When We Talk About Health Care, We're Forgetting One Important Group: The Already Insured

Continued from previous page

When a doctor has time to spend with a patient, a more trusting and caretaking relationship can develop. Patients feel understood. Doctors learn about patients' real lives and social context, which enable them to tailor their treatment to the idiosyncratic needs of the three-dimensional people under their care. It is axiomatic that when someone who is sick feels understood, he or she feels better, more engaged and more likely to take care of him or herself.

These issues are exaggerated among people who have no or limited access to care. But there isn't a person I know who has medical insurance who doesn't have a story about neglect or mistreatment at the hands of the medical system, who doesn't share the frustration of not being able to get through to the doctor or of the latter being unresponsive to his or her needs.

Recently, a family member asked me for help with her 17-year-old daughter, who had been suffering from intense back pain for two months. This girl eventually saw her primary physician at a local HMO, who told her that only the physiatrist in charge of physical medicine (including physical therapy) could order an MRI.

When she went to the PT department, she was told that she first had to have physical therapy for four to six sessions before the physiatrist would see her and, if necessary, order an MRI. My friend raised hell and got the physiatrist to order an MRI before physical therapy began, although it took 10 days to schedule. She was then told that it would be another 10 days before she could meet with the physiatrist, who would read the MRI, evaluate her daughter, and recommend treatment.

I intervened and took the daughter and her MRI to a neurosurgeon I knew at a nearby university hospital who saw immediately that there was severe disk disease and that surgery was imperative. He called the chief of neurosurgery at the HMO, who saw the patient the next day and operated on her -- successfully -- two days after that.

Obviously, without the help of someone like me who could pull strings (in another bureaucratic medical system), this girl would have suffered the fate of many other Kaiser patients who spend untold days and weeks in needless suffering because their medical system doesn't relate to them as real people in real need.

I'm sure that there are many patients at this HMO who have found their care to be adequate or even good. We all tend to accept what "is" as the way it's "supposed to be." When the rudiments of medical care are delivered adequately, and we're helped to feel better, we don't naturally judge the process critically. The problem, of course, is that we haven't experienced any alternative and when we do, the problems of the original system become immediately apparent.

Everyone has stories of going to see a specialist or an internist who spent a lot of time with them and, to a person, they leave with an enthusiastic, even ecstatic, view of how great the doctor was -- simply because of the time, interest and sense of personal commitment they experienced. Too many of the stories, unfortunately, are of the opposite.

We all have stories like this. "We" includes folks with insurance, even with decent insurance. Unfortunately, most progressive demands for universal coverage include little obvious direct benefit for us.

Yes, we occasionally hear about demands to reduce waiting times, and slogans like "quality care" might be interpreted to include concerns about time spent with providers. But, in general, all sides of this debate focus primarily on access, availability and affordability. They avoid the "soft side" of the issue primarily because of the implicit assumption that some care, even indifferent care, is better than none, and we have to start with the basics.