The Blind Men And The Elephant



“You have no idea”, the doctor muttered beneath his breath.  He repeated the comment.  “You have no idea”.  Realizing that his statement had had little impact, the doctor decided that a stage whisper might be more effective.  “None of you have any idea”.  Success!  He had our attention.  It appeared that it was up to me to ask him what he was talking about.

The doctor explained the new reality of hospital emergency room care.  E/R units, equipped with suites of examination rooms, were now limiting patients for a specific period of time, 13 to 16 hours, to maximize charges.  If the patient’s conditions didn’t warrant admission, he/she was sent home.  It didn’t matter if the clock ran out at 2 PM or 2 AM.  When 16 hours hit, the patient was cut loose.

Payment dictates care.

The doctor is a first person observer of how the new law, the Patient Protection and Affordable Care Act (PPACA), has altered the delivery of hospital based care.  He declared himself an expert on the PPACA.

*   *   *

I got a call from a chiropractor.  His patient, one of my clients, was no longer covered for indefinite once a month visits.  The government (Medicare) has sharpened the definition of medically necessary.  The insurance companies quickly followed.  Conditions need to be clearly defined and treatment plans must have a beginning, a middle, and a predictable ending.

The chiropractor is a first person observer of how the Patient Protection and Affordable Care Act has altered the delivery of ongoing care.  He declared himself an expert on the PPACA.

 *   *   *

The psychiatrist described her newest challenge.  Treatment might be covered by Medicare and the insurers, but the tests to determine the most effective form of treatment might not.  What’s covered and what’s not seemed like a moving target.  The culprit had to be the PPACA.

 *   *   *

I am reminded of the story of the blind men and the elephant.  In the ancient Jain version, six blind men are asked to describe an elephant.  They each feel a different part of the animal.  Each is convinced that he, and he alone, understands the nature of the beast from his limited contact.

But the elephant is more than just the one part each encounters.

Insurance agents are first person observers of the PPACA.  We see who can now access and afford insurance and who has been exiled from the market.  We talk with doctors and hospital administrators.  We fight with our insurers over claims.  In February I was in Washington to meet with members of Congress and last week Columbus to talk with our representatives in the Ohio House and Senate.  But like my friends the doctor, the chiropractor, and the psychiatrist, we too are simply describing the parts of the elephant we’ve encountered.


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