I’ve heard US health care called a lot of things, but the
one that has me both laughing and angry is “the best health care in the world.”
For one thing, we’re not even ranked at the top. Last I heard, we were ranked 37th in health
care, according to the World Health Organization.
37th place is nowhere near first place. But I digress.
Let’s talk about availability of health care. In the US, if you need to see your doctor,
you need to make an appointment months in advance. If it’s critical, chances are your doctor
will pawn you off on a PA, or Physician’s Assistant. I don’t know what the educational requirements are to become a
PA, but in my personal experience, I would have been better off seeing a
nurse. The PA I saw did absolutely nothing,
plus, I had to pay for the appointment, despite the fact that nothing was
done. And it wasn’t cheap.
If your needs are more critical, every last help line
you might call has a recording that says, “If this is an emergency, hang up and
dial 911.”
Nowhere in there do they say what’s going to happen if
you’re poor and you actually do this.
For one thing, do you really think the ambulance they may send out is
going to be free? No way.
Then there’s the hospital bill, because remember: if you’re
uninsured, this is America. Meaning,
too bad if you can’t afford insurance…you’re supposed to have thought of that
long before you got sick. You should
instead have neglected to eat, gas up your car to go to work, pay your rent or
mortgage or your utility bills, in favor of paying hundreds of dollars per
month for health insurance, even though that insurance company isn’t required
to cover anything and you may wind up paying all coverage yourself,
anyway.
Let’s assume your problem isn’t an emergency…by the time you
get to any kind of emergency, you automatically know you’re
screwed. Instead, let’s assume this is
some kind of routine issue. Say you’re
having headaches or some kind of knee or foot pain. Though some headaches are life-threatening, let’s say these are
non-life-threatening headaches that are keeping you from doing things you would
normally do in your life, or some kind of knee or foot pain that causes you to
cry out in pain when you walk.
The first thing you need to do, particularly if uninsured
(though being insured really doesn’t magically change things), is to figure out
how much health care you can afford. I
hear conservatives mentioning how health care that’s anything other than 100%
insurance company controlled will be “rationed,” but frankly, rationing health
care because you simply cannot afford it is about as rationed as you can get.
So maybe at this point you’ve realized you’re screwed, so
you suck it up, deal with your pain, end of story.
Should you choose to persevere, unfortunately, getting
health care isn’t simply a case of calling the doctor’s office and getting a
ballpark figure. Matter of fact, most
of the time, they won’t even give you a set price. And that price doesn’t include all of those wonderful “extras”
that are usually part and parcel of getting health care, things like…tests.
For every test, there is an equal and opposite lab fee.
I once went to a doctor who diagnosed allergies as my
problem. Since he didn’t know which
ones, he recommended certain allergy tests, and even though I was insured at
the time, I wanted to find out how much these tests would set me back, because
remember, nothing is covered 100%, not even with the best of the best
insurance, which is what mine certainly wasn’t.
The doctor wrote something for me to hand in at the nurse’s
desk as I left, where I should have gotten a price. The person who normally talked to patients about these tests
wasn’t in.
This began a three week process of calling around to find
out the price of these damn tests. I
didn’t call every day, but since I had to work these calls in between my
work, I couldn’t be spending all of my waking hours on the horn to the doctor’s
office.
The person at the doctor’s office apparently didn’t want to
do the work herself to find out the price, so she gave me the direct
number of the lab. Not good, but
okay. I called the lab.
The lab wanted to know the codes for the tests. How in the eff did I know? Mind you, I was just a patient. Matter of fact, the lab usually didn’t talk
to patients…they spoke to personnel at doctor’s offices, so my request was quite
unusual.
I still had to work around the doctor’s office, and so I
played phone tag with the person whose job it should have been in the first
place, that administrative person, who had the paid job to call around
to find out prices. I finally managed
to reach her for the codes for the lab.
By then, I was so annoyed with the whole thing, I didn’t
bother to get the pricing. Money was
running short, anyway, and whatever my allergies were, an OTC remedy was just
going to have to do. Which it didn’t,
but c’est la vie when you live in the US and your money either stretches
enough, or screw you.
I contrast my experience with those of my friends. I have several friends in many different
areas in Europe and Canada.
My friend in Belgium has spent days in the hospital,
with treatments for severe back pain, with a bill that was so nominal, we can’t
even see a doctor (or the aforementioned PA) for that little money.
At my request, my friend in England looked at his doctor’s
schedule. He found he could see him
within a couple of days, efficiently making an appointment online. If he had something more immediate,
something that, say, wasn’t a true emergency but required seeing a
doctor—not a PA—he can see one on the same day, but there’s no
guarantee it will be his own doctor.
I don’t know about you, but I would much rather see a
real doctor than a PA, even if it’s not my “regular” doctor.
If my spouse wants to see a doctor (not a specialist, just
the usual old GP for a yearly checkup to get a prescription renewed), that
requires making an appointment at least three months in advance. An appointment which definitely won’t be
covered by insurance, because we don’t have any, but when we did, it wasn’t
covered anyway…and why not?
