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Local doctors say health-care reform is necessary


Reasonable people can disagree on the proposals to reduce the crippling costs of care and insurance and the merits of a public option, but no one should be comfortable with the status quo, several area doctors said.

HOUMA -- Lost amid the posturing and politicking that raged at town-hall meetings and “recess rallies” across the country last month are the dysfunctional realities of the health-care system doctors like Houma ophthalmologist A.J. delaHoussaye deal with every day.

Up to 80 patients a day pass through the door at SEECA, delaHoussaye’s eye clinic on Corporate Drive.
He pays an office staff of five people to help his patients understand and negotiate the medical insurance they pay an insurance company to provide. And on their behalf, delaHoussaye’s employees often wind up fighting the company’s “blockers,” workers who exist solely to deny, defer or obstruct paying benefits for services clearly covered by the patient’s policy.

“I have got some horror stories. ... We have had tremendous difficulty with some cases that are black-and-white, by-the-book, where the insurance company should have paid and didn’t,” he said. “Their main job is to deny health care. It really is crazy.“

Reasonable people can disagree on the proposals to reduce the crippling costs of care and insurance and the merits of a public option, but no one should be comfortable with the status quo, several area doctors said.

“I agree, just like the rest of the country, that there does need to be significant reform,” delaHoussaye said. “There are no easy solutions here. But there are real issues that need to be addressed, and it needs to be de-politicized.“

DelaHoussaye, as the owner of his own practice, can also testify from the perspective of a business owner who’s seen the cost of insuring his 18 employees escalate dramatically.

“Every single year I’ve offered insurance, they go up 10 percent,” he said. “Do I continue to bear that cost or do I pass some of that on to my employees? How can health care be so much more expensive year to year? Where is the extra money going? Somebody needs to put some investigation into why the same amount of health care in 2008 costs 12 percent more in 2009.“

Another topic that hasn’t gotten much attention in the debate over health-care reform is the nation’s shortage of doctors, delaHoussaye said.

If the 46 million Americans who lack health insurance are suddenly covered, where will the doctors to treat them come from?

“They’re really aren’t enough health-care providers to provide that care,” he said. “My practice is bursting at the seams. I’m at the point of saying I can’t see any more patients.“

A 2008 study by the American Association of Medical Colleges predicted that by 2025, the country will be short about 124,000 doctors if trends continue. Some proposals for reducing the shortage, such as raising Medicare reimbursement rates for primary-care providers and eliminating cost-sharing for preventive services, are included in the bills working their way through Congress, according to the New York Times. The bills would also increase the residency-training slots available in primary care and try to entice students with lower student-loan interest rates.

But adding millions of newly insured patients to the nation’s waiting rooms would undoubtedly create backlogs, doctors like delaHoussaye say.

In an August conference call with reporters organized by the pro-reform National Physicians Alliance, three Louisiana doctors said doing nothing is unacceptable.

“We can’t afford not to reform the health-care system,” said Dr. Jonathan Arend, a New Orleans physician. “If we do nothing, the average family will spend about half of their income on health care in 10 years.“

The group is calling for an end to coverage denial based on pre-existing conditions and putting a stop to discrimination by gender or health status. It also advocates a cap on out-of-pocket expenses, as well as coverage for preventive care, such as programs to help people quit smoking.

About 840,000 people in Louisiana, 22 percent of the state’s population, are uninsured, according to the Center for American Progress.

That means they skip appointments and don’t get doctor-recommended lab tests, and “then they show up in the emergency room with a problem that really could have been treated much more effectively early,” said Dr. Jim Theis, a family physician in Marrero.

Those costs get passed on to everyone else.

Michael Bergeron, a Houma accountant who’s been on the board of Terrebonne General Medical Center for 10 years, said uninsured patients cost the public hospital about $10 million a year.

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