San Diego — As we approach the November election, one issue continues to be ignored by candidates for public office: the ongoing crisis in providing adequate healthcare to Americans. The ability of physicians to treat patients with catastrophic ailments is hampered. You may be thinking: What? Hasn’t the Affordable Care Act been the biggest issue of the past seven years? Hasn’t its passage and implementation solved everything?
Well, no. Obamacare is still a work in progress. And the average citizen who uses it, or traditional insurance, should be aware of the deficiencies of today’s healthcare system when faced with the need for immediate surgery.
In my career as a reconstructive plastic surgeon, I’ve witnessed many cases in which a patient’s important needs go untreated. But today’s insurance environment is disillusioning. I’m not talking about a patient who wants something elective, such as a tummy tuck, a breast enlargement or a face lift. Insurance companies and ACA cooperatives are denying coverage for immediately necessary surgeries, or underpaying the expenses incurred by doctors performing medical treatment. Many doctors I know are rethinking their careers.
In the last fifteen years, I’ve done a great deal of philanthropic work for patients in serious need in the U.S. and abroad. A surgeon colleague and I devote much time to serving the poor. Now, insurance companies and cooperatives formed as a result of the Affordable Care Act seem to expect me to provide pro bono services for the insured. This leads to less choice for patients who need help — and it’s dangerous.
In southern California, where I’ve practiced since the late 1990s, there are plenty of needy patients whose chances of getting good care for reconstructive procedures is no better than that of people in the third world. Our American medical system has deteriorated, and we face the prospect of becoming one of those underserved nations in Asia. Doctors remain competent, but we are constantly beholden to uncaring insurance and cooperative managers whose only interest is in preserving their job or the bureaucracy itself.
Recently, I saw a patient insured by Covered California, the Obamacare cooperative here. The woman had a melanoma on her cheek that was large enough to give her a death sentence if it remained untreated. I conveyed my opinion to the patient and her family, and suggested she consult an oncologist, get a PET Scan, and that I would perform surgery as soon as possible. I modified my schedule to be able to do this urgent surgery.
Two days later, I checked with my staff assistant responsible for coordinating surgeries with insurers. Bureaucracy had thrown a monkey wrench into the woman’s fate: The nurse manager at Covered California had told my assistant that the exchange would cover the cost of my patient’s surgery only if it was done at a hospital where I did not have medical privileges. I wanted to remove the melanoma at the hospital where I have long enjoyed privileges. (I couldn’t simply remove the cancerous growth in my office.) The medical director supervising the nurse manager wouldn’t allow me to proceed unless I used the other hospital’s facilities. It would take time to get privileges at the other hospital. As I realized my patient’s fate was in the hands of insensitive numbers-crunchers, I found a surgeon who used the other hospital and he proceeded to remove the woman’s melanoma there. She survived. But it was a close call.
The crisis is nationwide. Dr. Jeffrey Oppenheim is a board-certified neurosurgeon in New York. He describes the problem with the ACA: “The great fallacy of Obamacare is pretending that we made progress simply by reducing the percentage of Americans without health insurance,” Oppenheim says. “Because Obamacare plans have higher deductibles and insufficient networks of doctors and hospitals, people we thought we were helping are no better off. Worse yet, millions of people who had better insurance have been forced into these low quality plans. In my practice, I routinely get calls from patients who had high quality insurance who are now covered under ACA and are horrified when they find out they’re no longer entitled to the care they used to receive. A major Obamacare insurer here in New York, Health Republic, just went bankrupt.”
Oppenheim describes the incredible hassles he experienced in performing spinal surgery on an amateur athlete, who was covered by a New York healthcare exchange, and who was in danger of permanent paralysis: “I did emergency surgery on a weekend and saved him from becoming paraplegic. Then, we were refused reimbursement.” Oppenheim, who has practiced neurosurgery for twenty-two years, didn’t think twice before doing the surgery. And he’s not complaining. But he was forced to cover the expenses related to his patient’s emergency treatment — forgetting the entire weekend he spent with staff putting the man’s spine back together. In Oppenheim’s opinion, “Obamacare is like bread in the old Soviet Union. Officials boasted that bread was only one ruble, but there was no bread in the stores.”
Now, I’ve had challenging experiences with insurers before ACA. Once, a patient of mine whose arm was nearly dismembered in an accident needed emergency reconstructive surgery. I went ahead and did it — the man was on the operating room table. But after his insurance company declined payment, I went on local TV to call out the parties denying coverage. The company fessed up and paid, thanks to the reach of San Diego’s news station. However, with today’s cooperatives and insurance companies it’s different. Not even a local news segment can embarrass them anymore.
Munish K. Batra is a board-certified reconstructive surgeon who practices in San Diego, CA.Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
