The current Health Care Reform Bill passed today, a move that now allows it to be debated on the Senate floor. Since opposing sides have characterized the others position as either cow -towing to the insurance lobby or the law lobby, the question of who is "winning" at this stage begs to be asked. But the more telling question is who is losing. And the answer is consumers of health care, otherwise known as patients, and doctors. And the reason is because the impact of this particular legislation is continuing to take health care down a road that will now become a super highway. Although this will be touted as a progressive, more efficient, and more cost effective way to deliver health care due to it's ability to handle more people in the system, the reality is that it also ushers out an era of medical decision making that has made us the envy of the world. What we as patients lose is also what physicians lose - the autonomy that our doctors have had to do the right thing, for the right reason, at the right time.
Doctors are already currently experiencing this within their practices in the form of insurance denials for particular tests that are used to diagnosis by way of exclusion. For example, there is not a specific test to diagnosis Meneire's disease, (a debilitating disease involving the inner ear). Doctors will order an MRI to rule out other diagnoses (i.e. acoustic neuroma or multiple sclerosis), whose symtoms present similarly. These tests are now being routinely denied where in the recent past the test could be used to diagnosis by exclusion ("if it isn't this, then it must be that"). But what happens when a doctors request for an MRI is denied, and subsequently a more developed acoustic neuroma is discovered resulting in a more difficult and complicated surgery with increased risks of permanent hearing loss or facial nerve paralysis for the patient? The patient sues. And it is not the insurance company that is sued, it is the doctor.
So the answer to the question I started with - "Who is winning - the insurance lobby or the law lobby" is unquestionable. BOTH.