For me, it comes down to this. You've got some symptoms, so you go to the doctor. The receptionist asks you for your insurance information and makes you sign a form that says you promise to pay any charges not covered by insurance, no matter how large. You fill out a bunch of other forms authorizing your doctor to share your sensitive medical information with insurance people, who offer you no guarantees of privacy. You wait, sometimes for a couple of hours. You see the doctor. The doctor takes tests (sends samples to a lab not covered by your insurance; you get a bill). The doctor spends five minutes with you because he can't afford to dawdle, unless he can work a procedure into it, which he gets paid for separately from the office visit.
Days or weeks later, you get the results back. It's something serious. He refers you to a specialist. You go to the specialist. Same insurance drill. You see the specialist. He's a putz. He doesn't know his ass from a hole in the ground. He picks his nose and chews his boogers. All he tells you is that some people die from this, some people get better. We'll cut the top of your head off and take it from there. You want a second opinion.
You go to another specialist. What insurance do you have? Sorry, we don't take that. Do you have out of network coverage? I think so. What's your maximum out of pocket? What's the deductible? What are the co-pays. If you need surgery, you have to work out a deal with the anesthesiologist yourself because they don't take insurance. Now you get to see the new guy. He's great. He knows exactly what's wrong with you. He's treated 5000 people with the same thing, and they all live to be 95. He's gonna save your life, make you feel like you're 25 all over again. Thank god. How much is this gonna cost me? We don't know, could be a few hundred, could be a few thousand. Could be more.
All through this, you get "explanations of benefits" that explain absolutely nothing, and bills from people you never even heard of for stuff that was never done to you, but you're getting sicker, and something has to be done. So now you have a choice: Let the angel in the white coat save your life and wipe out your savings, or let the putz sew boogers into your cranium for free.
OK, so maybe this is a bit of a caricature, but not that much of one. No matter how good any of these doctors is, the first thing you talk about is insurance and money. While you're getting diagnosed, you talk about insurance and money. All of your choices are influenced by insurance and financial concerns. You spend more time on the financial implications of your illness than you do on the medical concerns. Once you're cured, you spend months, maybe years, filing and re-filing the same claims that have been inexplicably rejected, and all this is with "good" insurance. The administrative and financial burden, under the best of circumstances, infuriates you and distracts you from the task of getting better, or taking care of a sick loved one. Moreover, none of this actually about making good health care decisions. Rather, it is about clawing the right quantity of the right kind of care out of the P&L statement of an insurance company that for completely arbitrary and impenetrable reasons has contracts with some doctors but not with others.
Even in a market dominated, capitalist society, it does not have to be this way. Despite the right-wing rhetoric, France, Germany, and Holland are not communist countries. Switzerland is not a communist country. England is not a communist country. All of these countries have simpler systems that provide high levels of care and better outcomes overall at lower costs, without forcing people to do the insurance dance and worry about bankruptcy. Some are single payer; some have a mix of private and public insurance. However, they all have strong, central government bureaucracies that impose universal coverage and consistency without requiring patients to go nuts with paperwork. They all have compromises, but not the ones we're stuck with.
It's also not this way in the United States, if you're over 65 (or at one time, 62). My father had a massive stroke when he was 56 that left him permanently, severely disabled and forced him to retire, at greatly reduced pension. To get to that level, he had to spend four months in hospitals and inpatient rehab, and a year in outpatient physical and occupational therapy, while seeing multiple medical specialists. Managing the insurance and bills became such a huge task that my mother had to cut back on her teaching courseload and hire someone to help her.
Magically, when my father turned 62 (and became eligible for Medicare), all this went away. No more secretary at home. Doctors who wouldn't see my father welcomed him with open arms. Hospital admissions took minutes instead of hours or days. Out of pocket medical expenses were virtually nil. All at a lower overall cost (according to those pesky EOB's) than with private insurance.
No one who has ever been sick and had to deal with the nightmare of our insurance system could spout the nonsense that passes for debate in Congress. Not that I would wish any ill will on, say, Mitch McConnell or Jim Boehner, but maybe these guys might learn something from, say, a heart attack or a brain tumor. Then again, maybe they've already been sick and went to see Dr. Putz, who sewed so much snot into their craniums that the drivel they've been spouting is the best they can do.
2 comments:
Does this work? Do you get the comments? It all seems a bit suspicious to me. In any case, what impresses me the most is that you have will to form a coherent, intelligible position on this and then write about it. Me, every time I look at the front page of the times and think about this health care "debate," I lose my will to live. I admire your maturity that you can actually look at this and think about it and then write about it instead of rolling up into a ball and drinking gin and tonics. Will be in NYC in two weekends; wanna go have one?
Yup, I get the comments. In a rare moment of weakness, I watched Meet the Press this morning, which featured a panel discussion on health care reform. On the right were Dick Armey and Tom Coburn; on the left were Rachel Maddow and Tom Daschle. The level of dishonesty, evasion, and misdirection on the part of Armey and Coburn was absolutely stunning. Daschle was a complete wuss about the whole thing. We are doomed. But year, G&T sounds nice.
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