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'Coverage' but not care

by G Keith Smith, MD

An uninsured patient scheduled for surgery just cancelled her procedure today because after all she "will be able to get insurance after the first of the year and then the insurance will pay for her surgery." Let's break this down.

First, she is assuming that she can navigate the "exchanges." This is not necessarily a valid assumption as many of you now know. I believe that the failure of the exchanges splashed all over the news was not unintentional, as this merely represents phase one of the planned failure of this entire program. TUCA (The Unaffordable Care Act) was written to fail, as I have written before, the plan being that its failure will allow Uncle Sam to usher in the sequel, single payer.

Even if this patient could manage to gain "coverage" through the "exchange" she would have just that: coverage, but likely no care. You see, TUCA will bring to a new low the phrase "abusive carrier." This is how physicians refer to insurance companies who after collecting premiums, do everything imaginable (and unimaginable) to avoid paying claims. This can be accomplished by requiring the physician to jump through so many hoops that few doctors will see patients with a certain brand of "coverage."

Let's say that your doctor thinks you need sinus surgery for chronic sinusitis. In order for your insurance to consider paying for this, you must have a CT scan of your sinuses. In order for you to get a CT scan (one your insurance will pay for), your doctor must obtain prior authorisation. After multiple phone calls and an hour on hold to obtain authorisation your doctor gives up. No CT scan means no sinus surgery. I am not making this up. This is often how it works.

Let's say your doctor has the pre-authorisation denial scam figured out and manages to get your sinus CT scan "approved." The CT scan confirms what your doctor already knew, that you indeed need sinus surgery. After performing this procedure, the physician is paid $325 for his/her trouble. Needless to say, this reimbursement will move patients with this "coverage" to the back of the line. Physicians respond to this by telling their scheduler, " . . . no more than one slot in my clinic schedule per week for folks who have 'XYZ insurance.'" This is how long lines begin.

Back to our cancelled patient. While we doctors frequently hear patients say that they are going to delay their surgery until they go on Medicare, "so that it will be free," we are actually seeing the opposite with TUCA. Hoards of uninsured patients are wanting their surgery done prior to the full implementation of this "law." TUCA has inspired more fear, it would appear, than relief. I wonder sometimes if deep down, most people know that TUCA is a disaster (one designed that way intentionally), and are desperate to have tests or procedures performed that have otherwise been delayed.

Failure, phase 2, is not far behind the rough roll-out of the "exchanges." Rather than create a black eye for TUCA, this is, I believe, all proceeding according to plan. So who will be the "fall guy?" It will be the very existence of any semblance of private medical care at all. The problem won't be TUCA. The problem will be that TUCA can't work properly as long as private medicine is also available. Just think how much more successful the Post Office would be if FedEx, UPS and email were outlawed.

As time goes by, I think it will become more and more apparent that the goal of the tyrants will be to save this government program, rather than to deal with concerns about the cost and delivery of health care. Those of us who have embraced the power and reality of the free market in the health care industry will continue in the meantime to provide the highest quality healthcare at affordable prices. Nothing else can better reveal the intent of the TUCA tyrants and their cronies.

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Resources

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