My Diatribe on Healthcare Reform

I began a thread on Facebook the other day about the recent appalling recommendation from a government appointed panel that women don't need mammograms until age 50. This set off a fairly interesting conversation amongst serveral of my Facebook friends who have differing opinions on the whole state of health care/proposed reform, etc. As it was I who started this topic, I figured I'd weigh in a bit more on what I think. And, it IS what I think; not necessarily right or wrong or even as informed as it should be. Incidentally, I've found what everyone has posted on my Facebook page to be well thought out and each post has given me food for thought. Which is as it should be.

IMHO, I see the current health care mess as a dysfunctional three-legged stool with a sometimes wobbly seat. By dysfunctional, I mean that, at any given time, one or more of the legs are shorter than the other(s); these legs being: The Government, The Insurance Companies and (let us not forget) The Medical Practices/Health Care Systems. The seat is us consumers; who either take care of ourselves physically and emotionally (or don't); get regular check-ups (or don't); have jobs (regardless of what they pay) or have had jobs in the past or are either retired, have been laid off, have found other means of money (inheritances); whatever (or have never worked and/or contributed in any way to society).

Because I think it's usually best to provide an opinion based on in some part personal experience, here is mine (long-winded as it turned out to be).

Leg One: Insurance Companies. Like most people, I've had my run-ins with them. Most recently, when having to shop around for a new policy, I received a quote from United Health Care (Aetna wouldn't provide an individual policy in NC) for a fairly decent plan. I knew I'd be paying a higher deductible in turn for a lower monthly premium, but, so long as the plan covered preventative/well-women care before deductible, a relatively low co-pay for office visits and a prescription drug plan before deductible, I was ok with it.

I completed an on-line application and received a pretty decent initial quote. I was then required to send in three months worth of premium and wait to hear the official terms of the policy/if I'd REALLY be approved from the underwriters (that dreaded group of folks who must complete their tasks while they are chained up in hell). About two weeks before the effective date of my new policy, I had a phone call from the underwriters. They wanted to know about my prescription for Clarinex (allergy medication); how long I'd been on it, how often I took it, the dosage, etc. I answered all their questions honestly.

A week later, I received my policy in the mail. I'd been approved BUT they had placed a rider in the policy that stated the usual $100 deductible per year for brand drugs was raised to $1,200 per year (there is no deductible for generic drugs, just a $15 co-pay per prescription). It was, of course, no coincidence that Clarinex is only offered in brand form (still under patent). They, in effect, assured that they would not have to pay for the Clarinex because, surprise surprise, a one year's supply is currently about $1,200. Additionally, they raised my monthly premium about $45 per month. I called and inquired as to why. "Because you take a prescription". "Excuse me, don't MOST people, even healthy people, take prescriptions from time to time?" "Why yes, but, that's the way the policy is written". In other words, take it or leave it.
I took it, because a) my other insurance was running out in a week and I done enough shopping around to know that this was about as good as it was going to get; b) other than the prescription thing, it covered everything I wanted it to and c) I could get around them not paying for my allergy medication by switching to Allegra, which does have a generic alternative (which they are covering at $15 per prescription).

However, what if this had been a drug that I desperately needed and either there WAS no generic alternative OR, even if there was, the generic wasn't as effective? As one Facebook friend pointed out, at least I had the option to tell them to go to hell and go find someone else HAD I WANTED TO; and, yet, chances are, I'd have run into the same thing with ANY one of them. For people that are truly sick/need the coverage/have had something denied and have filed a complaint; the insurance companies can be masters at the red tape nightmare. One woman wrote in an editorial (about a battle her cancerous husband had with their insurance company over a claim) that this is one way insurance companies have gotten around the whole pre-existing condition; they don't deny it, rather, they simply keep rejecting it, asking for more input from the doctors, sending more paperwork, etc. until the person gives up (or dies, which is what happened to her husband).

In this regard, I'd love to see some regulation, but, given this recent government panel's recommendation regarding mammograms, I'm no longer so sure that the government alternative would be much better. BTW, what I think I understand about the "reform" is that it isn't as though there will not be private insurance companies that folks can utilize, it is that there will also be what equates to a government insurance company that will provide insurance for anyone and everyone who needs it. Of course, this will mean the rates for the private insurance companies will skyrocket as they loose business. One of the issues that some folks have with the potential for the government insurance company (this is just what I'm calling it) is it's not going to be cheap to cover millions of people who currently do not have insurance (a vast sum of which can't afford to pay for it) and this means either more deficit and/or higher taxes.

The other issue is the concern that certain programs will be cut in order to pay for it and the folks who administer the government insurance company will be ignorant, uniformed, inefficient, have their own share of red tape and rude (think DMV employees and shudder). There is probably also a little bit of, "Why should I have to pay for other lazy slobs to be insured?" I know I sometimes feel this way, but, my feeling is there are more people out there that deserve to be insured but have been caught up in the same stuff I was (but denied for significantly worse conditions) than there are people that are looking for handouts who won't get off their butts and get a job (this would be one set of the wobbly seat contingent).

