Tuesday, September 14, 2010

Health care in America: A 4-letter word

Metaphorically speaking, of course.
I have a couple of excellent case studies that should illustrate just how broken this stupid system is. And I'm not interested in people's "Well, it's only broken for a few people; on the whole it works really well." Garbage. It is broken. Maybe it's still rumbling forward and functioning, but it is broken.
Fact 1. I am a healthy, white, middle class female; I've almost always been insured.
Fact 2: I average a health care issue once a year. In the last five years, I've gone to the doctor for a bum knee, a bacterial infection from a cat bite, stomach flu, two physicals and a lump in my breast. I've also gone to a physical therapist four times.
Fact 3: In my adult years before that, I went to the doctor for tendonitis, a sprained ankle, severe recurrent headaches and another physical.
Fact 4: I take no prescription medications.
Fact 5: I have not needed emergency medical care since I was 11 and had to get stitches.
In case you're not getting it from all my HIPAA confessions, I am not a health insurance risk. I have not cost any insurance company much money at all, not even when I was born (thank you, Army).
And yet, the system, even from my limited perspective, is severely broken. Consider these two scenarios:
1. I'm almost 25 and have just quit my job to go on a mission. I had been on my mom's insurance but would get kicked off at 25. I wasn't too worried about health care, but I applied for catastrophic coverage from a company I'd been with for years just in case something horrible happened.
I was denied. Why? Because of my recent knee strain. Besides I'd slightly injured one knee six months prior, I was too risky. You have got to be kidding me. I'm sorry, but if I'm too risky for health insurance companies, no one should qualify for health insurance.
2. Just yesterday, I was rear-ended. As the accident faded into the past, the neck and headache jumped into the now. I decided to see a doctor just in case something was seriously wrong; I didn't want to be stuck with neck pain for the next six months. I called a doctor to make an appointment, wanting to go with the least expensive route for everybody involved.
Well, guess what? Doctor's offices don't process auto insurance claims. Neither do urgent care centers. I either have to pay for the services before I leave -- and come on, it's not like we're talking about an oil change here, this is going to be in the hundreds of dollars, I have no doubt -- or I have to go to the emergency room. Where they will way crazy overcharge me and where I do not belong because this is not an emergency, but where I don't have to pay for it.
So pretty much, the health care system is telling me, go to the ER. Sure, it's more expensive and way more of a hassle for everybody but you, but you don't have to pay for it right now. Somebody else will pay out the nose later, but you don't have to pay for it right now.
Ridiculous! The system drives people into emergency or higher-cost care. Yes, naysayers, something needs to happen. This is not good.

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