Health Care/Joan Retsinas

Enter the Pseudo-Docs: When Judges, Legislators, Citizens Don Scrubs

Enter the pseudo-docs. Judges, legislators, and ideologue-citizens have donned scrubs, pushing into the medical arena.

Consider the Supreme Court justices who tossed abortion to the states, in effect leaving legislators, bound to constituents, bound to ideology, bound to contributors, to decide the fate of women with ectopic pregnancies, women bearing moribund fetuses, women suffering from rape or incest. Physicians’ judgment? Irrelevant. Let the pseudo-docs decide.

Why not throw emergency contraception and intrauterine devices into the hands of pseudo-docs? Missouri state Sen. Paul Wieland, joined with the Thomas More Society, wants to restrict not only access to abortion, but to those services.

Consider too the judges who have morphed into experts on primary care tests. What is, or isn’t, medically necessary? Is a yearly physical exam a luxury? What about Pap smears? Diagnostic x-rays? Mammograms? Colonoscopies? Who decides? In the long ago past of the Affordable Care Act, a panel of physicians, the US Preventive Services Task Force, pointed to a grab bag of preventive measures, dubbing these essential. As such, a legitimate insurance plan should include them, with no co-payments. The panel of medical experts decided.

Enter the court in this new era when Justices trump (I use the word advisedly) physicians. Why let physicians rule on matters of health?

Texas Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas responded: Let insurers rule. Let those companies decide what they want to cover, and how much they want to charge enrollees. The notion of “essential” preventive care is “unconstitutional,” with no basis in judicial precedents. In this new order, insurers can impose co-payments on those preventive measures that physicians have decided will improve the nation’s health.

The impact on health is clear. Co-pays will most assuredly decrease compliance. With a swathe of Americans staggering under medical debt (a figure that includes people with insurance), many patients will hesitate to pay for a preventive exam, even though the subsequent lumpectomy or colon surgery may, in retrospect, show that decision as ill-advised. But patients without hindsight are gambling that any test would show up “negative.”

The rationale for the ruling laid the blame for the ACA “essential provisions” on the ACA panels: the list was not sufficiently vetted, not sufficiently open to public scrutiny, as though a panel of physicians must go for a plebiscite on the worth of mammograms, or colonoscopies.

That same judge jumped more audaciously into the medical arena, echoing the religious mindset of the Supreme Court justices who couldn’t accept a plurality of views about abortion.

Judge O’Connor looked at the preventive treatment for HIV (PrEP) for people most at risk of HIV. The Affordable Care Act had included that treatment, plus HIV testing, as essential. A Christian-owned company balked at covering HIV-prevention because the people at most risk are men who have sex with men. The company, objecting to homosexual sex, sued. Judge O’Connor agreed: under the Religious Freedom Restoration Act, companies need not insure for activities that violated their religious beliefs. The court has asked for supplemental briefs before making a final decision.

In 2018 Judge O’Connor had ruled the entire Affordable Care Act unconstitutional, a ruling that the Supreme Court reversed.

Patients look to physicians when they are ill. No longer: we have pseudo-docs.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, November 1, 2022

Populist.com