Editorial: Exercising free speech carries cost

Wednesday, Oct. 2, 2002 | 9:03 a.m.

Doctors, especially obstetricians, for months now have said that health insurers aren't reimbursing them adequately for the care they provide. This has created a hardship, the OB-GYNs say, when the lower reimbursement rates are coupled with the skyrocketing rates for medical malpractice insurance they've had to pay, forcing some of them to leave the state or consider doing so. On Sept. 18 doctors who are members of the Clark County OB-GYN Society met with Gov. Kenny Guinn to complain about what they say are low reimbursement rates from Nevada's Medicaid program for low-income patients. The doctors also want to eliminate the need to get insurer permission to perform some services.

One of the insurers that helps run the state's Medicaid program, Sierra Health Services, subsequently decided to drop from its plan obstetricians who had met with the governor. Under the terms of its contract with the physicians, either the insurer or the doctor can end the relationship for any reason, but that doesn't mean Sierra Health's decision was right. Doctors shouldn't be afraid to speak their minds, and Sierra Health's terminations will have a chilling effect on free speech for physicians in its plan.

Jenny DesVaux Oakes, assistant vice president of Sierra Health Services, told Sun reporter Steve Kanigher that the insurer opted to terminate "a small number" of obstetricians because of their vocal opposition to managed care companies. "They've made a a lot of statements we take issue with, and a lot of their statements have been inaccurate and misleading," DesVaux said. "We don't think it's appropriate to send our clients to a provider who criticizes the plan under which our clients are covered. We don't want to send pregnant women to someone who is reluctant to provide care." But this issue had nothing to do with the quality of care that pregnant women were receiving. This was all about doctors meeting with the governor and suggesting that the state's current Medicaid program was creating a hardship.

When we go to see a doctor, we expect that they will provide us with an unbiased, honest assessment about what's the best course of treatment to cure what ails us. We don't want the insurer dictating what care we should receive -- we want the doctor to have that power. In the same vein, doctors should be free to meet with elected officials and honestly tell them what business relationships they are in that have the potential to harm their practices. If doctors have to limit the number of patients they see or even shut down, because of the difficulties they're experiencing with managed care, ultimately the quality of medical care will be impaired.