Thursday, January 8, 2009

A New View from the Inside

Every time I hear any of the entitled ones, whether they be Republican or Democrat, talk about "Health Care," the only thing their little narrow minds can envision is "insurance." I wish it was that easy. I wish that the health care solution could be one of two things:
  1. The really easy fix: All of our health care problems are being caused by evil, profit-mongering insurance companies. The federal government could force them to offer us all health insurance for fifty dollars a month, and cover it 100%, and we would all be healthy and happy.
  2. The "throw money at it" fix: We need to replace greedy, capitalistic health insurance companies with a benevolent, government controlled socialistic "one size fits all" health insurance program, taking a meager amount from our earned income and paying hospitals to keep us healthy and happy.

Obviously, both of the above scenarios are fairy tales. I do not deny that insurance companies will try to find ways to keep from paying any money they don't have to, sometimes unjustly. What I do deny is that they have played a main role in the crisis that is ongoing now. I am trying my best to avoid merely repeating some of my earlier rants on this blog site. Let me try to state some things in a new way. In this past week, I have been "on the inside." A person close to our family has had a hospital experience. I have just a few observations to make.

  • It takes at least 15,000 dollars to ride a helicopter from one hospital to another. I think I found a way to pay my own medical expenses. First, I need a helicopter so I can make 14,500 dollars profit on each ride. If I furnish as few as two rides a day, I can pay maybe half my daily hospital expenses for just what I'm charging for the helicopter ride.
  • Doctors no longer understand the entire body. I think there are doctors that treat only the left ear, and others only the right. Some treat veins while others treat arteries. And none of them know how to read an x-ray. They have to hire that out.
  • Hospitals are constantly under construction. I guess they have to find some way to "tax shelter" the money they charge. All hospitals are under construction.
  • Only doctors and employees can park within five blocks of a hospital. Everyone else has to park further away, and has to pay for the privilege.
  • Half of the "emergency room" parking is "handicapped only." What say we make an allowance here, and speculate on the fact that perhaps everybody that needs an emergency room is at least temporarily "handicapped." Maybe someone didn't get a chance to apply for a handicapped plate between the time he got the knife in his back and the time he arrived at the hospital. Maybe we could forego the restrictions and signs.
  • Hospitals like mazes. There are no straight lines in hospitals. If they have letters before the portion of the hospital, they will not necessarily mean anything and will never be in alphabetical order. "A" wing will never be next to "B" wing.
  • Oh, and parking places are like gangland turf wars. Instead of "crips" and "bloods," etc, hospital parking lots are the turf of "radiology" or "enterology" or "cardiology" parking only. If your kidney just blew up, sorry about that. Find the renal lot. This one belongs to the heart people. If you see a sign that says "doctor parking," you are too close to the hospital anyway.

Sunday night, I had driven 120 miles to catch up with the helicopter, and as we waited for only six hours to get someone a room, I looked in that emergency ward. Everywhere I looked, there were people on cell phones, and one big word I kept hearing was "insurance." A bigger one, though, was "medicaid." I heard snippets as I walked by, of people saying, "I don't know how we will pay for this." Recently, one of my own friends talked about when his mother came out of her coma in a trauma ward, and her first words were, "How will we ever pay for this?" I can't recall anyone in the eavesdropped conversations talking about the health condition of a friend or loved one. It was all about spending the rest of their lives trying to figure out how to pay everything.

This morning on ABC's "Good Morning America," Michelle Katz, author of at least two books I plan to buy, spoke of how, after the trauma of saving her husband from a fatal heart attack, she then had the harder job of getting a correct hospital bill. She and her husband were overcharged thousands of dollars for the stay. Several months ago, Mellody Hobson, also on "GMA," said that up to 70 percent of all medical bills are in error. That was kind of her, because merely "in error" would have meant that some patients were under-charged, which never actually happens.

