RUTHFULLY YOURS

Last year, I ordered a CT scan of the chest on a 63-year-old patient whose chest X-ray had revealed a lung nodule. I had no problem getting the test approved by his private insurance company. The radiologist suggested that I repeat the CT scan this year to make sure the nodule hasn’t turned into cancer.

But this year, the same insurance company is denying the test, having clamped down on several elective services while also raising its premiums. This company now has to cover children with pre-existing conditions and can place no lifetime limits on care. It is struggling to preserve its profits as Obamacare kicks in — profits that, to begin with, are only approximately 4 percent of its total revenue.

Next year, my patient will have Medicare. He can’t afford a secondary insurance plan (Medicare Part B covers only 80 percent of most charges), and he doesn’t qualify for Medicaid as his secondary, so he was hoping to join a Medicare Advantage plan — a private insurance plan that seniors can choose to receive, partly at government expense, instead of Medicare. But in 2011, Medicare Advantage is due to be cut $140 billion by the new law, and it is doubtful that the plan he wants will still be available. Harvard Pilgrim, the second-largest insurer in Massachusetts, has just dropped 22,000 patients from its Medicare Advantage plan in anticipation of these cuts. Soon seniors everywhere will have the same problem. In fact, the Medicare actuary estimates that 7 million out of the 11 million people with Medicare Advantage will be set adrift over the next seven years.

One of those patients will likely be my fellow with the lung nodule who needs a follow-up scan.

President Obama clearly hasn’t visited a real doctor’s office recently. If he sat on my office couch, he would immediately discover that real patients are terribly worried about how dysfunctional and expensive all health insurance, public and private, is becoming under the new law of the land. Of course, the problem of spiraling health-care costs and inadequate access to essential services was already happening before, but Obamacare is making it far worse.

My medical office is changing, and not for the better. As I write this, I have a patient waiting in the next room who has to pay cash to see me because his employer’s contribution to his plan has dropped this year, and his deductible has gone up. Many employers are getting ready to dump their employees on the state exchanges in 2014. They are adopting plans that won’t “grandfather in” under the draft regulations of the new law, which mandate low deductibles and low co-pays. I am treating my patient for high blood pressure, which may be due to his worrying over his medical bills. My bill is minor compared to the hundreds of dollars that the laboratory charges him for the routine blood tests his insurance no longer covers.

Next door to this man is a woman complaining about her premiums, which are up 20 percent from last year. She wants to add her 23-year-old son, who has diabetes, to the policy under the new law — but she can’t, because her son has a full-time job and is supposed to get it from his employer. But the employer isn’t offering it, and is prepared to ultimately pay the Obamacare penalty that is supposed to enforce the “mandate” that he provide insurance.

Under the “consumer protections” that just kicked in, private insurers are unable to charge co-pays for preventive services including mammograms, colonoscopies, and vaccines. This sounds good until you consider that when these services are “free,” demand for them will increase, and we doctors are ill equipped to handle such a demand surge. Further, it is unlikely that doctors will receive greater reimbursements to compensate for the lost co-pays — and so they will stop providing these services in droves. Your insurance may pay for your colonoscopy, but you may not be able to find a doctor to perform it.

And things are only going to get worse. Full-throttle Obamacare, which comes into effect in 2014, will promote insurance plans that require little payment from patients out-of-pocket — and thus are easy to overuse. This will remove the brakes from the system. In my doctor’s office of the near future, I expect the waiting room to be clogged with more and more patients even as the government and private insurers limit the tests and treatments I can offer.

Yesterday I saw a patient who just lost his job. He had no insurance, and I saw him for a very small fee. He expects to end up on Medicaid (it will be much easier to qualify under Obamacare), and since I don’t accept it — and more and more doctors are doing likewise — he will likely end up getting his care in the ER. But ERs are already overcrowded, and are not ready to handle more patients.

The president can keep telling Americans that their health care won’t change. But for my patients, it already has.

– Marc Siegel, M.D., is an associate professor of medicine at NYU and the medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical contributor.