Doctor Forgoes Employer's Health Plan

PHOTO Will NicholsonCourtesy Will Nicholson

While medical students and doctors-in-training are often told to try and put themselves in their patient's shoes, one Minnesota physician has taken that idea a step further in trying to understand what many of his patients go through in trying to navigate the individual health insurance market.

And so Dr. Will Nicholson gave up his employer-based health insurance.

Having finished his residency, Nicholson, a family medicine doctor in Maplewood, Minn., opted not to take COBRA -- a federal program that would have allowed him to continue the insurance plan from his residency -- and not to get insurance through his new job at St. John's Hospital.

Instead, he said, he plans to buy insurance individually -- a situation he said is a necessity, rather than an option, for many of his patients.

"What I'm trying to do is navigate the private health insurance market," Nicholson said. "A lot of my patients have to deal with this, they have frustrations and problems."

And he hopes to learn more about exactly what those frustrations and problems are by experiencing them himself.

"I'd like to challenge myself to do a little bit more, as a physician, the way I challenge my patients to do a little bit more for their health on a regular basis," Nicholson said.

Through this experiment, he said he hopes to determine what an informed consumer can purchase on the individual insurance market.

"After seven years of medical training, I should be pretty adept at navigating the system," he said.

On the other hand, he said, the experiment may show that insurance can be better had by the individual. He said one thing he hopes to see is whether a savvy consumer could actually save money through the individual market.

While extending his previous coverage would have cost $300 per month, Nicholson said his current plan costs less than $100.

Although Nicholson, 31, said he has no conditions that would require a great deal of medical care, he noted that, "As a physician, I'm acutely aware of the possibility."

Praise for an Imperfect Experiment

"I think it's a great idea. I think it would be great if some of our politicians would do the same thing," said Dr. Robert Barnet, a scholar-in-residence at the Center for Clinical Bioethics at Georgetown University.

He said he had been in favor of an idea with a similar goal.

"I've always thought that it would be a great thing for medical students, young physicians, to go in to the emergency room with sort of a mock illness and see what goes on there," Barnet said. "It's really an extension to what [Nicholson is] talking about. Both things would give a physician an opportunity to empathize with the situation.

"It will give him an experience that will help him understand his patients better. I don't think it will affect a large number of people, unfortunately."

Nicholson's experience will differ in some ways from that of many people on the individual health insurance market.

Barnet noted that most patients on the individual insurance market would not have as much money as a physician -- even one on a starting salary, in addition to being older and having families.

However, he said, "I think it's to be commended, even if it may not give him a totally typical understanding of what's going on. It should give him some taste of it. Just going through the paperwork that you have to [complete] can be a problem."

A Doctor's Insurance Challenges

Nicholson said it is too early in his experiment to know much about the individual health insurance market, aside from what he learned in his role as a doctor.

Some of the frustrations, he said, arise from determining what an individual patient's plan will cover.

However, he said, greater frustrations arise from concerns he has about simply listening to his patients and completing their medical records.

He told of one patient who had lost a job and whose life was falling apart.

"They disclosed to me that they were thinking of ending their own life because it was so hopeless," he said.

After the patient got a new job, that depression was considered a pre-existing condition.

"You have to worry what you start documenting on people, that it's going to be used against them," Nicholson said. "If you can't be safe telling your doctor what your problems are, you've got a lot of big problems in health care.

"I just think the simple idea is that everybody in the health care equation had to put the patient first, even in the most paltry sense," he said. "That would make a huge difference in our health care system."