If the medical world were held accountable like I, a private citizen, am held accountable, we might be able to solve many of these problems. Yet medical institutions are not held to these rules, and we are bombarded by these bank breakers:

  • Bills sometimes come 6 months to a year after the fact. I have thought at times that I was totally paid, and then, long after the account was settled, had it re-opened by a late but substantial billing entry.
  • Billing is not uniform. I have found that it is better not to mention at all that I have insurance. A few years ago, I had to take my son to the emergency room. The sign said in English and Spanish, both of which I read, "Emergency room expense is 200 dollars." That was good for me because my policy at that time paid up to 200 dollars for the emergency room. Imagine my surprise when, six months later, I got the bill from the hospital for 250 dollars. They had billed my insurance company 450 dollars for the 200 dollar emergency room, the insurance company had paid its 200, and I was left owing 250. If I had just denied having any insurance, I could have saved fifty bucks.
  • Billing is not unified. Even a CPA could not keep up with billing. There is the doctor's bill, the hospital's bill, the ER bill, the specialist bill, the radiology bill, and then the bill for someone who, 200 miles away, at 4 AM, allegedly read the xray and did something worth 600 dollars. Then there are incidental bills for medicine, meals, kleenex (at 12 dollars a box), etc. Your hospital and any of the others above will be more than happy to forego the inconvenience of an itemized bill for these things. In addition to the insurance and payment nightmare this poses, it also allows for double billing, even triple billing of the same treatments.
  • The burden of proof is on you. Not only that; if you take the time and effort to straighten out the bill, the hospital usually says, "Okay, you got me. Pay the rest." On one of our bills, the hospital billed our insurance company, got an offset of the bill (about half) and then, three months later, billed us for the full amount. When we called to ask them about it, they said it was the full amount that we owed. After another month that included getting a statement of payment from our insurance company, the hospital, without comment, apology, or admission of error (actually theft), merely sent us a new bill showing about a two thousand dollar "adjustment" with no explanation.

It is a frightening dichotomy. On the one hand, we have the best doctors, not only in the world, but in history, living in the US right now. We have miracles of medicine that extend and save lives, and diagnostic equipment that my grandparents only dreamed of. On the other hand, the medical world is a world of uncertainty, humiliation, financial disaster, and interminable waiting in lines, of mountains of repetitive paperwork. As we waited to admit our friend the other night, I was amazed at how many times differing departments asked her the same questions regarding address, phone, medical history, insurance numbers, contact numbers, etc. It seems that all that information, once in a computer, could be readily available for all. My wife and I had updated our contact information on one floor of that huge hospital, but that updated info did not make it to the destination floor, where they tried to contact us at an outdated number.

One key I see is the huge, bottomless pit of money and resources that can be drawn from the federal government. If tomorrow, all medicaid and medicare was shut off, hospitals would go broke all across the country. Add 100% group plans that very few people get, and we'd lose them all. When the idea of a general practitioner was abundant and every village of 500 or more in the US had a clinic and doctor, it was possible to pay a medical bill without mortgaging the rest of your life away. It was also possible to park within 100 feet of your doctor's office. When the local MD knew you, shopped, dined, and worshiped where you did, there was an ambience of friendship, of relationship, that precluded the idea of "malpractice," either the "doing or the suing."

If there were any way to turn back the clock to these times, to eliminate the monstruous medical complexes in favor of the local clinic and hospital, to allow a doctor to deliver a baby without fears of being sued every time, we might be able to pay our own way. But now, if you have something worse than a hangnail, you have to be referred to the nearest city of 200,000 or more to get it taken care of. Local G.P.'s can't -- or won't -- be bothered with it.

The worst possible thing we can do about this crisis is further nationalize and regulate it. We don't need government-provided health insurance. The most radical, but probably the most effective remedy would be for every American to cancel his or her health insurance tomorrow, to tear up every medicare and medicaid card, and let the medical industry free-float to a market value it deserves. Oh, and of course, put a strict limit on lawsuits and liability, so a doctor can insure himself for less than six figures a month.

But of course that's not going to happen. So when you get sick, be sure to bring lots of pens and paper for the paperwork, prepare to walk several miles, and say goodbye to all your money, even if you have insurance. Because health care needs fixing, and it's not going to happen if we keep treating the symptoms. Doctors used to know that.

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