It wouldn’t be a Maine election season without yet another opinion poll, only this one will still matter long after Nov. 8. That is why we should start paying attention today.
According to a recently released national and statewide survey from the Partnership to Fight Chronic Disease, 42 percent of Maine residents have seen their health care costs increase. Isn’t that somewhat more than what was promised?
The news gets worse. Almost one-third say coverage for them is not only getting more expensive, it’s actually getting worse. Add to the fact, nationally, 77 percent of Americans polled offered that they or someone they know had difficulty using their health insurance just in the past year.
Could it be any clearer that patients aren’t getting what they were looking for from the institutions that claim to serve them? This is what is known as a national emergency.
While many are focused on drug prices (which certainly need to be dealt with), there is an even more serious crisis at hand — the denial of essential medications prescribed by doctors to their patients.
Though it seems unbelievable, it is nonetheless true — a doctor can prescribe a treatment he or she deems necessary or even vital, a patient can agree and then a pharmacy benefit manager can overrule them both. Insurers are operating under the belief that it is acceptable to allow a patient to fail first or become sicker on a lower cost medication before agreeing to provide drugs their doctors had originally prescribed.
Everyone knows someone in need of daily medication for an ailment or disease. The expenses can be high. But what economic theory justifies the denial of life-saving cures because one medication may cost more than another?
The survey revealed that an alarming 18 percent of Mainers say the treatment their doctor recommended wasn’t covered by insurance, while 20 percent say the treatment of someone they know had the same problem.
An eye-opening 88 percent of Mainers declared as very or somewhat important the need for transparency regarding how and why health plans are deciding to deny coverage of doctor-prescribed treatments.
Even more challenging, patients often accept their insurer’s judgment and don’t pursue administrative appeals. Don’t be surprised; people fighting for their lives don’t often look to open up another front in another war.
The rejection of medically necessary drugs combined with higher health care costs is a truly deadly mix for patients. Denying vital medications could result in serious consequences. Who is responsible when that occurs? Doctors are required to take an oath to do no harm; should insurers be asked to do the same?
Fundamentally, this isn’t just the patient’s fight, or only their doctor’s cause. The advocacy community must lend its voice of concern to this obvious policy problem, insist on comprehensive reform and bring an end to what is obviously health care’s secret scandal. And lawmakers must listen.
Given this depressing data, it really isn’t a big surprise that Mainers believe their insurers are failing them. According to the PFCD poll, Mainers say that the top health care priorities for politicians and government officials should be managing premium increases, lowering co-pays and deductibles and holding insurance companies accountable.
It’s time to put patients first and make health care, medicines and treatment easy and accessible. There is no humane reason health insurers should be inhibiting the decisions of our doctors and there is no excuse for denying vital medications while patients become sicker and their lives remain literally in the balance.
How did the most vital medical decisions in your life go from the expert in the white coat to the bureaucrat in the gray flannel suit? As the survey shows, it’s a question an awful lot of Mainers are asking as well.
Jonathan Wilcox of California is co-founder and policy director of Patients Rising and Patients Rising NOW.
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