Monday, July 22, 2013

The Shame of U.S. Healthcare

The lie of healthcare in the United States needs to come to an end. All of my life I have heard how we have the best healthcare in the world. How anybody who wants healthcare can have it, and if you don't get the care you need, it's nobody's fault but your own.

I call bullshit. Actually I call double-deep bullshit, bullshit up to the wazoo.

In today's Roanoke Times, there is a story about the free clinic in Wise County. Thousands of people - yes, THOUSANDS - venture to this weekend event to have their teeth pulled, their eyes checked, warts removed, or have other ills, some quite serious, taken care of.

Most of these people are uninsured or underinsured. They have lost jobs. In the most devastating turn of events, they once worked but had an accident or illness and lost their job, and thus their healthcare, right when they needed it most.

I find this completely unacceptable in a country as wealthy as the United States. This is the kind of stuff you expect to see and hear about in some unknown small nation in some forgotten third-world country. But this is here, in Virginia, in the USA. Right down the road.

But even if you have insurance, you're not home free. It is estimated that at least 60 percent of all bankruptcies filed in the U.S. are due to exorbitant health care bills. That is over a million people a year who become ill and need care, but can't pay for the help they need.

Plus the insurance companies (not the government, now, the private insurance companies) have allowances - you're allowed so many visits to the chiropractor, so many visits to the eye doctor, so many visits for this or that. If you're someone who needs more visits than the policy allows, you either don't go or you pay for it yourself. In that case, you're underinsured.

On top of this, the insurance companies and the medical communities have this interesting con game going on wherein the medical facility or doctor bills at one rate, but will accept a lower rate from the insurance agency. Some doctors require the patients to make up the difference, but many do not. Why is there not one rate? Why does it cost the insurance company one amount but the person who pays cash another? How is this even considered to be anything other than dishonest and some kind of scam?

I have a high copay for doctors who are "specialists" - which is every doctor but my family doctor. To my mind, that high copay is enough for a visit, but the doctors charge more and more on top of that. For example, in May I went to see a specialist about pain in my foot, and the bill sent to the insurance company was for $684.00. The insurance company actually paid $480.00, I had already paid my copay of $40.00, and later I received a bill for an additional $28.00 for something that the insurance company said was "allowable" but they didn't pay. I have no idea what happens to the difference in there. Or why one thing is "allowable" and something else is not.

Not only that, but the charges for health care are nothing short of obscene. Take a look at this:

$12,913 - hospital (pre-op, operating room, post-op, a room for about 16 hours)
$ 2,182 - surgeon charge
$ 1,045 - anesthesia charge
$ 2,760 - initial emergency room visit
$   882 - emergency room doctor
$   138 - visit with my family doctor (as instructed by ER)
$   100 - radiology
$    85 - pathology
$   200 - what the urgent care facility charged to tell me they couldn't help me and I should go to the ER

Total (so far): $20,305.00

These are the charges for my gallbladder removal, starting with my initial visit to the urgent care (because I didn't want to go to the ER and the urgent care is supposed to be cheaper for everyone; I didn't know I would end up needing surgery). If we didn't have insurance, we'd be declaring bankruptcy along with the other 1.5 million people who will do that this year, I imagine, as we simply don't have that kind of money under the mattress. But we are fortunate - I am fortunate - and have health insurance, which we pay for to the tune of about $8,000 annually - just for me. His employer pays most of his share.

The health insurance company will not pay out $20,305, though that apparently is the amount a person with no insurance would be expected to cough up.

No, the health insurance didn't "allow" all of those charges and instead will pay out less than half of that amount. My share will end up being around $1,000, I think. I'm still waiting on all the bills to come in and I'm basing that on the "allowable" charges. It could be more.

The reason I am so fortunate to have health insurance is because my husband has a decent job, the kind that are becoming scarce. I made a good choice in a mate and he has taken care of me. I have had multiple health issues over the years and while I have always worked, at times I have had to leave jobs or change jobs to accommodate health care concerns. I have been lucky that I had a husband who could work a job that offered decent healthcare. But not everyone has this opportunity, and not everyone can work and keep their healthcare.

You shouldn't be punished and lose everything simply because you're sick. I see people in our area who have to have fundraisers for cancer treatment - they hold square dances or bake sales or something. Who thinks that this is okay? It is not okay with me. I think it is about the saddest thing I have ever seen, and it should be a major condemnation of what is going on in this country. Every time I hear about one of these events I cry.

I personally am glad we have made changes in the healthcare law because the system is incredibly broken, but I don't think the changes implemented under President Obama go far enough. They do not fix the issue but instead were a gift to the insurance companies. I don't know that prices will decrease, or that quality of care will be improved.

A true change in healthcare would involve building hospitals, training people, and ensuring that we have the infrastructure we need to take care of people. Without that in place we have no foundation upon which to build. Stimulus money should have gone to those types of projects immediately, but of course it did not.

It looks to me like everything needs to be changed, from the way medical charges are billed to payouts to claims. A complete overhaul.

I want a New Deal, one that helps everyone. People should stop bitching and moaning about the upcoming Affordable Health Care Act and instead try to make the damn thing work.

7 comments:

  1. Hospitals are no longer even about health care. They are about making money just as is every company. Also, keep in mind the insurance premiums they are paying for their errors and omissions insurance that they pay to insurance companies for their fuck ups. When they mess up on someone's healthcare they get sued for millions and so they have to have the E&O insurance. Insurance companies are the only ones who come out smelling like a rose and making money. Write a letter to the CEO of your insurance company and ask him why he makes anywhere from $10M-$20M per year while the regular Joe is being driven into bankruptcy? I doubt he will answer you but that's the bottom line as to why insurance is so high and pays so little, to keep the rich cats rich.

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  2. I have to say that I agree with Diane. Sad times we are living in.

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  3. Insurance companies in healthcare should be ranked as a racket, and they should be looked at as just that by the Justice department, which is currently looking in too many directions to catch them at it. HMO's suck.

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  4. Capitalism is about using money to make more money. Success is registered if you do so, failure if you don't. Like most ideas in economics (before the marketing and PR departments get involved) it's a dead simple idea. Expecting companies set up first and foremost to make investors rich to instead put service to patients first is like expecting wolves to turn vegetarians. It isn't going to happen. I live in a country with a first rate health service, free to all of us (because we pay for it out of taxation: I'd rather do it that way than pay even more in something which is just as much a tax, though taken by private insurance firms, and which will only buy health for me, not my fellow citizens) yet an incredible amount of political effort is now being put in by the Tories to privatise the NHS and saddle us with the American system. I'll direct anyone who is wondering whether it might be a good idea to read this excellent blog.

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  5. I agree. this country is in a big mess and I wish some hero would come along and rescue us.

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  6. Well-said, Anita. Thank you so much for writing this.

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  7. The health care system in this country is deplorable. ABC World News had a recent report where they showed how the cost of a medical procedure varied between half a dozen different doctors in one city--a difference of as much as hundreds of dollars. It's ridiculous!

    And it's not just the insurance companies and doctors making out, but pharmaceutical companies as well. Come down on all and people might be able to afford basic care again. Too many people in this country live in fear of getting sick or being in an accident. While it's great that insurance companies can no longer exclude people based on genetic or pre-existing diseases/conditions, only the insurance companies benefit when the government forces evertone to buy insurance. Let's face it: if people could actually afford insurance, they'd already have it. Even with recent overhauls, too many fall into that gray area of not being able to afford it, but not qualifying for assistance, either. Of course, it doesn't help when you have idiot governors who refuse federal funding to expand enrollment.

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