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Posted over 3 years ago
One of the animating principles (or should I say ideologies) of the Obama Administration’s health reform effort is the notion that Americans who have health insurance “like their insurance.” To genuinely address the underlying problems in our health care system in ways even the President admits would be the most effective — like having some form of national, tax supported health care system, Obama says repeatedly, would “disrupt” peoples’ health insurance. Well let me tell you from long and hard personal experience and observation, I do not know anyone who “likes” their health insurance because I do not know anyone who likes their health insurer. People like being insured. But they do not like the fact that they are not getting what they paid for. Nor do they like the fact that their health insurance is already being “disrupted’ not by reform efforts but by their health insurance company.
Tell me what other product you purchase — and make no mistake about it, we are purchasing our health insurance even if we get it as a benefit of employment because health care as a benefit exists in lieu of salary improvements — where it is standard operating procedure for the seller not to deliver the service the buyer has bought. If you go to a store to purchase say a dining room set, and you pay $5,000 for the table with three leaves and eight chairs, does the store routinely deliver a table with one leaf and five chairs? If you call and explain that you didn’t get the extra two leaves and three chairs do they respond,”well of course you paid for everything but when you sent the check in you didn’t sign in script but rather block letters.” Do they tell you that you can’t have the extra three chairs because you didn’t explain that you were routinely planning to have eight guests for dinner? When you made the purchase, did they tell you they were sorry that but you can’t buy the dining room set because you have a pre-existing condition –i.e. you like to eat dinner in a dining room?
Well that is exactly what happens when we spend our hard earned dollars on health care. Let me give you an example of the kind of “disruption” that is typical under the current system — a disruption that the none of the plans now wending their way through Congress will address. Last year, my husband traveled to El Salvador to visit my daughter who was working there with an NGO. Before he left he got a lot of shots. The travel clinic at the Mount Auburn Hospital offered him a rabies shot but the doctor told him it probably wasn’t necessary because he’d only be away a week. There wasn’t much risk of him getting bitten by a dog in that period of time.
So guess what, day four of his journey, he goes out for a run, and a dog that’s just lying on the side of the road, leaps out and bites him. He goes to the hospital to get it disinfected but they don’t give him any Rabies shots. Needless to say, in a poor country with a lot of feral dogs, no one put the dog in quarantine for ten days to see if it had Rabies.
When my husband got home he told his Primary Care doc about the dog bite and asked about Rabies shots. That’s a no brainer, the doctor responded, of course you have to get the shots. So my husband went to the clinic at which is in a local hospital to get ten Rabies shots at the cost of $1000. If my husband didn’t get the shots and developed Rabies in a few months or a year, he would definitely die — and his death would cost a whole lot more than $1000. No matter, the insurer wouldn’t pay the bill. Why? Because it wasn’t coded as “medically necessary.” As if he were just bored and wandered into a clinic begging for ten painful shots.
Much back and forthing between us and the insurer and hospital and when the “medically necessary” coding was inserted, the insurer refused to pay the bill because they don’t pay for shots given at a hospital but only in a doctor’s office, clinic or ER. Much more back and forthing to explain that the shots were in fact given in a clinic that just happened to be in a hospital. For over a year, my husband spent hours — and I do mean hours — on the phone with the hospital, doctor’s office, insurance company 800 number trying to get the three — not one, three — bill collectors off our backs about these shots. Finally, he had to call his company’s HR department to get them to sort it out. Although the bills were finally paid, we are still receiving harassing notes from one of the bill collectors (you got it, none of the arms knows what the others are doing). The amount of time and money the hospital, doctor’s staff, insurance company, and my husband’s employer had to expend on this beggars the imagination. Aren’t there better things we could do with our health care dollars?
So this is what happens routinely to those of us who supposedly love our insurance and don’t want our lives disrupted by reform. I voted for Obama. Unlike right wing talk show hosts, I want things to work out well. But the animating ideology has to change if we are to really reform our health care system. We need a reality check in Washington. How about this for an idea. Before they determine how health care should — or should not change — let every member of Congress experience a real private plan as opposed to their socialized medical insurance — for a year. Make sure everyone in their family has at least one encounter with the health insurance system and then see, do you like your insurance? Do you want to disrupt it? I think the answers will be no and then yes.