“The question of right or wrong” is a complex, delicate and multi-layered issue that has been taken on by so many thought leaders throughout recorded history – from philosophers to essayists to educators, judicial and spiritual leaders to mothers and fathers, just to recognize a few. It is a question that almost never has clear-cut answers but always sparks other questions.

I will narrow the field and concentrate on an issue that affects most Americans: health care, insurance companies and physicians. As complicated and difficult as any other question of “what is right or wrong” are the following few: Can it be “right” that insurance companies dictate the medical care, and therefore the health of Americans, when consumers put their faith in the hands of their doctors, whose influence over the well-being of their patients has been dramatically reduced with each passing year?

While insurance premiums increase between 10-15% each year. the doctor’s reimbursements have been steadily decreasing over the last 5-10 years. Flawed logic in that…similarly, if an insurance company refuses to “allow” a physician to perform the simplest of medical tests the doctor believes is necessary to provide a patient with adequate medical care, that be hardly be considered “fair” or ultimately “right?”

Friends and family are doctors and other medical personnel, I’ll admit. And after dedication to their education, they are finding it necessary to work double the hours to barely make ends meet; many doctors and hospitals are being forced to close their doors because of the economic failure caused by the substandard reimbursements they receive. Administrative personnel are kept waiting on “hold” for forty-five minutes, on average, during all-too frequent phone calls they make in the effort to collect every penny due to the provider. With a click of a mouse, an insurance company can deny a physician reimbursement for an asthma treatment a patient’s health care provider considered essential in doing the “right” thing, possibly saving that patient’s life, responding to that patient’s legitimate respiratory distress.

Here is where I slide in that simplistic but realistic question of “right” and “wrong. Could it possibly be fair that it could take medical support personnel up to forty-five minutes to “fight for” a preauthorization for a scan for a patient who might have a life-threatening blood clot? Is there any way an insurance company could possibly justify the actions of one of its clerks denying a patient a “lung scan” because his or her lung nodule is a microcentimeter below the “required” size? If a patient dies or suffers needlessly because of such a judgment, does the insurance company have any culpability? In terms of “right” and “wrong,” when it takes certain insurance companies seven months to pay for services rendered, who is being served. Similarly, should medical professionals who sacrificed greatly to become doctors need to work a second job to pay for their families’ basic living expenses? Or that talented and motivated hard-working teens who might otherwise seek a career in medicine be turning in other directions, away from long-held dreams of being physicians, because they fear never being able to repay loans or making a significant income? The regrettable reality is that doctors have been relegated to glorified insurance company employees, according to people I love…where is the “right” in that scenario.

Another staggeringly impossible picture: if a patient requires and is able to secure a “pre-authorization” for a critical test or treatment, one is often faced with the alarming paradox that the “authorization” he or she has received may not, ultimately, be valid. It actually defies logic when you consider the process of the patient waiting for the insurance company to approve a particular procedure only to be told that the “authorization” is not “guaranteed?” Consider, too, that any patient who is in a situation in which his or her health or fate may rest on an “early” diagnosis and the factor of terrible stress rears its painful and disturbing head. It’s a miserable situation for both patient and physician, because the physician is not being allowed to provide the patient adequate care, at the very least.

Worst of all, perhaps, is the vexing question of whether or not it can be right that insurance companies have dramatically changed the landscape of medical care for all Americans? And disturbingly can we ask the dreaded question of whether the insurance company executives are profiting greatly at the expense of America’s physicians and the public?

As we all watch the quality of medical care deteriorate as doctors are unable to work under these kinds of constraints or tolerate this situation, what can ordinary citizens do? Until the lives and health care of politicians and those they love are directly impacted by this crisis in health care, I fear that nothing will change.