MEDICINE BY PROXY

Medicine by proxy is growing rapidly in the United States and I don’t like it!  It’s just not healthy, unless you are the employer/insurance company/ Medicare.

According to Wikipedia, “Proxy voting is a form of voting whereby some members of a decision-making body may delegate their voting power to other members of the same body to vote in their absence, and/or to select additional representatives. A person so designated is called a “proxy” and the person designating him or her is called a ‘principal’.’”

In the case of medical care, the “principal” is my patient and the “proxy” (in past times, the physician was the “proxy”) is now the insurer/Medicare.  While proxy voting may work well in the political world, it fails miserably in the medical world.

First, let’s look at how a proxy works in the political arena. “Principals” and “proxies” should have closely aligned goals and aspirations.  If I designate my neighbor as my proxy for a neighborhood association meeting, I know my neighbor will vote both on and in my best interest.  If my neighbor and I disagreed about what was in my best interest, I would never grant him my proxy.

Now, let’s explore a medical proxy.  Patient A buys an insurance policy with Charge’em and Screw’em of America (CSA).  Patient A signs on the dotted line, having no real idea what he is buying and what his rights are.  He also doesn’t know what rights he signed away.  Patient A expects that the medical care provided by his doc will be covered by his new “proxy,” CSA.

CSA’s goal is to make a profit!  Their goal is to cover as little medical care as they can and immediately start exercising their proxy.  How?  Let me explain.  Patient 

A has hypertension that is well controlled on Exforge and high cholesterol, also well controlled by a medication called Crestor.  CSA does not want to pay for either medication as they will cut into the company’s bottom line, so they exercise their proxy by refusing to pay for Patient A’s medication or by requiring a mountain of paperwork from the patient and his doc.  

CSA, the proxy, inserts itself between the patient, the pharmacist and the patient and often is successful in forcing a change in the patient’s care.  Many times, the change is financially costly to the patient (increased number of office visits and additional testing to stabilize the patient on the new med), as well as medically harmful.

So, what’s a guy to do?  You’ve got to have insurance, don’t you?  Of course, you do; but you should know everything about your insurance coverage and your rights under your policy.  You should also recognize that your insurance company does not have your best interest in mind!  You should not allow them to dictate your medical care.

Freedom has a price!  In olden days, people had a Christmas fund where they socked away money for next year’s presents.  It’s time to establish a Health Savings Account where you sock away money for next year’s medical expenses.  Going to the dinner and the movies next weekend?  Maybe a quiet meal at home and a Red Box movie would be just as fun and the money you save can be put away for future health needs.

If you are going to choose a healthcare proxy, chose your doc, not CSA!  If there is a safe and less expensive alternative, trust that he’ll find it!   Most of us are acutely aware of our patient’s financial problems and the cost of healthcare.  I didn’t go to medical school to bankrupt my patients!