Tuesday, September 18, 2012

“The Best Health Care in the World”

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!”