May 13, 1993

Article at

Need a doctor? Let's ask my contractor's sister

A RECENT SURVEY of Americans on the subject of health-care reform reveals that a whopping 67 percent are concerned or very concerned about losing their ability to choose which doctors they'll go to under a new system. In fact, this concern could potentially derail much of the reform process. And that, frankly, makes me sick.

First of all, I assume that this 67 percent doesn't include the 37 million Americans who have no health insurance. Or those milllons more who are so underinsured that their problem isn't choosing which physician to see but whether to see one at all. 

Second, I assume that this 67 percent includes a lot of people like me who exercise their freedom to choose a doctor something like this:

"Hey, Joe. I'm having a terrible time. Lots of congestion, runny nose - I think I'm coming down with allergies. You know a good allergist?"

Joe is the guy putting new gutters and downspouts on my house. I've known him for about two hours, but he seems like a stand-up guy.

"My sister, she had terrible sinus. She went to some guy over by the mall and he fixed her up. I think those sinus guys do allergies, don't they?"

"Your guess is as good as mine, Joe. You got the guy's name?"

Ah, the freedom to choose. A beautiful concept in theory, but in practice, a little overrated. Certainly not something over which we should jeopardize serious health-care reform.

When was the last time, for example, you called the State Medical Board to check up on a doctor you were considering? When was the last time you asked your doctor for references from colleagues or patients? Asked to see a copy of his or her license to practice? When was the last time you interviewed your doctor about his or her philosophy of medicine? Found out if your doctor was conservative or aggressive in treatment? When was the last time you asked your doctor for his or her list of fees and then shopped around to see if they were competitive?

Don't feel bad. At least you got his or her name from a knowledgeable source - your cousin Vinny or Marge, the beautician. Which brings me back to my referral source, Joe the gutter guy.

Funny thing. I checked Joe out pretty thoroughly before I chose him to put gutters and downspouts on my house. First, I got three written estimates. Then I checked Joe's references. I checked his certificate to operate in my city. I checked his status with the Better Business Bureau. I inquired about his philosophy of screened gutters vs. traditional gutters. I asked what gauge aluminum he would use. And yet, I called the allergist Joe recommended without knowing anything more about him than that Joe's sister thought he did a bang-up job on her sinuses.

I admit, I should be pickier about the doctors I go to. But I probably won't be. So losing that choice under a new system won't bother me much. Not nearly as much as all these scare tactics aimed at making us think that we have total freedom of choice and that a new system will take it away.

If you're like most Americans, your insurance company started to limit your choices several years ago to control costs. Chances are only certain hospitals and/or doctors are covered fully under your plan. If you choose another physician or hospital, you'll probably pay more for that choice. Under some plans, you can pay 100 percent for that choice.

On the other hand, most of the reform plans under consideration are similar to huge HMOs or PPOs (Preferred Provider Organization) - not dramatically different from those that millions of Americans belong to right now. Under these new managed-care groups, the propagandists warn us, we will be left choiceless. Captive to the doctors who are part of our plan or alliance or whatever. Well, that could be anywhere from several dozen to literally several hundred doctors. And that's more of a choice than I would ever be willing to exercise.

True, there might be some guy near a mall somewhere that my plumber says is a great vascular surgeon who isn't covered under my plan, but I think I could live with that limit to my freedom, knowing that it helped 37 million Americans gain the freedom to simply see a doctor.