Monday, August 25, 2008

America's Health Care System is broken

This has been perking in my head for almost a month now, but yesterday and today pushed me over the edge.

One of the problems with the system is that it is dependent on employment. My current health insurance is scheduled to end with the end of this month. I will "suck it up" and pay the COBRA to be sure that I (and my dependent) continue coverage. We have health issues, and need the continuity of coverage. That alone indicates that the system is broken.

Here are the three issues which pushed me over the edge about speaking out:
  • who choses the medication?
  • who pays the bills?
  • why does it cost so much for insurance?

First: medication choices

I have a medical condition where, at the moment, there is one medication which works for me. I have tried the generic and it does not work. Here is the story. I had bad, continuous heartburn. I was diagnosed with GERD (Gastro-Esophogeal Reflux Disease). I started with one name brand, it stopped working, and I changed to another. It also stopped working, and I moved to a third. All was good for a couple years. Then I changed jobs and therefore health insurance. The first time I renewed my prescription under my new employer, the pharmacy went back to brand #1. I did not fight, and after a couple weeks, I was in agony again. I talked to the pharmacy, and I was back to what worked. Last July, my employer changed health plan providers. Suddenly I was dealing with a "formulary" process. This is, in my opinion, nothing less than a price-fixing cartel process where the insurance company, for whatever reason (which may include discounts...) did NOT include my drug. Suddenly I went from paying $10 per month to a random amount, usually over $35. Fair? I don't think so? This summer I renewed my prescription, and the pharmacy again provided the generic. I refused to take it. Why? In January, I had taken the generic for two weeks, and my symptoms returned! Would you? What price is your health worth?

Why can someone in an insurance company, who has never met me, and not ever even talked to me, decide that I cannot have a prescription drug that I want. I can tell you that I spent almost 10 hours on the phone and in emails dealing with trying to get the medication which keeps me from having constant heartburn.

Second: Doctors and business practices

The more recent incident has to do with doctors offices and their willingness to deal with health carriers. My current carrier is technically a "cooperative" and is fairly local. My daughter is many states away. I chose a health plan which provides for "out of network" services. Well, my daughter's doctor's office management are a bunch of (well, I will be kind) dorks. (I have not decided if I will call them out publicly.)

Because my health insurance provider actually has a person answer every phone call, and does not use "voicemail hell" to screen calls, but is not a big player on the national scene, that office does not deal with them. The first time I called they referred to my carrier as "non-par." As a lay person, that sure sounds like "sub-par" which is not a compliment. Each time I called, they used "insurance-ese" even though they knew I was not an insurance person. They consistently refused to even talk directly to the insurance provider, and once when the insurance provider called were "more rude than anyone [we] have ever dealt with." And that was according to one of the experienced "member services" staff of my insurance provider. The fact that a medical office would refuse to deal with the insurance carrier of one of their patients absolutely boggles my mind. It is so antithetical to the customer service attitude which we in libraries try to provide.

I may be telling my daughter to find a new doctor for the rest of the time that I am responsible for the medical insurance. How else can you send a message?

Third: Insurance costs

I think I have known this for some time, but it has recently been driven home to me when I received my official COBRA paperwork. For my personal situation, it will cost me over $1,800 per month for insurance. Where does that money go??? That is $21,600 per year. I know that is more than many library workers are paid! I guess I always knew that it was expensive, but I had not really paid attention to the level.

Now, I don't begrudge any of my caregivers what they receive. When it costs $150 for a doctor's visit, I know that only a small part of that goes to the doctor. There is money for the rest of the staff (receptionist, nurses) and overhead (space costs, utilities), and even worse for them, malpractice insurance. Medical personnel must have to see a large number of people each month to meet the bills (plus have money to eat -- and to pay for their own health insurance!). But the amount paid for the insurance seems to me to be outrageous. Even more so when I remember that in July 2007, my employer changed providers when the prior provider wanted to boost rates by more than 50%!

I rest my case. The system is broken. I wish I knew how to fix it.

1 comment:

  1. I know exactly where you're coming from, Michael. My oncologist had to fight with my HMO's bean counters to get approval for a medicine to treat my cancer. I am in chemo as we speak.