How many times have you heard politicians say that no bureaucrat should come between you and your doctor? You and your physician should decide when you need to go to the hospital or when you might want to wait out that cold before taking an antibiotic. At least that’s been the American ideal of the doctor-patient relationship.
The reality is something very different. We are reaching a crossroads in this country in terms of physician autonomy, says Dr. Luis Collar who writes on the blog KevinMD.com. In an essay a couple of weeks ago he wrote: “Despite the foul smog of competing interests that permeate this new delivery paradigm, one thing is clear—physicians are no longer calling the shots.” Collar is talking mainly about insurance companies and hospital administrators that are dictating what they can and cannot do.
Increasingly, all of us are waking up to that realization. For me it’s been happening at the pharmacy where a kind of rationing is taking place in how much medicine people can get at one time. A woman comes into my local pharmacy and asks why she can’t get a 90-day supply of a medicine the doctor ordered. The pharmacist tells her the insurance company won’t pay for 90 days only 30 days.
Why? The pharmacist gives a couple of reasons. Insurers, he says, want to push people into mail order pharmacies or pharmacy benefit managers, which might be able to supply the drug cheaper. If patients become annoyed, more of them might agree to get their prescriptions through the mail. He also said they aren’t sure that a doctor won’t change your medication so they don’t want to waste money on something policyholders might not need or use. In other words, the insurance company is making the call about what you will need and when you can have it.