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Question of Who Pays

March 29, 1998

I am one of the physicians affected by the restructuring of MedPartners Inc. ["MedPartners Reports Loss of $840.8 Million," March 19]. I would like to illustrate what happens to the patients.

As a rheumatologist, I specialize in arthritis and autoimmune diseases. My patients suffer from chronic illnesses that have no cure. Often the conventional treatments are fraught with problems, and state-of-the-art science fails to meet the expectations. Thus the patient-doctor relationship is crucial in forging an alliance and in every step of the treatment decisions.

MedPartners notified our office that my patients with their group will no longer be "authorized" to continue their care with me. I was given roughly two months until the official pink slip. For the past three weeks, I have been sharing this information with my patients as they returned for their follow-up visits. As much as I dreaded "springing" this on them, they were reassured that they could have at least one more visit. Their response was uniform: surprise, anger, followed by "Now what?"

Unfortunately, I had no answer to their questions: "Who is going to be my doctor?" "Do I have a choice?" "How do I come back?" For them, this was yet another curve ball in their lives. They are desperately trying to cope with their illness and establish a sense of order in their lives.

It would be too easy to keep blaming the HMOs. The answer lies with the hands that control the money. The patients have been left out of the loop for too long. For most of our working lives, employers negotiate with the insurance companies for the best rates, and the insurance companies decide what they will cover and how much. After 65, Medicare picks up the tab for whatever the government decides. Almost no one questions this. And no one prepares for an illness, as one is expected to save for a house, a car or retirement. This has led to dependency and a sense of entitlement. Patients have become captives of the third-party payers, whereas physicians have become their slaves.

For patients to receive truly unfettered medical care, they need to control their money. For this is their right.

Medical savings accounts offer this opportunity. This is a high-deductible plan with a portion of the premium going into a savings account. Whether you need a visit to a family doctor for a physical or you need a neurosurgeon for a brain tumor, you will have a choice.

For those who feel that they deserve as much health care as they need, irrespective of their ability to pay, medical savings accounts may be a foreign concept. But I see no other alternative to the current fiscal/ethical problems in all sectors of health care.

Dr. CHRISTINE H. PARK

La Palma

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