[img]139|left|Jessica Gadsden||no_popup[/img] What do western Europeans do with all of their free time? The last twenty-fourhours of my life have been filled with calls to doctors, and insurance companies trying to get my insurance company to authorize pay for a non-invasive diagnostic screening in lieu of an invasive, expensive one that I’d rather avoid. Needless to say, in our fee-for-service medical marketplace, the doctor (I hesitate to call him my doctor – let’s just say he’s the only specialist available to request the proper authorization) preferred the more expensive one, at, oddly, the potential expense of my personal health.
Instead of battling insurance bureaucrats, I imagine my French or British counterpart is contemplating how to spend her (generous by U.S. standards) vacation time, or is enjoying a leisurely glass of wine or sherry with dinner while I chug my liquor in a hope to settle my nerves between phone calls.
When, in our lobbyist- and special interest-controlled healthcare debate, I keep hearing about doctors making healthcare decisions, I feel like Bizarro Jerry on an episode of “Seinfeld.” My reality is the exact opposite of what’s really going on.
If Wishes Were Horses
I’d love to be insured in a system where my (real) doctor makes healthcare decisions. Last summer I tore my rotator cuff. My current Blue Cross insurance scheme (and it changes every year or so, depending on my job or money situation) requires that I see my primary care physician with any complaints. So I waited the requisite three weeks to get an appointment. She examined me, took some x-rays and scheduled another appointment. She’s cautious about requesting too many authorizations from my insurer.
A month later I took more x-rays, and then she suggested she had enough evidence to request a referral to a rheumatologist. The referral process is a mystery to me. It’s shrouded in more mystery than _______. My best guess is that my doctor describes my ailment to my local insurance bureaucrat, and they approve or deny a specialist visit based upon some mystical criteria based mostly on cost. Several weeks later, I receive my referral by mail.
Back in healthcare’s permissive heyday, I used to be able to schedule an appointment and bring the referral to the appointment. I was kindly informed by Cedars-Sinai last year that they have discontinued that oh-so-generous policy. Too many referrals not getting paid, they said. So I waited until I got my seal of approval (or rather the magic six-digit number), then called to make an appointment. It would take a month to see a specialist, I was told, and I thanked the powers that be that I didn’t have cancer, or that I was in Canada.
I finally get in to see the rheumatologist. His guess, a torn rotator cuff. But first, I’ll need an MRI to confirm it. See that above experience? Rinse, and repeat. Several weeks later, I get in for my incredibly noisy MRI. Then I had to call my PCP to get another referral to see the rheumatologist again. Why? you ask. Because my insurance company will only approve one visit at a time, and Cedars won’t get paid without that six-digit authorization number. Another month goes by, and I’m well into October before I’m receiving treatment for my summer injury.
Lo and behold, that first diagnosis was right. I have a torn rotator cuff. The rheumatologist gives me that all-encompassing cortisone shot and suggests physical therapy – but there’s a hitch. He thinks I would best benefit from ten to twenty sessions of therapy, but my insurance company will only pay for one. Yes, one. Their theory (and I asked) is that I can learn all I need in one session and do my own therapy at home.
And this is from my 100 percent employer insurance coverage. Many Americans, I suspect, could tell this story again and again, only substituting the ailment. Now where are doctors making decisions? At every point in my care where a decision needed to be made, Anthem Blue Cross either pulled the trigger or not. Three doctors and one patient had very little to say in the process. Now that’s rationing care. I’m currently operating under the theory that if they just push off my care until the day after never, then I probably wouldn’t be insured by the time any injury or illness is truly exacerbated.
A Winding, Twisting Sad Tale
Months ago, you may remember, I wrote my plaintive public letter to President Obama, hoping for true healthcare reform. Unfortunately, my future looks like much of the same, only more expensive. My pleas remain unanswered.
Either I haven’t lived long enough or I’ve become utterly naïve in my dotage, because I never expected health care ‘reform’ to transform into a $700 billion subsidy to pharmaceutical and insurance companies – with absolutely no cost controls – whatsoever.
The current leading House and Senate proposals on the table, all look like an expanded version of the Massachusetts plan. (I spent several long years in Massachusetts, and let me tell you, this is not the state I would turn to for good reform ideas. Ideas on how to tax, yes. Reform, never.) But in his own dotage, Ted Kennedy (who has healthcare – and alternately works from a boat in Florida or a beach in Cape Cod) has had far too much influence on healthcare policy. And the President is now considering a plan that mandates everyone have healthcare, with no money to pay for it. I never expected the phrase “unfunded mandate” to rear its ugly head during a Democratic administration, but here it is.
Piggybacking on the idea that half of America’s uninsured are without coverage out of choice (it couldn’t possibly be those nearly $8,000 per year per person premiums), the current fad is to require everyone to buy health insurance.
No, you didn’t read this wrong.
Not everyone receive access to quality healthcare as a basic human right, but instead everyone fork over their hard earned cash to a for-profit industry known for its single-minded focus on loss ratios in addition to its rationing. And if you can’t afford care (and what you can afford is still being debated – but right now 12.5 percent of your income is likely “affordable”), the government may pay part of it for you. So, yes, President Obama, many industry leaders came to the table to discuss health care, and many of them left with the biggest party favor of all – guaranteed government payments – and if they play their cards right, ever ballooning profit.
And, us little guys – who, incidentally, didn’t get a seat at the table and were lucky to squeeze into a seat at a town hall meeting, next to the aforementioned industry insiders, are left with another scheme to enrich the already rich, but we’ll be no healthier for it.
Jessica Gadsden has been controversial since the day she discovered her inner soapbox. She excoriated the cheerleaders on the editorial page of her high school paper, transferred from a co-educational university to a women's college to protest the gender-biased curfew policy, published a newspaper in law school that raked the dean over the coals with (among other things) the headline, “Law School Supports Drug Use”—and that was before she got serious about speaking out. Progressive doesn't begin to define her political views. A reformed lawyer, she is a fulltime novelist who writes under a pseudonym, of course. A Brooklyn native, she divided her college years between Hampton University and Smith.
Ms. Gadsden’s essays appear every other Tuesday. She may be contacted at www.pennermag.com
