Primary care concerns

Since the CN&R’s Health and Fitness issue last January, I’ve gotten additional insight into medical care. Privacy laws keep me from overhearing enough doctor talk to make diagnoses, but I’ve picked up enough on the business side to realize what system ails patients the most.

Not circulatory.

Not respiratory.

Not musculoskeletal.

Not immune, nor limbic, nor renal.


My personal physician had to play hardball with the area’s biggest private insurer to get the reimbursement rates he needed to stay afloat. His group went so far as telling all its patients that it wouldn’t accept the PPO’s plans as of Jan. 1. Fortunately for me, the company blinked and the doctor made a deal (or maybe vice versa).

When it comes to medicine, I’m not only a consumer—I’m also a purveyor, at least on paper. I own half a practice, thanks to laws governing community property. My N&R boss prefers I not plug the other place here; let’s just say it has a mural of Upper Park and a lot of kids in the waiting room.

We have a physician, nurse practitioner and staff who know a child doesn’t choose which family to join (otherwise, everyone would call Bill Gates “daddy” or Oprah “mom"). Diseases don’t preselect patients based on parents’ insurance plans. So it’s hard to say, “Sorry, we’re not accepting Medi-Cal,” even when coverage is key to a practice’s health.

Lest you think we’re talking about Dr. 90210 demands, consider this: Chico has lost a half-dozen general practitioner types in the past year. They’ve become hospital-based doctors at Enloe, where they won’t have to deal with reimbursements or overhead expenses. Only one in 10 graduates of U.S. medical schools goes into primary care, which is where the bulk of treatment occurs.

I don’t blame them. When I see the stress on my favorite pediatrician, I wonder why she didn’t choose dermatology. (But don’t worry, hon—I never wonder why I didn’t choose a dermatologist …)

The biggest problem, as mentioned above, is the byzantine insurance system. Each company has its own set of rules to navigate and reimbursements to negotiate. Each of those companies has different plans: PPOs, POSes, HMOs, etc. Then there’s Medi-Cal, Medicare, TRICARE …

Our practice uses a billing service. We probably would even if the system were simplified, since collections are a whole other headache, but now the other choice is to hire an experienced, dedicated, full-time biller.

Proponents of universal health care—a.k.a. single-payer insurance—offer myriad arguments in favor of reform. They don’t talk much about making doctors’ lives easier, and that’s fine, because the plight of the uninsured is far more pressing.

What I’ve come to see is the interconnection.

Red tape isn’t just a hurdle—it’s an expense, part of the cost of doing business and dealing with disparate administrative staffs. Plus, in a capitalist structure, for-profit insurers are middlemen taking as large a chunk as the market will bear.

Forget the “socialist medicine” rhetoric. Think of “direct medicine” the next time you hear talk of single-payer plans.