Leg Two: The Medical Practices/Health Care Systems (hospitals, medical groups, HMOs, PPOs, specialists, labs, pharmacies, etc. etc.) In this, I'm not referring to any particular PERSON (e.g., doctor, nurse, lab technician); although some of the administrative people can be quite rude. Anyway, really, my biggest rant is for this leg. I have countless examples of how ludicrous their fee/rate schedules are, or, how they try to confuse/bully people into paying bills that they are not responsible for. It may be as simple as sending a bill (say, for the difference between what they charged for a procedure and what the insurance company will pay (which they'd agreed to; the whole "preferred provider" thing) OR calling and leaving countless messages to call patient accounting and threatening to send an account to collections (for an amount you don't even owe). Some people, a lot of people, would either assume they owed the money and pay it, or, give in to the threats (especially in this economy when a bad blip on your credit is an even worse blight than it was before).

Here is one example. I had to go to the ER five years ago; nothing serious but Mr. B figured I'd best go. He took me at 2:00 am. They did a few simple fluid tests, I talked to a PA, they gave me TWO pills; but, mostly, I laid there waiting because my situation was not life or death and it was an ER, after all.

There had been a blip in my insurance coverage right around that time as I moved from an employee policy to COBRA. It was the same insurance company, but, they inadvertently dropped me out of the system so I showed up as uninsured. As I dealt with that, I started receiving the bills from my stint in the ER. All totaled, it was something like $2,000 ($100 of that was for the two pills; $50 a pill, give me a break!) $2,000 for, basically, a lab test, a brief consult with a PA, and two pills. It took about a month for the insurance company to get their act together and coordinate with the patient accounting people; in the meantime, I received bills almost daily with threats that they'd go to collections. I called patient accounting and explained what was going on; they wanted me to pay it, the entire $2,000, anyway, and then get reimbursed by the insurance company once the insurance mess got worked out. Uh, I don't THINK so!

What the insurance company ultimately covered was around $250; the rest was written off, yours truly paid absolutely nothing (other than my monthly insurance premium, that is) and I never heard from patient accounting again.

So, a person who did not have insurance would have been stuck with a $2,000 bill. My point here is, these practices are charging the very people who cannot afford and/or have been denied insurance astronomical amounts of money for services.

Along those lines, here is another, more recent example. Mr. B had an ER stay this past June. The hospital/patient accounting somehow missed the fact he had insurance (even though he gave the receptionist his card at check-in). He was sent a huge bill for one particular service but was told if he paid it right away, there would be a 50% discount. What the heck is this? Anyway, his insurance paid about 1/4 of the total bill, the rest was written off. He is STILL getting calls from patient accounting telling him he owes the other 1/4 of the 50% discount because it wasn't paid right away! The insurance company keeps telling Mr. B that he doesn't owe it, yet, they are not bending over backwards to help out by calling patient accounting, either. Are they in co-hoots? I don't know; but, again, this type of crap can't keep going on. Mr. B will sue their pants off if they put something on our credit, but, not everyone has the fortitude and wherewithal to do something like this; to fight back.

Leg Three: The Government. OMG, haven't we ALL had issues with some branch/agency/area our government? I cited the DMV before; I truly do shudder to think about a slew of lazy, uncaring, underpaid people deciding the fate of my health (if that, in fact, is what it will be; I'm not still not sure). Or, anyones health, for that matter. In all fairness to the current administration, they didn't get us into this mess, it's been a long time coming. However, I am annoyed that the two primary parties are spending their time bickering about this and refusing to work together to come up with a plausible solution. So, the Democrats came up with some reform proposal that means higher taxes, more burden on business, higher deficit and the Republicans scream and yell and call for a holy war (that Senator from Utah, gotta love him) and yet refuse to propose something of their own. How does this make sense? So, this will be the entity, potentially, that administers this new reform; a government who won't work together? What sort of worse mess are we going to end up with?

The Wobbly Stool. Us. First off, we need to take better care of ourselves; in general, Americans are so damn unhealthy. Obviously, this is contributing to the problem; an unhealthy person likely requires more medical care, and, if they are not insured, who is paying for the cost of their care? This drives up premiums for everyone else (like the uninsured driver premium we all pay in our car insurance). Even those that are covered who routinely get sick simply because they are not taking care of themselves drives up the cost for everyone else in their rating pool. Hey, I know sometimes a person gets sick, contracts a dreadful disease and it's not their fault, but, there are too many people out there that could do something about the state of their health and they are not. That's one wobbly part. Secondly, if a person has a legitimate medical bill to pay, they should pay it, or, if they cannot, make arrangements to pay it off as they can. No more throwing up the hands and saying, "I can't afford it!"; that doesn't mean you don't OWE it! People walking away from their financial responsibilities, no matter how harsh, is NOT HELPING the situation.

I've spent the better part of an hour writing out this diatribe. And, now that I've come to a close, I have to confess; I'm not really sure what to do about it. I don't believe totally Government run health care is the way to go, however, something has to change in order to keep the insurance companies and the medical providers from continuing to make profits at the expense of consumers bank accounts and lives.

And, consumers need to be more accountable for their health and finances.

So, I'll close with an all-American thing to do; blame our government parties for squabbling about this (and also the government in general); insurance companies and medical providers for not figuring this damn problem out. Hell, if THEY can't, who can? I dunno, perhaps all my super smart Facebook friends who, although are not in agreement, have been making the most sense I've heard about the issue so far!

Mrs. B