Sunday, February 1, 2015
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Health insurance is great, but when can I see a doctor?

By
From page B10 | April 12, 2014 |

As the Affordable Care Act unfolds, newscasters report statistics about the numbers of “newly insured.”

Is the figure 6 million or 7 million? How many of them had insurance previously? How many of those who attempted to sign up for insurance have paid their premiums and achieved coverage?

Conflating health care access with having insurance coverage is a bit simplistic, however. For example, years ago I learned that Zimbabwe offers universal health care to its citizens. The infrastructure, I was told, was at times lacking, but the entitlement remained a source of national pride.

Some of my colleagues who lived in the Warsaw Pact countries before the fall of communism described a similar scenario. Citizens were guaranteed health care, although access required the use of considerable ingenuity. At times, bribes may have occurred. In other words, carrying around an insurance card was not enough. Sick people also need access to primary care, specialized care, medications and treatment modalities.

One may also have access to care without an explicit health care insurance contract. For example, when I worked for a local county hospital system, I treated many patients who had “fallen between the cracks” in a formal sense. To the best of my knowledge, most of them received health care treatment, with or without insurance. I recall sending quite a few patients to the social workers who would attempt to sign them up for Medicaid.

When I worked in correctional and mental health settings in our state, health care was also routinely provided.

By contrast, I hear stories all day from working patients with health insurance who have difficulty accessing health care. In order to see a specialist, for example, it may be necessary to be referred through a primary care clinic. Getting in to see a primary care doctor may take a while. And the primary care doctor may not refer the patient to the specialist. For example, I recently examined a gentleman whose cancer diagnosis was delayed as he sought referral to a specialist. Delay of care, in some cases, may prove catastrophic.

If you are fortunate enough to score a prompt appointment, your primary care “provider” may not even be a doctor. In order to improve time management and efficiency, many physicians rely heavily on nurse practitioners or physician’s assistants. Many are quite capable, but they are not licensed doctors.

Patients with industrial injuries are often referred for industrial medical treatments, only to learn that many specialists will not accept workers’ compensation cases. The physicians are generally just fed up with the associated paperwork, hassles and poor reimbursement. Indeed, I have read that apart from workers’ compensation cases, some community physicians are limiting their participation in Medicare and Medicaid programs, as well.

Trying to telephone a physician is an exercise in frustration. For example, telephoning the Department of Veterans Affairs, which is relatively efficient, requires one to negotiate a lengthy telephone menu, typically resulting in a conversation with a clinic scheduler.

In the community, nearly every medical office routes telephone calls to a recorder, admonishing us to call 911 if we have an emergency. The traditional doctor-patient relationship, it seems, is fraying under the influence of managed care. Doctors are increasingly working as salaried employees, with little incentive to increase their patient-care workloads. Those clinging to private practice models depend on government agencies, insurance companies and third-party payers.

In this brave new world, we will have plenty of time to admire our new insurance cards, as we wait in line to see our health care “providers.”

Scott T. Anderson, M.D. (email [email protected]), is clinical professor at UC Davis Medical School. This column is informational, and does not constitute medical advice.

Scott Anderson

LEAVE A COMMENT

Discussion | 4 comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

  • patrickApril 12, 2014 - 4:11 pm

    welcome to government obama care

    Reply | Report abusive comment
  • Mr. SmithApril 12, 2014 - 4:20 pm

    Sure sounds like we are in for a rough time of it. Surprisingly, no Obamacare supporters around here have taken the good doctor on. Crickets. Applecart upset of our healthcare system, and for what? Thanks, Obama. Thanks, democrats.

    Reply | Report abusive comment
  • PornacApril 12, 2014 - 6:03 pm

    Best solution would be to limit access to care for the masses. Maybe only property owners to have access to medical care?

    Reply | Report abusive comment
  • Mr. SmithApril 12, 2014 - 7:29 pm

    Here's the point, Pornac: Very soon, hardly anyone will have adequate ACCESS to medical care. We will all have "coverage" though. It did not have to be this way.

    Reply | Report abusive comment
.

Solano News

 
Fire Department honors top firefighters

By Bill Hicks | From Page: A1, 1 Comment | Gallery

 
 
4th annual Health and Wellness Fair a big success

By Susan Hiland | From Page: A3 | Gallery

 
 
Banish dry skin this winter

By Sarah Porkka | From Page: C4, 1 Comment

 
Chocolate: A long journey to deliciousness

By Karen Metz | From Page: C4

 
County board to consider DA reorganization plan

By Kevin W. Green | From Page: A5

Eurozone offers lesson in debt

By Mark Sievers | From Page: B7

 
Rodriguez graduate completes basic training

By Nick DeCicco | From Page: B10

 
Fairfield police log: Jan. 30, 2015

By Susan Hiland | From Page: A12

Suisun City police log: Jan. 30, 2015

By Susan Hiland | From Page: A12

 
.

