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Ami Bera, MD

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Can We Get the Government Out of Our Exam Room?

Posted: 03/ 1/2012 6:40 pm

Last week, Congressman Darrell Issa of California chose to review whether it was appropriate for President Barack Obama's administration to mandate that insurance companies cover oral contraception. This week, Sen. Roy Blunt of Missouri introduced legislation that allows any insurance company or any employer to decide what it wants to offer in terms of health insurance coverage. And Rep. Dan Lungren argued that companies had the first amendment right to deny their employees access to these medical services.

My frustration is that none of the above-mentioned individuals has ever gone to medical school. They have never sat with a patient and her family and helped navigate healthcare decisions that may have life and death implications. In short, why are individuals with no healthcare expertise about to decide how a doctor takes care of their patients?

I have been a doctor for more than 20 years. I love the opportunity to help my patients, to work with them to find the best course of action to get them healthy and to give them the information they need to stay healthy.

When I took the Hippocratic oath, and was effectively 'sworn in' as a doctor, I took the same vow that doctors have taken for generations. Patient autonomy is core to this oath. As a doctor, I have committed myself to provide my patients with the best options available and to explain the risks and benefits of those choices. At that point, it is up to my patients to make the best decision that respects their own faith, family and personal circumstances. I take that oath very seriously -- as do the thousands of doctors and medical care providers in this nation.

Members of Congress take their own oath when they are sworn in as elected leaders. They swear to uphold the Constitution, and to defend it against all enemies. But nowhere in their oath of office are they required to protect the medical health and well-being of their constituents.

That fact was driven home to me over the last few weeks as I watched members of Congress play politics with the health and well being of the women in this country.

I have heard the charge from Congressional Republicans that requiring health insurance companies to provide access to oral contraception is an encroachment on religious freedoms. I fear this misses the point. As a physician, I would never encroach upon the religious freedoms of my patients. As mentioned, the oath I swore explicitly requires that I respect patient autonomy. My job as a physician is to make sure I have provided my patients with the best options to make the decisions that affect their lives.

Patient autonomy is paramount to the oath that we take when we enter the profession of medicine. That is why I am appalled when the federal government gets between my patients and their right to the full range of medical information and complete access to health care. Only when fully informed, with all options in front of them, can a patient truly have what she needs to make a fully informed decision -- and to exercise their personal right to religious freedom. In fact, the arguments advanced by congressmen Issa and Lungren are an encroachment on the individual liberties of my patients.

For the record, I believe that women and their doctors should have access to oral contraception when desired by the patient and medically appropriate. I also think unfettered access to these medications improves health, reduces illness, and is cost-effective. This is good medicine and meets the community standard of care that dictates how we practice medicine.

It is not my duty to force oral contraception on my patients, any more than it is a politician's duty to limit access to medically accurate information and a full range of health care options.

It is time that we got the government out of our exam rooms. Yes, the government will have a role, as will the private sector, in determining the amount of resources that we have available to make sure every American has reasonable healthcare coverage. But once we understand the resources that are available, let's leave the business of delivering healthcare to those that have experience doing it.

 

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Last week, Congressman Darrell Issa of California chose to review whether it was appropriate for President Barack Obama's administration to mandate that insurance companies cover oral contraception. ...
Last week, Congressman Darrell Issa of California chose to review whether it was appropriate for President Barack Obama's administration to mandate that insurance companies cover oral contraception. ...
 
 
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12:00 AM on 03/10/2012
This type of legislation goes BEYOND womens' contraception issues. It covers ALL choices and options for medicines and medical care. That means people with HIV or ANY other illness are potentially impacted by this ridiculous legislative empowerment. An employer who is anti Gay or anti HIV patient could invoke their RELIGIOUS principles on others just as they could against women and contraception issues. Others' religious "restrictions" could affect anyone. This is not only in violation of Constitutional rights of others, it is unconscionable.
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HUFFPOST SUPER USER
hipocampelofantocame
retired pediatrician
07:57 PM on 03/09/2012
Several things come to mind. For- profit (a lot) insurance companies have no business
at all in supervising medical care. We also badly need a single payer option type of
system to level the playing field and make medical care efficient, which it isn't at present.
We do not need a bunch of politically motivated and largely ignorant partisan legislators
meddling in something about which they know nothing. We do need the ability to bargain
for generic medicines, including those produced elsewhere. We do need all States to be
on the same page as regards how medical care is given. We do need all of our people to
be included in our medical system. That alone will save a huge amount of money that the
rest of us are paying now. This is not rocket science nor a new concept. It's already being
done, and well. Kudos to Dr. Ari Bera for writing a cogent and well thought out article.
04:43 PM on 03/09/2012
A central theme of the PPACA healthcare reform legislation is "An ounce of prevention is worth a pound of cure." Consequently, there is a long list of preventive office visits that must be offered at no charge to the member. A good chunk of these no charge visits pertain to women's health.

