Tuesday, September 08, 2009

Why We Need Health Care/Insurance Reform

Whinge Alert: This Post Contains Several Paragraphs of Complaint. Do not proceed if you are not in the mood for a rant.

Those of you who are regular readers of this little blog will know that I have some health issues, and have had some challenging times in and out of the hospital in recent years.

I switched health insurance to the diocesan plan when I was hired for the deacon-in-Charge position at St Middle School. This was a blessing; my COBRA coverage as a retired employee of the BankThatIsNoMore was about to run out.

First challenge: find a Primary Care Physician. They assigned one. That's fine. I recognize that getting a PCP under this plan would mean I would leave the doctor who had served as my PCP for 15 years, but the good news was that my specialists participated in the program, so the really complex stuff wouldn't require a change. The insurance company assigned me a PCP in my area. So far, so good.

On Friday, we went to the ER in the evening, because I had some brutal pain on my left side for which there was no explanation, and it had progressed from an annoyance in the morning to a scream-each-time-I-move by late afternoon. The hospital took good care of me, ruled out a heart attack, then an embolism, then a couple of other nasty things, and gave me mondo painkillers and sent me home with the instructions to follow up with my PCP. I was grateful for their quick and thorough care, and was also grateful that I had my little insurance card.

Long holiday weekend. Some discomfort, but the Flexeril and OxyCodone kep me reasonably functional. The pain persisted, though, so I thought I really should get to the PCP for the follow-up.

So today was the day of trying to get the follow-up appointment. I couldn't even get through to the office of the PCP they assigned me until about an hour ago. Then the receptionist said "We don't participate in your insurance."

"Gee," I said, "the insurance company itself assigned me to your doc."
"Well," "said the receptionist, "I guess you'd better call up the insurance company."

So I called up the insurance company. After meandering through their automated system for ten minutes, I got a real live person, who looked up the doctor's name and said, "we show her on our system as a participating physician. Hang on a sec." So I sat there on hold while she called up the doctor's office, where she was told the same thing that I was. The insurance rep told me that the doctor's receptionist didn't seem too swift, and that she would be happy to help me find another doc. So she started gathering some names for me, and we were promptly disconnected.

I called the insurance company back, eventually got another customer service rep, who apologized profusely for the disconnect, and then set about coming up with some other options for me. We agreed that the most efficient thing would be for her to email me the list.

Great, right? It's been an hour, and I still don't have the email with the options.

The good news is that I was able to negotiate their website and find a doc on my own (I think this doc is participating in this particular subset of this particular subgroup of this particular plan - it's not completely clear on the website, but the receptionist seems to think we're good). I had to go through a number of docs on the list before I found one that could see me sooner than three weeks from now, even though this was a followup subsequent to an ER visit.

Took me the better part of an hour and a half to get this sorted out. If I had been elderly, with bad hearing, and in some discomfort from my infirmities, I would have given up fairly early on.

And if I was still experiencing something near the level of pain that I had when I went to the ER, I would go back there rather than trying to make an appointment with a doctor. And we all know that going to the ER is much more expensive for the whole system than going to the doctor's office.

And if English wasn't my first language, or if my illnesses made me difficult to understand....who knows what I would have done.

Contrast this, then, with single payer plans in Canada and England, where the access is relatively quick (certainly not two-three weeks for someone with an active medical problem), where you don't have to check in each time to see if your doctor participates in the plan, where you don't need a referral each time you go see the specialist for a chronic illness...

You get the picture. I was lucky. I got quick service in the ER, and I found someone who will see me for the follow-up visit on Thursday (no idea whether she's any good or not - we'll cross that bridge later - in my experience, physicians who participate in this kind of plan are young and are using it to build a practice base, and that could be good or it could be bad), and I didn't have a heart attack, even though I had several of the symptoms.

But the system as it is currently configured is clumsy and confusing at best, and exclusionary for those who need it most at its worst.

So when I hear people saying that single-payer should be off the table, I really try not to wish them a chronic illness, but I sure wonder how their perspective would be changed if they did.

Socialized medicine? Perhaps. Medicine that serves society? I sure hope so.

1 comment:

Maggie said...

What a story! And this is the system that so many are bound and determined to preserve. Oy vey. My siblings and I are having the worst time getting any kind of coordinated care for our 81 year old mother,who has multiple medical problems. In the UK she would have a GP who would coordinate her care. No such luck here in the US of A.