I have long been quietly watching this health care debate in our country from the sidelines.  Once again, I feel compelled to get in the mix and explain the viewpoint of a physician working on the inside and dealing with the frustrations of governmental medicine.

Approximately 48% of all children in the state of Georgia under the age of 16 are on Medicaid.  As a pediatric ophthalmologist practicing in Atlanta, I see quite a number of Medicaid patients each day. 

In the past two years, I saw two Medicaid patients under the age of one, both of whom presented with Horner's Syndrome of the left eye.  This syndrome is characterized by a droopy eyelid with a small pupil as compared to the uninvolved eye.  People come to the ophthalmologist thinking something is wrong specifically with the eye.  Actually, this syndrome is often associated with Neuroblastoma, a malignant tumor which involves the paravertebral sympathetic nervous system chain.

As a pediatric ophthalmologist, I know that this tumor can occur in the chest or the neck.  So I ordered a CAT scan of the chest and the neck.  Both times, I was told that the Medicaid protocol permits only a CAT scan of the chest.  It took me over an hour and a half to get permission for the CAT scan of both the chest and the neck.

The CAT scan of the chest was normal in both children, but the CAT scan of the neck revealed a tumor which, in both cases, turned out to be a malignant Neuroblastoma.  Both children are doing well because the cancer was treatable, having been diagnosed at an early stage.  It is very scary to think what would have happened if I had accepted the Medicaid protocol to obtain a CAT scan only of the chest.

Recently, I operated on a 4-year-old who had esotropia (crossed eyes).  I had obtained prior approval from Medicaid to do her surgery.  On the day of surgery, I went to touch base with the child and family just before and noticed that the condition had changed since the original office visit.  I now needed to perform a different surgery from that for which I had originally obtained permission.  The surgery went well, and the child had a very good result.  Medicaid told me that since I had performed a surgery different from what I had requested, they were going to pay me nothing.  In fact, the surgery that I performed was less costly to Medicaid than what I had originally requested.

Each of us, as a patient, trusts his physician to do the best humanly possible for him.  We trust our doctors to change their minds to give what they feel is the best treatment at the time of delivery.  How can anyone go to a doctor and trust him or her to do the best for us if the doctor knows that by changing the plan, he or she might be penalized?  The same is true when going to a general surgeon who operates for a suspected appendicitis and, upon exploring the patient, finds something else, such as an ovarian cyst or ectopic pregnancy.  We trust the surgeon to do the best for us regardless of what he or she might find at the time of surgery.

Also in the past year I have cared for three children, covered by Medicaid, with corneal ulcers, a serious eye infection.  If a corneal ulcer progresses and perforates the eye, the child can lose that eye.  The protocol with Medicaid, when a physician wants permission to use an antibiotic not on the  Medicaid-approved list, is to call the Medicaid office.  They will then fax a request form.  The doctor fills out the request form and faxes it back to the Medicaid office.  Usually one will not receive a response for ten days.  By that time, the eye could be perforated and lost.  On one occasion, I did get a response granting permission to order the antibiotic which the patient needed, but it arrived 10 days after the request, meaning that timely and effective treatment was delayed.  In the other two cases, I never even received an answer from Medicaid.  In all three cases, I made the effort to obtain the proper non-approved antibiotic from the manufacturer gratis for these three children.  They all did well with the proper treatment.

As for the children with the corneal infections, not much has changed since I wrote my first discussion of this problem three years ago.  At that time I was denied access to the antibiotics that I needed to treat three children with corneal ulcers.  This year, I obtained permission for only one, and that arrived too late to help the child.  Had I waited for the Medicaid response, the cornea might likely have perforated and produced a blind eye.

In the past three years, the situation has not gotten better for the patients covered by government health insurance.  I shudder to think what will come with more government control and more people under the Medicaid health program.

I have practiced medicine for more than thirty years, and I honestly feel that 99% of doctors want and strive to do the best for their patients.  However, with increasing government controls, I do not know how patients will be able to trust their doctors to do the best for them.  I am worried that a panel of fifteen or so in Washington, most of whom likely will be non-physicians, will be deciding what treatments will be allowed.  I fear that under this system, I will not have the access to advocate on behalf of the specific needs of my patients.  When a doctor tells a patient that he will follow a particular plan of treatment, how can the patient believe that this plan is the best approach for his specific problem?  It may simply be the only plan that government medicine allows under a system of cost-based, and therefore rationed, care.

Every week, several of my Medicaid patients ask me if I am going to quit after the election in November.  They fear that they will lose their pediatric ophthalmologist, who accepts Medicaid and who has been treating them for many years.  My answer to them is that I am in the same boat as they are, since I, too, am a patient with Medicare insurance.  By its very nature, expanded government medicine will limit every American's access to physicians and level of care.

I encourage everyone to vote for candidates who support a limited role of government in medicine.  Disease has no label of Republican, Democrat, or independent.  As a physician, I treat only patients, not Republicans, Democrats, or independents.  If you love your wife, husband, children, parents, grandchildren, grandparents, cousins, and friends, do what you can to insure that doctors have the freedom to deliver the best care possible.

(Watch related American Thinker Video selection.)