Feb. 13, 2008 -- After a barrage of criticism from doctors, privacy groups and government officials, insurance giant Blue Cross announced Tuesday evening that it would halt letters it had sent to California physicians that urged them to report patients' pre-existing health conditions, possibly causing them to lose insurance coverage, according to The Los Angeles Times.
Doctors across the country seethed with indignation at the requests, which they felt placed business interests over the needs of patients.
"This is outrageous," says Dr. Arthur Feldman, chairman of medicine at Jefferson Medical School in Philadelphia. "The 'Blues' are sitting on billions of dollars while most cannot afford health insurance and 46 million have no insurance. This will require congressional action."
"This so simply and succinctly exposes what health care 'insurance' in the United States is: a business," says Dr. Joanna Cain, director of the Center for Women's Health at Oregon Health and Science University in Portland.
"For a business, this makes sense," she says. "For a basic service that more Americans every day are losing access to, that will impact the financial future of the nation with a less healthy population, and that makes us the laughing stock of the developed world for not covering basic medical care for our citizens, it makes no more sense than any of our health care financing schemes."
The doctors' reactions to the proposal by the state's largest for-profit health insurer echoes that of the California Medical Association, which blasted the idea Tuesday morning. Dr. Richard Frankenstein, president of the Association, told The Associated Press that the letter sent by the insurer asks doctors to "violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality."
Cost-Cutting Effort, Company Says
Telephone messages left with the press office of WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, were not immediately returned. A spokesperson for the company told the Times, who broke the story Tuesday morning, that the request was made in an effort to cut costs for members.
The letter that the company sent out to doctors clearly implies that these cuts would come from revoked medical coverage for members who did not report certain pre-existing conditions.
"We ask for your assistance to help identify medical omissions because you, being the primary care provider, will have firsthand knowledge of services provided or requested," the letter reads. "Within the first two years of membership, Blue Cross has the right to cancel the member's policy back to its effective date for failure to disclose medical history."
Doctors say the approach is flawed -- and could ultimately damage the trust between doctors and their patients.
"Personally, I believe it is another corrupted concept by insurers," says Dr. Joel Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor.
"While I understand the importance of that info to them, physicians cannot be asked to compromise the special trust and relationship we develop with our patients. We cannot be cast into a policing role to enhance insurers' profitability."
Dr. Walter Peterson, professor emeritus of medicine at the UTSW Medical Center in Dallas, agrees. "I applaud any effort to save money, but it should not be a doctor's responsibility to blow the whistle on his patient," he says. "If a patient has lied on his or her application [about] pre-existing conditions, it is up to the carrier to find out, not a physician."
And Saper says patient health could be the main casualty if the doctor-patient relationship is strained. He notes that if patients fear their doctors will report discrepancies in their medical records, "it will induce patients to be inaccurate in the timeline of their illness patterns, which must be accurate in order to establish the correct diagnosis and clinical perspective, and so much more."
Others worry that such a system could prevent patients from getting needed care simply because it would become unaffordable without insurance.
A Sign of Things to Come?
But along with their indignation at the Blue Cross letter, some doctors say they fear that this cost-cutting tactic could become a trend -- especially as new diagnostic tests for disease or disease risk enter the medical realm.
"I do believe this is the wave of the future, and it will become more prevalent as we move into the genomics and specifically gene screening for disease risk and, in particular risk for diseases for which there is no treatment," says Dr. Mike Hogan, assistant professor of medicine at the Mayo Clinic in Rochester, Minn.
Others, like Dr. Sanjeev Saksena, say that the development should be regarded as a call for universal health care.
"This is already being done in other surreptitious ways by all insurers," says Saksena, professor of medicine at the Robert Wood Johnson Medical School.
"One of these days our public will realize that not-for-profit payers are needed for health care and finally appreciate what all other Western nations know -- universal health care is needed and cannot be provided by the for-profit sector."