. Critics doubt any savings will cover the costs.
"It's a math equation. You're going to lower costs and increase access and you're going to do it at the same costs or the same fees and people in America know that doesn't work. So you're going to have to figure out how you're going to pay for increased access to care for more people," said Dr. Joe Hardy, family practice.
Though it's too early to pinpoint a final plan or its financing, all four reform proposals currently in Congress consider expanding access through government funded insurance programs, also known as the public option.
"I think it's the only way in which insurance companies will have any competition and it's the only way in which insurance companies will start to decrease their premiums and look at other ways of trying to be more cost efficient when they're competing against the government as a payer," said Dr. Frank Nemec, gastroenterologist.
The doctors insist reform must include regulation of the private insurance industry. Among the top issues: Coverage for those with pre-existing conditions, health insurance portability, and a prioritization of patient care over profits. "When I make a decision on something that I want done for my patient, I have to get prior authorization. I'm talking to someone who doesn't have a clue as to what I'm talking about and they're making the decision for me," said Dr. Barbara Neyland, pediatrician.
"I don't think the insurance companies are the problem, I think they are just given the wrong rules in which to work. They're being paid to manage costs and they need to be paid to manage care," said Dr. Heard.
And then there are those who think we should get rid of the insurance companies all together. Dr. Chudacoff advocates a health savings account where patients are responsible for their healthcare dollars and pay their physicians directly, thus removing the middleman.
Wednesday night we'll examine health care reform and how electronic records may improve the quality of care.