US / World

From ocean to ocean, through the Panama Canal

By The Associated Press | From Page: C1

 
NASA launches Earth-observing satellite

By The Associated Press | From Page: A1

 
Bay Area agency accuses former official of embezzling $1.3M

By The Associated Press | From Page: A5

Los Angeles female-only mosque may be first in US

By The Associated Press | From Page: A5

 
California health care contract fight resolved

By The Associated Press | From Page: A5

Man arrested after body parts found in suitcase

By The Associated Press | From Page: A5

 
Scientist considered father of birth control pill dies

By The Associated Press | From Page: A5

‘Rolled Sleeves Bandit’ tied to 7 bank robberies in custody

By The Associated Press | From Page: A5

 
Letter with suspicious powder received at Samaritan’s Purse

By The Associated Press | From Page: A6

 
 
Snails slither into spa scene in Thailand and around world

By The Associated Press | From Page: C6

Airport authorities: Traveler beats homeless man with chair

By The Associated Press | From Page: A7

 
Kerry: ‘Enormous interest in new relationship with Cuba

By The Associated Press | From Page: A7

Drivers: Return to your dealers for a 2nd air bag recall fix

By The Associated Press | From Page: A7

 
Hatfields, McCoys make moonshine legally in southern W.Va.

By The Associated Press | From Page: A7

 
Islamic State fighters admit defeat in Syrian town of Kobani

By The Associated Press | From Page: A9

Africa agrees to send 7,500 troops to fight Boko Haram

By The Associated Press | From Page: A9

 
From car lots to city budgets, cheap oil means change

By The Associated Press | From Page: B9

 
5 given preliminary charges over jihadi network in France

By The Associated Press | From Page: A9

Fire devastates major Russian library, threatens rare texts

By The Associated Press | From Page: A9

 
Swiss police: 4 dead after avalanche hits group of skiers

By The Associated Press | From Page: A9

Fire at Bangladesh plastics factory kills at least 13

By The Associated Press | From Page: A9

 
British actress Geraldine McEwan dies at age 82

By The Associated Press | From Page: A10

Greek leader tamps down rhetoric, vows to pay off debts

By The Associated Press | From Page: A10

 
Civilians flee east Ukraine town as fighting intensifies

By The Associated Press | From Page: A10

 
.

Opinion

 
Sound off for Feb. 1, 2015

By Daily Republic | From Page: A8

 
Editorial Cartoon: Feb. 1, 2015

By Daily Republic Syndicated Content | From Page: A8

 
.

Living

Community Calendar: Feb. 1, 2015

By Susan Hiland | From Page: A2

 
Today in History: Feb. 1, 2015

By The Associated Press | From Page: A2

Sundance doc pulls back curtain on Scientology

By The Associated Press | From Page: C3

 
Prayer, commonly misunderstood

By The Rev. Rick L. Stonestreet | From Page: C3, 7 Comments

 
Horoscopes: Feb. 1, 2015

By Holiday Mathis | From Page: C4

Volunteer or visit because February is National Salute to Veteran Patients

By Kathy Mitchell and Marcy Sugar | From Page: C4

 
.

Entertainment

Review: ‘First Bad Man’ is Miranda July’s debut novel

By The Associated Press | From Page: C2

 
Lorrie Moore nominated for short story prize

By The Associated Press | From Page: C2

 
New book to feature unpublished Hemingway conversations

By The Associated Press | From Page: C2

PUBLISHERS WEEKLY BEST-SELLERS

By The Associated Press | From Page: C2

 
TVGrid

By Daily Republic Syndicated Content | From Page: B11

.

Sports

Mustangs win the whole Encalada

By Marcus Lomtong | From Page: B1, 1 Comment | Gallery

 
Super Bowl the final act of the NFL’s worst season

By The Associated Press | From Page: B2

Lowest prices on last-minute Super Bowl tickets near $9,000

By The Associated Press | From Page: B2

 
Seau, Bettis, Brown, Haley, Shields voted into Hall of Fame

By The Associated Press | From Page: B3

 
Rodgers wins MVP, Watt unanimous top AP defensive player

By The Associated Press | From Page: B3

Lydia Ko takes No. 1 spot at 17, Na Yeon Choi wins opener

By The Associated Press | From Page: B3

 
Laird takes a 3-shot lead in Phoenix Open

By The Associated Press | From Page: B3

.

Business

On the money: Low gas prices, incentives change math for electric cars

By The Associated Press | From Page: B7 | Gallery

 
Small talk: NFL players find second careers as entrepreneurs

By The Associated Press | From Page: B7 | Gallery

Recalls this week: space heaters, orbital sanders

By The Associated Press | From Page: B8

 
Sumptuous seaside hotel sells for record-shattering $360M

By The Associated Press | From Page: B8

Review: Open e-book format comes with headaches

By The Associated Press | From Page: B9

 
.

Obituaries

Anthony Neal Hunley

By Nancy Green | From Page: A4

 
Frank Z. Perez

By Nancy Green | From Page: A4

Flora Mae Brooks

By Susan Hiland | From Page: A4

 
Lester Singer

By Nancy Green | From Page: A4

.

Comics