Why I wasn't called on at McCarthy's meeting
| Saturday, Aug 29 2009 10:19 PM
Last Updated Saturday, Aug 29 2009 10:20 PM
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I went to Wednesday's town hall meeting because I am a family physician, I love my job, and I love my community. Like most in attendance, I didn't get the chance to speak, but then again, I'd virtually guaranteed that I'd be ignored. How?
Before the meeting started, I shook Rep. Kevin McCarthy's hand, thanked him for doing his job, and proceeded to explain why thousands of family doctors support HR 3200. But I didn't get a chance to explain it to the 3,000 people in attendance at Cal State Bakersfield, or the many others watching on television. The consequence was unfortunate, because I would have pointed out that McCarthy had voiced support for many of the same concrete solutions that I endorse.
If he had called on me, I would have explained that the American Academy of Family Physicians and the California Academy of Family Physicians support this health care reform bill because it helps doctors take care of patients. We look forward to changes that will hold insurance plans accountable for the health and quality of care of their members. We finally have hope of restoring the doctor-patient relationship as the core value of the American health system. The system we have now, on the other hand, holds profit as its core value, with insurance companies profiting by denying care and limiting the amount they pay out while asking consumers to pay more in.
If he had called on me, I would have told him how I see insurance gimmicks, like high deductibles and co-pays for doctor visits and preventive care, getting in the way of caring for patients on a daily basis. I see folks stretch a one-month supply of medication for three months, or wait until they are too sick to come back to see me, or fail to get their cancer screening tests on time. I have a patient who waits until she is so weak from anemia that she requires blood transfusions at Kern Medical Center a couple of times a year because she can't afford the monthly injections of vitamin B12 she needs to treat her condition.
When we pass health insurance reform, we'll change the rules of the game for these plans. They will no longer deny coverage for pre-existing conditions, they will not charge co-pays for preventive services, and you will have the security of knowing that your coverage cannot be dropped if you get sick and you will have the choice to keep your doctor even if you lose your job. If he had called on me, I would have thanked the congressman for pointing out the need for these very same reforms and agreeing that all Americans need and deserve health insurance.
McCarthy also agreed with one gentleman who suggested that we need to address the looming shortage of primary care physicians, but he failed to inform the gathering that this bill does just that. If he had called on me, I would have underscored that universal health insurance coverage is an empty promise without the historic investments this health reform bill makes toward rebuilding America's primary care workforce. There will be improvement in payment for primary care services and chronic disease management. There will be expansion of loan repayment programs and the National Health Service Corps for doctors and midlevel providers who come to work in underserved areas. And for the first time, there will be support for the modernization of medical offices and the creation of Patient-Centered Medical Homes. This AAFP- and CAFP-endorsed model of care is centered around the doctor-patient relationship: You will have access to same-day appointments with your primary care doctor, and your doctor will be able to coordinate care with your team of providers and be proactive with prevention and chronic care case management.
If he had called on me, I would have explained that both experience and evidence have proven that health systems centered on primary care provide better care for better value. When you tell me, your family doctor, that you were up all night with a headache, I already know the history of these headaches over the last year and I also know you are especially worried because I helped your dad through a stroke the year before that.
I don't need to "practice defensive medicine" and order an unnecessary and expensive MRI because I know you and I understand where you are coming from. After a thorough examination, you would feel heard and we would discuss the treatment plan together. This kind of care happens rarely these days for many reasons, including the pressures of fee-for-service and the shortage of primary care specialists. Kern County has over 60 medically underserved areas and health professional shortage areas. In some of these places, this means there is one primary care provider for over 3,000 people. Yet this primary care-centered medicine is exactly the kind of care this bill would help us to achieve.
It won't happen overnight. It will take decades to train enough primary care specialists so that every American has access to a medical home. And that is exactly why we need to get started, now. It's going to be hard work and all of us will need to support each other.
I came to Bakersfield only to pay back my National Health Service Corps scholarship by working in a medically underserved area. I've stayed long after I've paid back my medical school debt, and chosen to raise my family here, because in this town, neighbors take care of neighbors.
I regret that the town hall meeting was a missed opportunity to reassure people of our common American values. I regret not having the opportunity to be heard because I would have tried to help people through this time of uncertainty and change by showing them that concrete solutions for their health care concerns are within our grasp. That is the work I do every day.
Michelle Quiogue, M.D., is a Bakersfield family doctor and president of the Kern County Academy of Family Physicians.
