AnnotatedOpinions.com

One day soon, the checklist that I use to screen my patients against common diseases might be dictated by federal mandate. [AO: And one day soon we may discover a huge source of fuel here in the United States allowing us to say “no” no Middle East oil. Who knows? Anything can happen in the uncertain future.] 

Page 17 of the Senate health bill refers to ratings that will affect insurance coverage for “(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force.” What will come of
tests that are graded C’s and D’s? [AO: All of those against the government only paying for medical treatment that is supported by scientific evidence raise your hands. I rest my case.]  

Today, I use my own checklist based on 20 years in practice. When my female patients are younger than 21 and sexually active, I refer them to a gynecologist for a yearly pelvic examination and a Pap test. At 40, I order a mammogram as well. All patients over 50 are sent for a colonoscopy. Elderly patients are prone to both depression and falls, so I screen them for these issues.  

Unfortunately, in my examination room of the near future, my hands may be tied. I will want to order the same screening tests and procedures, but I might need another checklist of the services that my patients can’t receive because Medicare or private insurance will no longer pay for them. [AO: And how is that different from what happens now? Recall that many states have had to pass legislation to require private health insurers to cover certain treatments that states consider important. What do good doctors do now when a patient walk into their office and has private insurance coverage that will not pay for a necessary diagnosis or treatment and the state has not passed legislation requiring that all private health insurers provide that coverage? I suspect doctors will continue to do what they do now.]  

In the current health care debate, much has been made about overuse or over-interpretation of tests. Yet the problem isn’t with the tests, but with the doctor who orders them for the wrong reasons. If, however, physicians are driven by fear of malpractice into excessive testing, then the problem should be addressed with tort reform. . . A doctor who fails to administer tests that later reveal cancer, for instance, will still be held liable, even if the insurer denies the test in the first place. [AO: Good point. Under the current system, a doctor who has done nothing wrong cannot be held liable. Why do we need tort reform if, as the writer suggests, after tort reform only doctors who have done something wrong will be liable. What’s missing? What’s the point of tort reform?   

Tort reform, all too often, is about making it harder for patients who have been injured by their doctor to recover for the injury or it is about limiting what a patient can recover from a doctor who has wronged him or her. It is not about only holding doctors liable when they have done something wrong.]