“Death panels” were a hot topic during the run up to Obamacare. The right warned about them, while the left reassured that death panels didn’t exist and never would. What most of us didn’t notice, hiding behind more palatable names, like claims review and prior authorization, was that death panels do very much exist. If you doubt me, take a moment to listen and read this article from CNN. Call it what you will, but what this poor young woman faced, and likely will continue to face, is very much a death panel.

While we thankfully don’t often deal with such dire circumstances in eye care, we do deal with insurers that decide how we treat our patients and what we can use to treat them—regardless of what our good medical judgement and common sense dictate. We live this scenario every day, while our patients pay a huge price for this professional second-guessing that bolsters insurance company profits. This situation didn’t happen overnight.

Years ago, patients typically had catastrophic coverage for hospitalization. As inexpensive as hospital costs of the 1950s seem today, they still were significant by 1950 standards. Most medical care was provided by GPs, generally out-of-pocket and affordable. As specialty practices and new technology emerged, insurance companies began to offer broader and increasingly expensive “medical insurance” coverage. As fees rose and profits sagged, brilliantly misnamed “managed care” promised to manage costs by controlling doctor fees and other expenses. The concept of “usual and customary” soon gave way to “you’ll take what we pay you or we’ll cut you off from your patients.” Free choice was no longer free, and patients began to select providers, not by reputation or word of mouth, but by participation in a plan or panel.

Along the way, doctors were painted as money-hungry and elitist, and their reputations were thrown to the curb as their position in society tanked. This wasn’t accidental or a result of societal evolution, but an intentional campaign to wrest control from the doctors and break the scared bond between them and their patients.

Today, managed care and insurers are out of control. They are among the most profitable of corporate ventures, yet are primarily responsible for driving the insanely high cost of drugs, routinely depriving patients of necessary and, as with this case in point, sometimes-lifesaving care, while managing to often control the dialog regarding health care in our country. This has to stop.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com