California HealthCare

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Daniel Weintraub, of the Sacramento Bee, talks about health care in his column today and notes that trend of doctors opting out of the insurance networks is continuing:

Dr. Marcy Zwelling-Aamot is sick of being told how to care for her patients. So the Los Alamitos physician - and president of the Los Angeles County Medical Society - says that as of July 1, she will no longer be working with health insurance companies.

"I am divesting myself of every insurance contract," said Zwelling-Aamot, an internist. "I can offer better care less expensively to my patients. I have a list, a waiting list, and I haven't even started advertising yet."

Zwelling-Aamot hopes she is on the leading edge of a wave of the future, which would really be a return to the past. She envisions an era when doctors and patients once again deal directly with one another, without the reams of paperwork, authorizations, second-guessing and billing nightmares that come with the current system.

All well and good, over on the previous site, we have talked about this trend before. Weintraub then brings up an unfortunate little bill standing in the way of market forces in California, SB 2.

But Zwelling-Aamot's dream of bureaucracy-free medical care is clouded by one thing: SB 2, the proposal heading for the November ballot that would require California companies with more than 50 employees to provide health insurance to their workers.

The idea sounds good at first. So good that it was enthusiastically supported by the California Medical Association, the state's largest professional physician group and the parent of Zwelling-Aamot's county medical society.

But Zwelling-Aamot and a number of prominent CMA members fear that the measure, if approved by voters this fall, will bring the downfall of quality health care in California by putting still more distance between doctors and their patients.

"The politicians say that people are uninsured and we need to cover them," Zwelling-Aamot says. "But coverage doesn't mean care."

The proposal would require any employer of more than 50 people to provide coverage or else pay a fee into a state fund that would buy insurance for their workers. Companies with more than 200 employees would also have to provide care for dependents of their workers. A government board would establish the minimum benefits required, and set the level of the fee charged to companies that cannot or will not provide coverage.

This is supposed to increase access to care for those who don't have it now. But as Zwelling-Aamot and others point out, it might not do a very good job of that and in the meantime could wreck health care for everyone who has coverage today.

"This just perpetuates a failing system," said Dr. James Knight, a San Diego urologist and president of that county's medical society. "It doesn't do anything to address the problem that we're seeing, and actually will perpetuate it. There are many physicians who believe this is very dangerous legislation."

With costs climbing fast, due in large part to an aging population and expensive new technology, many businesses will find it difficult to keep up with rising premiums, Knight believes. Instead, companies will, in increasing numbers, opt out of the system and pay the fee, shifting their workers to the government-run system.

"Employers are going to pay the fee and the government is going to buy the lowest common denominator," Knight says. "We are going to build a bureaucracy that is going to run health care for probably 80 percent of the population."

And the health care the government provides will probably look a lot like Medi-Cal, the bare-bones program that now provides care for the poor. Benefits will be limited, and patients will have a hard time finding doctors who want to be part of that system. If costs continue to climb, pressure will build on the government to cap doctors' fees. But that would only lead to still more shortages of doctors willing to participate.

"It's going to be the worst kind of insurance out there," says Dr. Thomas LaGrelius, a Torrance family care specialist and a consultant to independent doctors who are part of preferred-provider organizations. "We are going to move in the wrong direction."

Perhaps the greatest insult of all is that the proposal requires workers to pay up to 20 percent of the cost of this care, which could lead many employers who pay for all or most of the insurance now to instead bill their workers at the level established by the government as the standard.

"Many people will get less insurance and they will be forced to pay more," says Zwelling-Aamot, "and they will have less control than they do now."

Weintraub kind of muddies it by making it appear that this needs to be defeated in November when it is already law. The decision in November is whether to repeal it. That makes me nervous, because it is a lot easier to just make people vote no.

Overall, I think the analysis is dead on. Eventually, companies will abandone marlet rate insurance and go to the government because it will most likely price itself cheaper. Of course, it will provide less coverage, but in the long run for medium and large size companies who alreay provide health insurance, this just another cost of doing business and takes some headaches off of their hands.

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This page contains a single entry by Bob published on May 23, 2004 6:11 PM.

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