08 July 2011

The Doctor Is, Out.

At least, the doctor we want. If Americans think ObamaCare will return us to the neighborhood family doctor, they are sadly mistaken.

I remember well as a child going to Dr. Webb in New Orleans. He had been my mom's doctor as well when she was younger, and he knew my dad. He knew us all personally, and treated us as such. We were, in the best sense of the word, his "patients". When I had bad bouts of bronchitis Dr. Webb would be at the emergency room at 2am. On several occasions he made house calls. My parents had major medical insurance, but the thought never crossed our mind to have someone else pay for the routine stuff. He preformed a service, and my folks paid him. We had the same relationship with our dentist, our eye doctor, etc., etc.

Now fast forward to 1988, and I was introduced to something called Harvard Community Health Plan (then HCHP, now Harvard/Pilgrim), a "community based" HMO. In it, I was assigned (no choice) to a clinic (in Watertown, MA), and I was told I could choose any doctor "accepting patients". Only two out of the 40 or so there were accepting. When you went to the clinic the wait was hours, not minutes, even with an appointment. Because it only "cost" a $5 copay people jammed the place unannounced for any minor malady. The doctor never knew me as anything other than a folder and a number - there was never any personal relationship. I remember bringing Dr. Webb a gift at Christmas (a bottle of scotch IIRC) and we'd chat about sports, Scouts, good eating habits and the like, and I remember him coming over to the house one Thanksgiving. My "primary care" doctor at HCHP didn't even recognize me in the grocery - "I'm sorry, I see SO many people", he excused.

HCHP was indeed cheap, but it was made that way by mass-production and a purposeful lack of relationship. Since those of us in it had little (if any) skin in the game, controlling cost through volume and "gate-keeping" were SOP. HCHP appeared to have little reason to develop personal relationships, because I wasn't anyone's "patient". The relationship we did have was apparently that of a wigit on an assembly line. You will fit here. You will go when we tell you, where we tell you. We will regulate you. We know better. Oh, and to hell with a second opinion.

When my daughter was born we were assigned a birth hospital, my wife was assigned an OB, etc., etc. Yes, we paid only a couple hundred bucks and lucked out with a great OB, but we had no, absolutely no, say in any decision affecting us. HCHP made the calls in the name of "controlling costs". And when my friend Hugh and I blew up a box of surgical gloves like balloons and taped them to my wife's bed, a nurse reamed us out for being "wasteful", and said we were helping to "drive up the cost of health care".

Harvard / Pilgrim is one of the programs Obama and pals hold up as an example of how they think "health care" should be "delivered". After dealing with that I prefer the old way. And write my own check, thank you.

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