I’ve got a lot of patients who are worried about health care reform. Most of it is expressed in right-wing radio talking points. They quite literally believe that they will no longer be able to choose their doctor, or that other doom and gloom events are imminent.
Have they no experience with government? Health care reform isn’t going to happen quickly. When it does, it will likely have an American character. While socialized medicine works very well in some other countries, Americans just aren’t into it, even if it were to work. Whatever I may think about it, it’s a non-starter.
But what should we really fear about health care reform? The answer of course depends on your position and ideology. I of course hope that something is done about reimbursement for primary care physicians, but that’s one issue of many. Leaving aside for a moment the cost containment elephant in the room, what ideologic fears might we have?
It seems unlikely, given American culture, that any plan will significantly limit choice of primary care physicians. Very few plans place significant limitations. In fact, Medicare, the largest health plan (which is “socialized”) places no limits on what doctor you can see. There is little reason to do so. The closest idea to this would be doctor quality control. If doctors are not practicing according to some (mythical) set of quality guidelines, they could be “punished” either financially, or by being cut from some (mythical) list. If current trends hold, doctors who fail to follow evidence-based guidelines will be punished financially rather than having patients plucked away. This has it’s own pluses and minuses, of course.
Access is certainly a problem, but not in the way the fear-mongers would have you believe. The largest problem with access is lack of insurance (either total or partial). Some other less spoken of problems (which are actually being proposed) are conscience clauses, which would allow doctors to refuse to render certain care; limits on abortion; limits on birth control, and other “moral” issues. The theocratic right knows health care reform is coming one way or the other, and they want in. Since they might not get the economic concessions, they hope to insert their religious agenda, and anyone who thinks this will not affect them is fooling themselves.
Health care is an inconceivably large and complex system. No single issue is likely to dominate the reform effort. When educating yourself, try to avoid the hype, and look to the real issues.