Health Insurance and Rocket Science

Recently, the HR Doctor’s 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 Jason’s 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 Elyse’s 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 hadn’t even been completed when her mailbox began being stuffed with a constant flow of scary looking bills from people Elyse couldn’t 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 that’s 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 “you’ve got to be kidding” kept emerging with every trip to the mailbox.

Once again, and very fortunately this time, a colleague of the HR Doctor’s 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 Elyse’s 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 weren’t 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 America’s 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 groom’s 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 America’s national health insurance crisis?

A final suggestion within the scope of this article is to recognize that America’s 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 don’t have the vision. Let’s bring both of them together and let’s 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!