The article stated the  American Legislative Exchange Council (ALEC) was driving this movement.  I read the information on their website and found it well presented yet inaccurate in places.  One of the premises for an amendment is to stop any single payer system.  Their premise reads:

                                            Protecting the Doctor-Patient Relationship

"ALEC's Freedom of Choice in Health Care Act ensures a person's right to pay directly for medical care.  Single-payer systems, like in Canada, make it illegal for citizens to go outside the government's health care plan and contract for their own medical services.  Cost overruns require most single-payer plans to restrict patient choices, and instead mandate an "evidence-based" treatment schedule that standardizes care."  (taken from ALEC website)

I am not going to discuss the single payer system but the premise that evidence based medicine already controls our health care.

This process already exists and it is called the insurance companies. One of the reasons I left private practice was because it was being controlled by the myth of evidence based medicine.  Our care already is dictated by what the insurance companies deem medically necessary based on cost and evidence based medicine.  It is an illusion to think that most doctors haven't bought into this.  It is the standard in medical care now.  Evidence based medicine translates into : thinking outside the box means no reimbursement and patient pays.  There is always a third person in the room with the doctor and patient , the insurance company.  How many people can afford a treatment not covered by health insurance?  Very few and many die because the treatment is unreachable financially.

ALEC also wants states to allow citizens to buy healthcare across state lines.  Great idea and  would agree if ALEC could guarantee it was not considered out of network.  Yes let's have more  insurance options with lower premiums.  The problem is all the options allow insurance companies to exclude for pre existing conditions and drop people if costs are too high.  Why can't ALEC get on board with no pre existing conditions?  Perhaps there would be less uninsured if insurance companies couldn't deny people coverage because they had been sick.

I would like ALEC to do the research or talk to  people like myself who daily are trying to secure health insurance or negotiate medical bills or get an insurance company to pay for a much needed procedure that every doctor agrees is necessary.    What relief will an  amendment give to any American to relieve increasing premiums or being denied for pre existing conditions or have thousands of dollars of medical bills?  I want an amendment that reads NO PRE EXISTING CONDITIONS and NO DROPPING PEOPLE FOR BEING SICK!

Stanford has a policy that no medications are prescribed on the first visit.  It is written on the new patient pages.  I was not told that by intake coordinator.  My client said the doctor was very nice and agreed he needed the medication at the prescribed dose.  He verified the letter that Beth Israel Hospital in NY was well known as a reputable pain center.  He explained to my client in cases like his, where medication is stable and necessary, Stanford likes  to support the PCP in writing the prescription.  He stated the research validates it is better for the client.  He gave my client a form to give to the PCP and said he would fax a letter  explaining the validity of the dose.  It all sounds logical and medical but my client was still left without a prescription.

My client went to the PCP's office, a community health center.  The nurse  informed my client the PCP had written a prescription for two days only (this was before any information from Stanford) and he was gone for the holiday long weekend.  My client spoke to a supervisor who said there was nothing to be done.  AND BYE BYE.  As you can imagine, my client called me in a panic.  What was to happen?  Would withdrawal occur?  Would increased pain and suffering occur after more than five years on pain medication?  By the time I received the call it was late in the day.  I made some calls and only got voice mails or  asked to leave a message.  

The next morning, I knew  something had to happen.  It was the Wednesday before New Years Eve and medical facilities close down.  I decide it was time to climb up the administrative ladder.  I was able to find the medical director's email, phone and fax numbers.  I proceeded to write the story, asked him to intercede and emailed it.  To my delighted surprise within twenty minutes, I had a response.  He was going to look in to it.  I faxed him a release to speak with me and waited.  Three hours and I decided to try and reach the  pain doctor as a back up.  I spoke with the Stanford front desk and left a message even though I was told most everyone was gone.  Again, to my surprise and delight, the doctor called me.  I thought, Happy New Year, 2010 is going to be amazing.  I had a great conversation and asked him to call the medical director.  He said he would.  He called me back in about fifteen minutes to say the medical director had already decided to write the prescription.  I was elated and very thankful and so told the doctor.   We even spent a few minutes talking about the role of an advocate.  I called my client and was told the medical director had just called to come pick up the prescription.

And so I wish, this was the end of the story.  Today, I received an email from my client stating the insurance was not paying for the medication until a new medical necessity form was received and reviewed.  This could take up to seven days.  My client will have to pay for a few days.  Luckily, California has a rush review that has to occur within three days.  But still the earliest, the medicine will be available is three days past the original end date.  My client, having a terminal illness and chronic pain is loosing hope.  It was a very depressed email I received and have been doing my best to uplift the spirit.

What can I say about a system that reminds me of a Kafka novel or the life of Job?  Is this story an extreme example of our current system?  Unfortunately, it highlights, the absurdity of many policies and prejudices of our system and the harm done to many who in good faith follow what is asked of them, only to end up in the same place, bankrupt and still suffering.

 It would be a simple task if there was a pain specialist who would take the insurance which is MEDI-CAL.  The PCP office referral person told me sometimes no specialists can be found.  As my client said, should I just give up and die?  I personally called 35 pain specialists in a 50 mile radius of my client and 32 did not take the insurance.  The other three only did injections and no pain medication management.  I spoke with pain centers at two major universities, three public hospitals(no new clients or no more MEDI-CAL) and the story was the same. The office of MEDI-CAL was unable to help locate a specialists either.  Four weeks later after writing letters, faxing medical notes, calling every day and getting my client to switch to a different part of MEDI-CAL  was my client accepted by a university center.  However, the appointment has not yet occurred so there is no guarantee of a prescription.  There is reserved hope.