Health Insurance and Rocket
Science
Recently, the HR Doctors
morning collection of e-mail included a spreadsheet and
commentary by the beautiful HR daughter, Elyse, concerning a
recent encounter with the wonderful world of health care and
health insurance.
Elyse spent Thanksgiving at a
guest ranch in the desert near
Tucson,
Ariz. with her friend Jason
and Jasons father, who is, coincidently, a physician. This is
a guest ranch that is rather exclusive. I know that because on
Thanksgiving Day, Elyse had sudden and extraordinarily
terrible abdominal pains. Those symptoms were immediately
seized upon by the four doctors who were dining at her table
hence the notion of a rather exclusive resort. The doctors
quickly agreed that the diagnosis was acute appendicitis, and
the treatment required rapidly getting to a fine hospital for
an encounter with an extraordinary surgeon.
The mini-conference of
doctors contacted a well-known local colleague who recommended
the best hospital and the best surgeon. They proceeded to
contact this gent and interrupt his holiday. He kindly called
ahead to the emergency room to announce Elyses imminent
arrival. Suffice it to say, within an hour, Elyse was at the
hospital and subsequently underwent a laparoscopic
appendectomy. The surgeon, it turned out, had his Thanksgiving
holiday interrupted by three emergency
appendectomies.
The wonderful news was that
Elyse recovered and was treated like a queen at the resort as
her stay was extended by several days of
recuperation.
That was the good news. The
bad news was that the recovery hadnt even been completed when
her mailbox began being stuffed with a constant flow of scary
looking bills from people Elyse couldnt remember or had never
actually met. These included bills from the hospital, the
surgeon, the anesthesiologist, the emergency room, radiology
and laboratories and a variety of other people, totaling
$40,000.
Fortunately, at least I think
thats the correct word, Elyse has health insurance. However
the insurance processing took on so many turns and twists, so
many issues of in network or out of network, emergency
versus non-emergency, usual, customary and reasonable,
deductibles and co-pays, that a second and perhaps equally
serious acute set of symptoms began appearing. Those were the
frustrations, the head-shakings and the amazed glances. Words
like youve got to be kidding kept emerging with every trip
to the mailbox.
Once again, and very
fortunately this time, a colleague of the HR Doctors and a
wonderful insurance broker and consultant for local
government, Lloyd Rhodes, rode in on the gallant charger,
dismounted and joined us in shaking our heads and saying this
is amazing.
Lloyd assisted us, as he does
with many people, by contacting the insurance company and
demystifying the process. He took a personal interest and
acted as both an offensive and defensive line coach, an
advocate and a universal translator of the strange alien
phrases which kept appearing on the bills.
At this point, it is safe to
go to the mailbox and to hope that amidst the many credit card
offers there may not still be another medical bill.
The real purpose of this
column is not to discuss Elyses appendix but rather to
recognize that here is an extraordinarily smart and articulate
lady with years of experience as a public official, with a
graduate school education and world travel experience. Despite
all that, the experience of dealing with one event, albeit a
major event, was as painful as the acute medical condition
itself.
Imagine if this werent
Elyse, the HR daughter. Imagine that it was one of the scores
of millions of uninsured with limited education, limited
awareness of practicing healthy lifestyles, and being, in
effect, a prisoner of a system gone awry. Chief among these
many millions of people, perhaps 50 million in
America
with no health insurance, are children and single mothers,
most of whom are relatively poor. Imagine, however, that it
might be you or me.
The chilling effect of such
a situation is enough to lead these people and many others to
stay away from doctors, hospitals and the health care industry
until it is absolutely critically necessary. This hurts
America
just as much as it hurts the individuals. It makes things far
more expensive for taxpayers, and for families and individuals
alike. It is estimated that in our gigantic health care
mega-economy only 3 percent of the money is spent on
prevention with the rest being spent on intervention,
including unbelievable amounts on pharmaceuticals. We truly
are a drug addicted society, even if the drugs are
prescribed.
What to do to about this
crisis? The HR Doctor has thought long and hard about this
over the years as a county chief administrative officer with
responsibilities for an acute care hospital, public health
clinics and mental health services. He has thought about it as
a vice president of one of
Americas
largest public hospital institutions, and as a city and county
human resources director. It is not enough to whine about it
or rant about it. It is important to offer constructive
suggestions as the HR Doctor has done in some past
columns.
It all starts with the
creation of a compelling national vision for health care in
the United
States a vision which is
and has been lacking. The vision might include every child
being able to see a physician, every child receiving health
care and every child receiving preventive
vaccinations.
It may further go to
insurance, whether government sponsored, private or a
combination targeted specifically at catastrophic care needs.
That is, that segment of health care needs involving major
trauma and acute intervention to save a life stemming from
acute accident or illness.
The HR Doctor recalls the sad
case of a young couple from the
United
Kingdom on their honeymoon in
Miami. The groom
made the mistake of crossing the street the wrong way, at the
wrong time, and was clobbered by a speeding
vehicle.
The bill of $250,000 was the
result of amazing work in the hospital, especially the trauma
center, to put him back together and save his life. His life
may have been saved, but the dreams and hopes for this couple
for the kind of life they wished to lead when they were
married were shattered just as the grooms bones were. They
had no insurance because for good or bad, the National Health
Service in the United
Kingdom handles this kind of
catastrophe.
Another suggestion stemming
from the experiences of the amazingly wonderful HR Doctor
daughter, Rachel, is that medical students and graduate
resident physicians almost always leave medical school with
huge amounts of debt. Why not harness the power of the
forgiveness of debts and turn it into the equivalent of a
domestic Peace Corps of trained physicians who can serve
children in particular?
I mean by this suggestion the
creation of a greatly expanded version of the National Health
Service and its traditional service in some significantly
underserved areas like Indian reservations. A quid pro quo of
debt reduction in exchange for service works to recruit
physicians in the military, why not let it help resolve
Americas national health insurance crisis?
A final suggestion within the
scope of this article is to recognize that
Americas
firefighter/paramedics are getting out of the fire
extinguishing service. More than 80 percent of the calls
responded to in many areas involve paramedics on medical
calls, especially automobile accident responses. Many of these
people work second jobs as hospital emergency room technicians
or other related work. Why not turn every fire station into a
children and senior citizens clinic dispensing certain needed
medications, monitoring the condition of diabetic people,
administering vaccinations and providing triage for physician
access? It would fill the days of these employees with
worthwhile and much needed services.
These meager suggestions do
not create the dreaded socialized medicine, but they do
respond to a terribly serious and growing national trauma
how to provide health care for the good of us all.
We have the resources. We
dont have the vision. Lets bring both of them together and
lets do the equivalent for all Americans in the next decade
what we did over 40 years ago in that compelling vision to put
a man on the moon within a decade.
Stay well! Do good
work!
Phil Rosenberg The HR
Doctor http://www.hrdr.net/
P.S. Elyse and her former
appendix both readily agreed that I could spill her guts
(sorry!) and share her medical experience with the world in
this article!
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