Health care crisis hits home

By Elizabeth Fuller

When our son was born last year, we found a pediatric practice that we love. It has a staff of great doctors (Dr. Harvey Karp, author of "The Happiest Baby on the Block" and "The Happiest Toddler on the Block" books is one of them). It has wonderfully flexible appointment hours, and the finest lactation consultant imaginable; she saved our lives, or at least the life of our son, more than once during the first few months of his life, when we had a string of major difficulties with breast feeding.

I intended to take our son to that practice until he was too old for a pediatrician and they had to kick him out.

Then, very recently, we got a letter from the doctors' office. It said that as of Jan.1, 2005, the practice will no longer accept health insurance of any kind -- not HMOs, not PPOs, not anything -- and that it is going back to a "traditional" payment system. That is, all patients must pay the practice its full rates, in full, at the time services are rendered.

The letter went on to say that we could still choose to submit claims after the fact to our insurance company, and the insurance company probably would cover the doctors’ services as an "out of network" provider.

That's hardly the same as having medical providers accept payment from your insurer.

Insurance companies usually don't pay as much for the services of non-network providers as they do for doctors who are members of their network, so we would be reimbursed at a lower percentage of the total costs than the practice gets under the present system. Also, when doctors work through insurance companies, they must accept lower rates and rate caps, which are negotiated with each insurance carrier, and that means the doctors and/or clinic usually are paid less than their "normal" rate.

The system does put a burden on the doctors and other health care providers -- which is why many, like ours, are starting to opt out of the insurance game altogether -- but it also helps patients by keeping over-all costs down to some degree.

Under the new system, we'll have to pay the pediatricians' office its full rate (whatever it chooses to charge), not a negotiated discount rate. If my insurance company will reimburse for the services at all, it will be for a lesser amount than before. And of course we'll still be paying the same insurance premiums as before, even though our share of the doctor bills goes way up and we'll have to pay the full price out of our own pockets every time we see a doctor or other practitioner.

The burden for rapidly escalating health care costs has just been shifted from the doctors --who were understandably upset about being forced to bear an unacceptable share of that burden --onto my family and other parents who have chosen that pediatric practice for their kids.

That means that many -- probably including my family – will have to switch from what we believe is a fabulous care system to one we may not trust so completely.

I'm furious, but not at the doctors. I'm disappointed by their news, and very upset at what it means for our family, but I can understand why they've decided to wash their hands of a system that frequently pays them less than they need to meet expenses and make a living. I’m furious at a nation and national government that has let our health care system get into such a mess.

One of the major arguments against national health insurance is that it would stifle freedom of choice. But if the current trend continues, and more and more doctors choose to drop out of the private insurance system, as ours have done, it's obvious that health care choices will become increasingly limited for all but the wealthiest individuals.

My husband and I chose those doctors and that medical practice to care for our son, but now we may be forced to move to providers that we consider less able simply because we can't afford to pay the doctors we've come to trust.

Whatever your feelings on national health care – and I haven't even mentioned spiraling insurance premiums, which also are squeezing consumers -- be aware that the crisis in health care costs is very real. If you haven't yet discovered how real, you probably will soon, in a manner similar to the shock that arrived in our mail .

For me, the time finally has come to start making a ruckus -- at the very least, to take a look at the positions this year's candidates for elective office hold on health care, and to be sure I vote for those who have the right answers. I also plan to hold the winners accountable for tackling the problem once they take office. The health of my family -- and probably yours -- depends on it.

Elizabeth Fuller, the daughter of James Clay Fuller, is a script reader and editor, a screen writer and a producer, writer and director of business films and videos. She lives in Los Angeles.