The federal government (under most current administrations) has tried to address the issue of the nation's need for better healthcare by focusing on improving what is already in place. Two of the regular efforts at this are the FLA (Family Leave Act) and the FECA, or Federal Employees' Compensation Act (DOL, b). The purpose of the first is to provide structured and economically efficient ways for people to be able to leave their positions, without risking their jobs, when they are dealing with either the birth of a child or a critically sick immediate relative. It is also seen as one effort to seek to protect men and women against the problems of gender injustice that can come about if women are challenged in keeping healthcare because of the choice to have children. FECA, on the other hand, seeks to ensure fair levels of compensation when workers associated with federal jobs are injured, disabled or killed in connection with their work responsibilities.
The third initiative is HR2457, which is a suggested legislative fix for the issue of allowing patients who have health insurance to have fair access to getting a second medical opinion (GovTrack.us). The evidence is overwhelming that second opinions can play a vital role in ensuring that peoples' medical conditions are properly detected and addressed. Unfortunately, many healthcare providers that rely on prepaid or similar group approaches find second opinions as when serious or unclear conditions occur. "According to recent data collected by three major second-opinion medical service providers," notes Wojcik in an overview of why businesses should consider second opinions a good monetary investment, "misdiagnoses are discovered in up to 20% of medical cases and treatment changes are recommended in more than half of them." HR2457 takes this understanding further and would establish getting second opinions as a right for those who have private coverage. The bill details the conditions of the right including specifics as to how it would have to be implement and under what conditions second opinions could be approved or denied.
Combining these three efforts into a single effort could well be the best thing that can happen. It could actually be one of the few options that actually exists to try to force operational change across the system. Each of the acts is highly targeted, seeking to fix particular issues. If they are brought together, they might widen the reach and convey a broader sense of accomplishment that the system realizes getting care especially when challenging problems arise needs to be something that more professionals are involved with. Getting a second opinion is something that many patients are being encouraged to do for a number of reasons; one of which has to do with the fact that difficult sicknesses like cancer respond better when treated appropriately (New Wave). In pulling the acts together, they might be more effective at achieving the proactive efforts that can be seen in parts of the Patient Protection and Affordable Care Act of 2010 (Wikipedia). ObamaCare prohibits denial of insurance for preexisting conditions and mandates preventative care. In both instances the logic is to makes sure that people get and keep the care they need. It is no great leap for other comprehensive approaches to do the same by using the logic that working in a coordinated way is smarter than fighting battles separately.
Smart Rights to a Second Opinion
Suggesting that the smarter use of the existing system would make sense is based on the assumption that we will not be fundamentally changing the system that we already have. But the fact of the matter is that the market-based system that is in place not been proven to be very effective in coming up with solutions that either encourage people to get care or to do so in a financially smart way. So the best way would be to do something much more dramatic. Ensuring that there is a fundamental right to a second opinion would be a powerful step in that direction.
In an appropriately named piece in the New England Journal of Medicine, Kuttner offers a second political opinion on why market solutions like tinkering with efficiency will not work. The entire system as we know it, he says, is built to serve particular financial interests not to check or question decisions. Here is a long but strong point on this very concern:
The private insurance system's main techniques for holding down costs are practicing risk selection, limiting the services covered, constraining payments to providers, and shifting costs to patients. But given the system's fragmentation and perverse incentives, much cost-effective care is squeezed out, resources are increasingly allocated in response to profit opportunities rather than medical need, many attainable efficiencies are not achieved, unnecessary medical care is provided for profit, administrative expenses are high, and enormous sums are squandered in efforts to game the system. The result is a blend of overtreatment and undertreatment -- and escalating costs (Kuttner).
A right to a second opinion would be a direct way to counter many of these influences by forcing patients to accept a check on what is happening -- a check of quality that is in their favor. Patients have very little protection otherwise, and those protections that do exist are usually monitored from within the healthcare and insurance systems. HR2457's approach is not that different from either FLA or FECA in that it seeks to conform specific laws associated with the Employee Retirement Security Act, the Public Health Service Act and the Internal Revenue Service code. A free-standing right would get around the issues of small attacks on a larger, failing market system and it would be more consistent with pushing ObamaCare.
Saving Money with Second Opinions
It is rather interesting to read in these materials about how small amounts of money in a big system can play such different roles. Those who advocate for special insurance coverage to support second opinions have determined that the cost for offering such a service could be just $2 to $3 per covered person (Wojcik). On the other hand, those who see the money aspects of the existing system as being the problem look at the relatively small co-pays (which can be $5 to $40 charges to start a service), recognize that these little inconveniences actually help keep people away from care (Kuttner)!
Covering prevention care as a free requirement in the Obama administration's plan was not done just to be nice. It is widely recognized that being proactive helps people find problems early and deal with them before they get worse. As far back as 1999 when one of the first studies was done on the issue of second opinions, it was discovered that those on prepaid care plans got second opinions less than those on traditional insurance plans that just covered conditions (Wagner & Wagner, 144). This meant that those who often got the least affordable plans might well have been receiving the least adequate of care because the system wanted them to stay away from second medical opinions. Today, the cost-benefits of having decisions double-checked is being seen as more than the right thing to do (New Wave).
There is little doubt but that part of the movement in the future will be toward having more doctors available (in health clinics or in regular medical settings) who can do at least the basics in care. Studies have shown that these doctors are quite good at addressing the illnesses they know (Wojcik). But they are not so good at dealing with the more technical challenges that arise with specialized treatment. This could mean that they may be forced to make judgments about illness that will lead to additional wrong and therefore more expensive levels of…