I am a specialist in Infectious Diseases. Last month, a patient of mine came very close to dying with the scariest infection I have seen for quite some time. Through her determination and the hard work of some very capable doctors and nurses, she pulled through, and was able to return home to her husband and small children on oral antibiotics. All’s well that ends well. Or so I thought.

Privacy rules prevent me from giving details, but suffice it to say that the diagnosis of what she had is most often made on autopsy. This was a tremendous save of an otherwise very healthy young mother. Her case was the topic of the Hospital’s "Grand Rounds" today, so I called her up earlier in the week to ask if she would be kind enough to attend so that we could hear directly from her what her experience had been like.

On the phone, she seemed a bit shaky and hedged when I asked her how she was feeling. I asked whether she was able to take the antibiotic and I was horrified to hear her say that she had been switched to another drug because her insurance would not cover the one I prescribed. I went ballistic. The medicine she was put on is expressly not used for the organism she had exactly because of higher rates of clinical failure! I only found out about this because I happened to call her. I honestly don’t know what would have happened otherwise.

She paid out of pocket for the right medicine while we fought with the insurance company and I think it is now all settled. It never should have happened in the first place, though. It should never be the case that in a life-threatening situation, expert medical opinion gets overruled by mindless insurance company policy. In a country where health insurance was about health rather than money, I could have settled this issue in about a minute by talking directly to one of their medical directors. Instead, it took a lucky accident and hours of bureaucratic slogging.

If anyone had any doubts about why such a large fraction of us on the front lines support public insurance (at the very least in the form of a public option), cases like this should make it clear. As long as it’s all about money, the best return on investment will not come from good care, but from good lobbyists and bureaucratic roadblocks. Wingnuts: don’t bray to me about bureaucrats coming between you and your doctor. That’s what we have now.