Monday, August 28, 2006

Health Care: The New Oxymoron?

Guest Post by Mr. Nimbus

In Vermont, there is a pretty amusing colloquialism that describes the state of an object when it self destructs in a big way.

You say that it "shit the bed".

When I first heard the term, I was struck by the hilarity and inappropriateness of it. Since then, it has become a huge part of my lexicon, as well as a phrase of choice when highly specialized systems suddenly give up the ghost for no reason at all.

So what does this have to do with the health care system in the US?

I'll get to that.

Recently, I went through the rather pleasant experience of major abdominal surgery. It seems that my appendix, a benign evolutionary throwback with no real function, apparently decided to become something other than a benign evolutionary throwback with no real function.

The net result?

After 43 years of peaceful coexistence, my appendix shit the bed.

The physical experience, as lousy as it was, paled in comparison to the realization of how financially unprepared I was to handle a major medical crisis. You see, when I was presented with the reams of gotcha's, deductibles and percentages that make up my health plan, which I pay out the nose for, I just did not appreciate the full ramification of the 10% coinsurance deductible or the yearly family deductible.

OK - "not appreciate" is too kind of a term. Perhaps "could not afford" would be a much better way to describe it. As it was, to buy into the next range of coverage would have doubled my already astronomical premiums. Even there, the deductible and coinsurance was only slightly reduced.

It wasn't always this way. In fact, I remember just a few years back when I felt my family could weather any medical crisis, that is, from a financial perspective. I mean - isn't that why we all hand over our hard earned cash to the insurance companies? Back in the glory years of managed health care, the hospital only charged about $20 per kid, copays for drugs were almost nonexistent and office visits were about 5 bucks a pop.

All in all, not a bad setup, and nearly worth every penny that that was doled out every week.

Then something changed.

Over the last 12 years, I have been working primarily for Fortune 50 companies. At first it was real simple, there were three types of medical plans: The cheapy plan for 20 something's who did not have kids, the well balanced plan for those who did and the executive plan, for those who could afford it. As time progressed, I watched as those 3 simple plans grew into confusing hydra of choices that dealt with primary care physicians, specialists, referrals, in/out networks rates, fixed copays, percentage copays and the most evil word in the English language: deductible.

If Ambrose Bierce were alive today, I am sure that his "Devil's Dictionary" entry for deductible would read :

Deductible - The art of giving nothing for something..

Now some of you might be thinking that it's not about recouping the piddly amount of money you contribute every month - it's all about being covered when a major medical crisis happens.

That is what I believed - until this year when I found out the hard way that I was within inches of having a hospital garnish my wages simply because the health insurance industry has been increasing the amount of small print on policies and reducing the amount of coverage that they actually provide, while, jacking up prices that exponentially exceed the rate of inflation.

Somewhere along the line, the insurance industry figured out that providing an infrastructure that allowed the best medical care was not very good for corporate profits. Hospitals figured out that quick patient turnaround was the only way to cut losses. Doctors figured out that they were fighting a losing battle on either front, so they caved in and entered into super practices, which maximized profit, reduced
malpractice rates, reduced beeper time and all but guaranteed that a patient would never see the same doctor twice.

And, no Virginia, this is not the result of evil illegal aliens driving up costs or lawyers suing the pants off of the insurance industry. Hospital administrators and health care executives (and believe me, there is no shortage of them) are still making more money than god.

This is the result of profiteering in a field that was borne out of mercy, care and the highest aspirations of humanity.

In short, what we have here is a system that is cutting costs at the expense of the patients well being; where bean counters with business degrees are making medical decisions that doctors are obligated to follow if they want to get paid; where everyone wants to send patients home before they are ready to go; where claim number snafu's hold up tests or worse deny them; where doctors treat people like pieces of
meat; and finally,where people are just as likely to die from corporate mismanagement and poor communication as as they are from surgical complications.

In my humble opinion, the health care system in our country, from the most experienced doctor to the lowliest claims adjuster has, in essence, shit the bed.

What are the alternatives? Well, there is socialized medicine, which works great for preventative care and emergency care, but really sucks when one needs treatment for conditions that are not life threatening. Additionally, people have died after their "non life threatening" condition has gone untreated under the socialized systems. Some states, like Vermont, are setting health initiatives, but, history has shown
time and again that government programs usually provide very little relief for all of their citizens.

To me, it comes down to is this: Can a health system actually run as a nonprofit that is staffed by medical professionals as opposed to a capitalist venture where stockholder dividends and quarterly profits are much more important than the actual business of providing patient care?

Considering the diverse opinions that are represented on a daily basis on this blog, I would be very interested to see what people think.

Extra points will be granted to those who can avoid the terms liberal or neocon. For this post, I want us to have a dialogue as Americans who are concerned over the state of our health system, not as ideologues looking for a reason to slam a political party or candidate.

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