I received more than my usual share of feedback from this week’s Upshot column. I thought I might answer some of the most common comments and questions here:
1. If we only had a single payer system. That would fix this, right?
Well, I’m not sure. I understand your impulse, but that would only solve some of the insurance problems. Medicare for all wouldn’t make it so that the lab, pharmacy, and doctor’s office shared an information system, or could even reliably share information. It wouldn’t change the fact that I need to jump through the order hoops, or the authorization hoops. I might make things easier, but it wouldn’t solve all of the problems. Ask people who have Medicare (which is much closer to single payer) if things are seamless. I doubt you’ll get a universally positive response.
2. You’re a doctor. Why don’t you just write your own scripts and solve this?
I try very hard not to be my own physician. That often doesn’t work out so well. I worry that in cutting a corner, I might leave myself exposed not only to actual medical problems, but also ethical issues. Plus, not everyone can do this. This wasn’t a column about my problems so much as an example of many people’s problems. This solution, while available to me, is not available to all. We need to fix the system.
3. Why don’t you do [insert inventive way to cheat the system here]?
You guys are like supervillains when it comes to circumventing the issues. I was amazed by your ingenuity. You suggested I ask my doctor to order me twice a day pills when I only need one. You suggested I pretend to lose a prescription and get a new one way early to have an extra supply around. You suggested I buy extra pills from [insert country here]. You even turned me onto sites which do this online. It’s amazing.
But it misses the point. We shouldn’t have to cheat the system to get good care. It should be part of the system. I choose not to do this stuff.
4. Why don’t I just order extra meds and pay out of pocket, circumventing the insurance plan.
As many of you likely know, care is much more expensive when you pay for yourself as opposed to the negotiated rate negotiated by your insurance plan. I don’t want to pay more. In addition, while this option is fine for me, it’s not fine for everyone. I don’t think asking people to pay for what they are already entitled to from their insurance premiums is ok.
5. Why am I not angrier at the various stakeholders? There must be a bad guy.
You’ll just have to believe me that every single entity I mentioned, when spoken to, is trying to do the right thing. There is no cackling boogyman behind the curtain. This is a systems issue. You could fix any one of them (see answer 1), and the problem would likely still exist.
6. Why am I blaming the ACA? or Why aren’t I blaming the ACA?
As I said in my column, the ACA was about getting more people insurance. It wasn’t about these issues. I had all of these problems both before and after the ACA was passed. In fact, I have employer-sponsored insurance, which was relatively unaffected by the ACA. Now, you may argue that narrow networks may make some of these problems worse, but that wasn’t started by the ACA. And you can often choose to pay more to avoid a narrow network.
I don’t believe my network is narrow. I have these problems.
7. Why don’t I change doctors/insurance/labs/etc?
This was a really common plea. In fact, many people wrote to tell me about their awesome health care system (although it was more often people employed or running such systems as opposed to people using them). I think that’s great. But people don’t have complete freedom of choice. I can only choose from the insurance plans offered by my job. That limits my choices for care. And I’m relatively free in my range of choices. Most people have far fewer options.
8. What medication am I on?
I specifically did not mention the medication I’m taking, because I don’t want this to be an ad for a drug. Anyone with UC knows that a lot of this is hit or miss, when it comes to what works for each person. So working for me is no guarantee it will work for you. But if you have UC, or someone you love does, and you really want to know, tweet or email me and I’ll tell you personally.
One of the nicest things about writing this column, though, was hearing from many of you with UC who felt some sort of relief or happiness because someone was open and unashamed about some of the more unpleasant aspects of the disease. The kind and thoughtful emails you sent made me cry at times. I was blown away by tweets, emails, and comments of support. If it makes your life easier for someone else to admit that they have pooped their pants many, many, many times – well I’m your guy.