Patient? What patient?

If you live in Western Pennsylvania, you know about the turf war between the two top healthcare insurers in the region: Highmark (think “Blue Cross/Blue Shield”) and UPMC (the insurance spun off from what used to be the University of Pittsburgh Medical Center, which now barely acknowledges its education roots and which took over the top floors of the city’s tallest skyscraper and plastered its name on it. Did I mention it’s a “nonprofit”?).

Now these powerhouses have decided to duke it out — if you choose to play in Highmark’s sandbox, you will be forbidden to play in UPMC’s, and vice versa. That’s the plan, anyway. The official split has been postponed for a year or so. But the effects are already being felt.

For example, we received a letter from my 93-year-old mom’s doctor’s office, saying that her doc and the other main doc in the practice had jumped ship and were joining UPMC. Mom could stay with the practice (and the new assigned doctors whom we know nothing about) or make the move with her old doc (whom we like and who has seen her for the past few years), but either way, her decision would impact which hospitals she could use.

This doctor thing is a big deal. Her previous doctors were worse than useless, having inexplicably changed her longtime blood pressure meds a few years ago, putting her on something new that made her dizzy and caused her to fall and break her ribs and require a lengthy hospital/rehab stay. In that process, we found a doctor we could tolerate (who listened when we insisted she needed to be on her old meds), and now POOF, he’s gone.

This hospital thing is also a big deal. We live in fear that something would happen to her that would require a hospital visit, and, if you live here, you pretty much know which hospitals you’d go to willingly and which you’d go to only if a body part has stopped or is broken or spurting and you have no other choice.

So, we can keep her doctor and cast our lot with a hospital system we’ve never preferred, staffed by doctors we don’t know, and that has none of her medical history. (I laugh at the thought that the records would ever make the move — we’d be starting over.) Or we can go with the new doctor, sight unseen, and *hope* we won’t be backsliding into the realm of the useless meds-switchers of yore, but keep the more familiar hospitals.

In the process, the whole notion of “what’s best for the patient” is lost.

All of us, not just Mom, are being forced to make these no-win choices. Yay healthcare reform.

“That’s some catch, that Catch-22,” he observed.
“It’s the best there is,” Doc Daneeka agreed.
~ Joseph Heller, Catch-22