On the day that the House Democrats present a bill that includes the public option, Dr. Marc K. Siegel, an internist, looks at his roster of patients to see how many would be helped.

Siegel appears to have a pretty ordinary group of patients:

I have a varied practice, with patients ranging from rich to poor, from chronically ill to “worried well.” On any given day, I see at least one quarter of cases (including Medicaid patients) without charge; one or two come in without insurance and pay me cash. Most of the time, I accept the patient’s HMO or Medicare without looking closely at how much I get paid.

Siegel goes into particular cases (using pseudonyms for his patients), including Jeff, a part-time janitor who doesn’t quite qualify for Medicaid. Siegel sees him for high blood pressure and charges him a minimal fee. What would the public option mean for Jeff?

A bit of a hypochondriac, Jeff calls me often for reassurance, which I happily give. He’d likely qualify for a public option — and be liberated to go to the emergency room for a minor complaint whenever I was unavailable, which he’s reluctant to do right now. (After Massachusetts adopted universal insurance, similar unnecessary visits to the ER rose.)

Celine is in favor of the public option, but it might not be helpful in the real world of daily medical attention:

My patient Celine is a 50-year-old administrative assistant at a small advertising firm. She can barely afford her share (about half) of the premiums for her basic, no-frills HMO coverage. With a troubling family history of breast cancer, she’s comforted by the idea that a public option would provide better, cheaper insurance than she has now. But I worry that her employer might be more inclined to “dump” insurance — and that the public-option insurance will prove unacceptable to the doctors she’s used to seeing, just as Medicaid is.


Do read Siegel’s article—it’s quite fascinating. He notes an already troubling problem that may get worse if we have the public option:

The biggest problem I’m having now is the shrinking network of doctors to refer my patients to for procedures or specialty evaluations. The public option won’t help here — and could make things worse.