Because we had a killer deductible. And ironically, what I call a “killer
deductible” wasn’t even a really high one, like $2500 or $5000. (Yes, deductibles like this really
exist. No kidding. You pay a smaller amount for your insurance,
but then you’re banking on the fact that if you have some terrible
illness…oopsie, too bad on you. Because
then you have to cough up the money for the bulk of your care, so while
you’re laying there in the hospital, worried about recovering from whatever
trouble you’ve been having, you also have the additional stress of worrying how
in the hell you’re going to pay for all of the care you’ve received, the
$2000 bandages and such, because your insurance defers those payments to you. And you have to pay that money out of
pocket until the amount of your deductible is reached.)
Because you are paying for the “privilege” of having
insurance, you can rest easy, knowing your insurance company will bargain down
the hospital or doctor’s price, right? Wrong. If you haven’t paid off your deductible,
your insurance company won’t do anything to negotiate or bargain the
price. You simply pay the uninsured
price, even though you are, technically, insured.
And so, you pay top dollar to see a doctor or go to a
hospital, you pay top dollar for tests, you pay top dollar for care plus other
incidentals before your deductible has been met, and then…
You pay on top of that.
Because you can’t forget about paying those premiums or your insurance
company is out of the picture and you become one of the Uninsured. Meaning you are a deadbeat, implying
you’re frivolously enjoying your riches while forcing your insurance company
CEO to slum it. Sadly, this very likely
isn’t for a frivolous reason, like you perhaps chose to vacation instead of
spending money on health insurance or you bought a very expensive sports car. Usually, it’s because you have to pay for
your housing, food, utilities, transportation, etc., your basic
bills. But insurance companies neither
care nor understand…an insurance company CEO just wants that bottom line to
keep booming with money. It doesn’t
matter if you’re at their mercy for basic health care…what matters is how much
money they can make from you, a nice chunk of it going to pay for politicians
to make decisions favorable to them.
That’s right, being a CEO of a health insurance company doesn’t just
mean raking in the bucks out of the pockets of customers; it also means
paying a politician good damn money to make sure they can keep raking in
the bucks out of customers’ pockets.
And this is the problem inherent in American health
care. It’s the fact that we pay a
middle man to do pretty much nothing.
The fact is that if we were to cut health insurance companies completely
out of the picture like the virulent cancer they are, if we were able to make
deals directly with doctors and hospitals to cover our own costs, we’d be paying
but a fraction of what we pay now.
The truth is that insurance companies aren’t so much “negotiating” with
medical service providers to give you a better deal…what they’re really
doing is negotiating down the unrealistically high prices medical practitioners
charge, where the amount charged for services is jacked up so those medical
practitioners can get an amount at least equal to what they’ve paid out
for their equipment, time, etc, after the insurance companies have
already stolen the largest percentages, so their CEOs may live in high
style. That cost is added to your
health care bill, so it can be handed off to you. An insurance company will negotiate the
price, not to save you money, but to save them money, and thus,
they can turn a larger profit. If it’s
to negotiate a better price for you…you’re on your own.
While I’ll give you that some of these extra charges levied
by health care practitioners are hugely exorbitant, many aren’t. Many of those charges have to make up for
the fact that these days, a lot of doctors are themselves scrambling to
survive, because they’re often forced to cover services not at all
covered, and rather than seeing their patients go without, they help out the
best they can.
I don’t want to paint all doctors in the self-sacrificing
light, since there are many who are in it simply for profit, but there are
certainly a great many who take their Hippocratic oath seriously and
want to see their patients thrive.
Or at least get well.
I began talking about all of the steps involved in getting
health care for some problem, such as headaches, knee pain, foot pain,
etc. Obviously, getting health care is
not even an option for many these days.
So what’s the answer? Keep
handing our money to insurance companies, so their CEOs can say, “The hell with
you…I’m going on vacation!” Or do we
get the same thing other countries already enjoy…hassle-free health care? Health care we all subsidize, meaning
we all get it, and no middle man is there to “handle” the money for us
first.
I don’t know about you, but when I go grocery shopping, I
don’t first hand my money over to a guy who takes a few bucks off the top and
then hands the rest to the cashier, negotiating my groceries back down into the
stratosphere after huge amounts were added to it to appease that middle
man. I pay for my groceries and I get
groceries. Insurance is the only
business where someone is actually allowed to take a nice cut off the
top for themselves…and give nothing in return. It’s kind of like the stereotypical stories about the Mafia as
portrayed on TV…the guys go in for their “protection” money from the hapless
shopkeeper, they take the big wad of cash, skim off what they want (the largest
portion), and the shopkeeper gets the measly few dollars left, at risk of
broken knees. Only with insurance
companies in health care, they not only break your knees for the money, but
then they tell you to go bankrupt for your health care, because maybe you earn
too little money to pay them in the first place.
But that’s right.
We’re the “best.” Or “we’re
number 37!”
