Friday, August 01, 2014

Greed, Avarice, and the Inevitable Doctor's Bill

I spent yesterday in futile pursuit of a psychiatrist. After filling out an hour's worth of paperwork, I met with a rushed, rude doctor who acted like the only reason he was even talking to me is that his arm had been twisted into it. He was willing, reluctantly, to be a referral service, but not to treat me himself. If this was his normal behavior, I wouldn't have wanted to be under his care. There were no open slots available and so I left, frustrated and confused.

One might think that in a large city where I live, substantial coverage gaps like these would not exist. Finding any provider other than in the field of mental health is usually not difficult. Most psychiatrists in private practice, which is to say most of them, don't accept anyone's insurance plan. Because of this, they can charge upwards of $700 for an initial examination and then $200 for every follow-up visit.

The Affordable Care Act was designed to increase the number of Primary Care doctors. The issue it sought to correct was a shortage of PCPs, especially in rural areas. The problem, as often is the case, is mostly economic. Specialists make more money. My Primary Care doctor, by contrast, charges $75 for each visit. A Specialist, like my Urologist, charges twice as much. This doesn't include inevitable testing and other fees, which are always tacked on later.

In a spirit of fairness, I seek to better understand the system and to take into account the positions of doctors and patients alike. It's difficult, especially at first, not to see the matter as simple greed and selfishness. That being said, in a city where owning a home in an affluent area requires a minimum income of a quarter of a million dollars, I can understand why some want to conform to a particular cultural standard.

DC is an expensive city and the cost of living must first be taken into account before anything else. Keeping up with the Jones is no easy feat. Renting space for an office and paying secretaries and other workers is an additional expense, which is why my psychologist, for example, uses her house as an office. Buying insurance to address malpractice suits is another factor.

But in the end, I think the issue really comes down to a question of ethics and morals. One of my doctors has chosen to work at a clinic for low-income residents and in the process makes much less in yearly income. He has no plan to move on up someday, and feels that his calling is in service to the poor and needy. His is a minority view, but it does exist.

Obamacare has largely been a success, in my eyes, but I don't think there's any way that government intervention can fully short-circuit the twin forces of capitalism and acquisition. As a person of faith, I happen to believe strongly in the lessons that religions teach us about looking out for the less fortunate and leading a life of humility. A focus exclusively on the self at the expense of others isn't illegal, but I do think that it is wrong. Legislating morality, as we learned from Prohibition, is not enough. It requires we change a toxic mindset, which is no easy feat.

As the saying goes, the rich get richer and the poor get children. Even faith-based programs ought to be predicated upon the free choice of the believer. Evangelicals believe that their duty is to win souls, and though some consider proselytizing unwelcome attention, the goal is to make sure people make it to heaven. Good intentions motivate many decisions, which is why we get so indignant when our views are rejected by some higher authority.

We should respect the rights of the individual, but we shouldn't flatly deny access to coverage by any means and for whatever reason. Here's the crucial distinction. Hobby Lobby turned away business that would have made it more profitable. The specialists I've mentioned never turn anyone away who can pay for their time. The two are absolute standards and neither will be easily or swiftly corrected. We are only left with right and wrong, with either winners or losers.

Argument aside, like many, I am left searching for a solution. A report will be drafted and sent to me, specifying other doctors and clinics to try next. I may need to go through this exasperating process two or three more times before any satisfying resolution is reached. My condition is genetic, purely a matter of inherited genes. I did nothing to create it and I do everything now to treat it. When the argument subsides and the words we speak conclude, solutions are what should come next.

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