Any one of these visits might detect a condition or illness that could be treated early saving the insurance company and possibly the government money. Healthcare reform has the potential to save hundreds millions of dollars annually for the insurance companies, the government and the members. To actively work against healthcare reform is to doom the states and Federal government to increasing healthcare expense for such programs as AFDC, CHIPs, Medicaid and many other programs to support Americans who are locked out of our current health insurance market place.
03:25 PM on 03/09/2012
I find this Republican "March to the 16th Century" in attitudes to be baffling. They complain about "government intrusions," yet can't wait to intrude into a citizen's health choices and even their bedrooms.
05:27 PM on 03/04/2012
Thank you for weighing in on this. Hearing a Doctor's perspective is so important.
12:49 PM on 03/02/2012
I really appreciate hearing Dr. Bera express, as a physician, the importance of women having the freedom and the means to decide for themselves what type of contraception to use. I wanted to add that the mandate requires that not just oral contraceptives, but any FDA approved method of birth control, be covered at zero-copay. Some of the longer acting methods, such as IUDs, have higher up-front costs, but save money in the long run. So the zero co-pay requirement not only allows all women to afford methods that are best suited to them, and therefore most likely to be effective, but can also potentially save money in the long term.
11:09 AM on 03/02/2012
"Congressman Dan Lungren once again is putting partisanship ahead of the health and safety of millions of women, personally refusing a request to film this important hearing so it can be made available to the public. As Chair of the House Administration Committee, Lungren approved airing the panel comprised solely of men, but is refusing to give equal treatment to a hearing on the same exact issue, this time including the voices of women."

Dr., I STAND WITH YOU in your efforts to represent California’s 7th Congressional District!!! We need a common sense representative who respects women's rights, and civil rights as a whole!

LTC and Mrs. Ivann E. Greene and family
Roseville, CA
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HermaO
Conservatism is intellectual laziness.
08:22 AM on 03/02/2012
"introduced legislation that allows any insurance company or any employer to decide what it wants to offer in terms of health insurance coverage"

The GOP doesn't seem to understand that the law they propose goes way beyond a religious conflict over birth control.
This "choices" one employer or insurance company could make over what to cover or not could have them refusing to pay for cancer treatments, HIV medicine, heart medication or surgery etc.
Or they get it just to well and just want to offer other ways for companies to deny theur employees healthcare
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zSpin2001
All your base are belong to us.
07:41 AM on 03/02/2012
I find the current debate interesting because when the shoe was on the other foot with keeping government out of the classroom, we threw the teachers to the sharks. I have asked "Would medical doctors allow lawyers to write the board exams or would lawyers let medical doctors write the bar exam?" It looks like we have our answer and yet we still let education flounder in bureaucracy mitigated by people that are not professional educators. I am happy that the AMA has bet inculcated into the fray.
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indeedie
Not intended to be a factual mico-bio.
07:30 PM on 03/09/2012
I'm willing to bet that you and I have more in common than not, politically, but still - I really hope you are not one of those teachers whose fate so concerns you.

"Mitigated" means "ameliorated, attenuated, made less bad or severe." I think you must have meant something more like "administered" or a similar term. "Inculcated" means "intoctrinated, trained, imbued (with), infused (with), steeped (in) - as with propaganda or repetitive drills or practice." I think you must have meant to type "been" rather than "bet," and then meant to use a word meaning the AMA had been introduced, insinuated, or otherwise brought into the fray.

Really - a person ought to stick with the words they really know rather than to reach for "sophisticated" words of which they are uncertain. Even smart people (and I suspect you are one) can use little words.
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AlfredE69
Liberty Lovin' Tree Hugger
07:20 AM on 03/02/2012
Yes, please, I don't want them watching my doctor examining me.
06:28 AM on 03/02/2012
I am absolutey appalled with the nedieval attitudes of the Virginia Legislature, a bunch of anti-abortion, Republican white males who recently voted that any woman seeking to terminate a pregnancy must be arbitrarilly forced to submit to having an ultrasound or other photographic device poked up into her vagina and a picture of the wriggling embryo shoved into her face.The men who voted for this are interfering between a patient and her doctor. They should all face arrest for practicing medicine without a license.
Mountain Momma
Seemed like a good idea at the time
03:59 AM on 03/02/2012
"In short, why are individuals with no healthcare expertise about to decide how a doctor takes care of their patients?"

Why are individuals with no education expertise allowed to determine state and national educational policies? For some reason, politicians have the misguided notion that just because a majority of yahoos vote for them, they become experts on everything.They don't need doctors to tell them about medicine, educators to tell them about teaching, law enforcement officers to tell them about policing, military officers to tell them about war ... they know it all. To hell with the rest of us and our expertise.
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hipocampelofantocame
retired pediatrician
07:29 PM on 03/09/2012
Mountain Momma: F&F
01:39 AM on 03/02/2012
I can see through the little Republican distraction games. Focus on abortion and birth control so they don't have to come up with bills to get people back to work and the economy rolling again. Unemployment is still the number one issue with most voters. Thank you Dr. Bera for your post. I hope a lot of people read it. I agree with other people that Republicans always talk about how bad big government is until it is something they want to meddle in.
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MissKaren
11:54 PM on 03/01/2012
How many politicians are qualified to do pelvic exams? Not all that many, if I recall. If they are not qualified to do that, they are not qualified to make decisions regarding women having access to medical care. I don't think I want Roy Blunt poking around down there.
11:43 PM on 03/01/2012
Thank you Dr. Bera. Universal contraception coverage is not an assault on religious freedom but blocking it is a religious assault upon the individual. If the religious patient does not want contraception prescribed or any other procedure then their insurance will not be charged. Additionally, if a religious institution is involved in the public health care business and hiring and treating people then they should be mandated to comply otherwise they are forcing their beliefs on those with different beliefs. Keep your religion between your religious leaders and their parishioners and keep the health care decisions between doctors and their patients.