As a journalist who prides himself on our traditional values, most importantly getting the story, whatever it is, right, I have not exactly been a fan of the populist documentary maker's work. But finally this week I watched "Sicko!" Like many people, I heard about the various errors and mis-statements in this expose of the broken nature of our health care and insurance system here in the U.S. Others praised the movie, though not so much as journalism as an act of passion that nailed the basic story as few have done.
Upon reflection, I count myself among the latter. I suppose my tipping point was a ridiculous, virtually unintelligible set of "statements" from Blue Shield of California, purportedly a leading health insurer, and the recipient every month of a hefty family policy payment by me under the COBRA regulations that prevent Blus Shield from doing what they would do otherwise, which is drop me the minute I became unemployed.
Kafka would smile at this absurd set of forms, which attempt to break what was a straight forward medical visit to an emergency room (the only one Blue Shield would have honored at all, as I know from (vast) previous experience).
Kids fall and cut their heads. Every kid does it; it's what being a kid is all about. Some kids do it multiple times. So I've been to ERs, what, 10 times or so with my children over the past 30 years. The most recent occurred on November 23rd; I probably mentioned it in this blog.
Back to the Kafkaesque billing papers some bureaucrat at Blue Shield bestowed on me. I guess I'll just list the numbers: $260, $51, $187, $3,518. In case your calculator isn't handy, that is a total of $4,016 in charges for one two-hour visit, the great majority of which was spent in the waiting room, holding my groggy kid and trying to minimize the bleeding after his accident.
The insurance giant congratulates itself of disallowing $1,190 of these clearly inflated charges (Blue Shield proudly calls these "network savings,") to which I say "TMI" -- TOO MUCH INFORMATION -- or something a pithier commenter would label for what it is, B.S.
The bottom line, after the hospital and the insurer have had their way with one another, is $2,826 in "billable costs." And the actual bottom line, for me, is $974.20. So, after a deluge of unnecessary detail that only succeeds in convincing your truly that he indeed the one getting screwed here, I am being told that this brief visit, where an apparently non-indicated technology was employed (a CatScan), cost almost three thousand smackers, and that I should therefore feel grateful to only have to come up with a thousand of them.
Why is it, instead of comfort, I feel as if I am the one getting smacked here?
So, I say, keep it up, Michael Moore. We the people have precious few leaders willing to take on the Medical-Insurance Complex and attempt to foment change. We rarely go into the streets protesting, but that's just because each of us sits slumped in his or her chair, staring in disbelief at papers like those staring back coldly at me on this cold, cold afternoon, wondering where the hell the money's supposed to come from.
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2 comments:
Thing is, Michael spends most of his time and talent making money by pushing emotional buttons. He's great at providing folks with that sense of, “Man, he's right! It ain't right”! (Whatever IT is.) Poignant examples of dumb stuff with which lots of us can identify. Yet, beyond his having pointed to stuff that pisses you off, there's little of substance to point at effective action to stop you from being pissed off (like ways to actually make some systems work better).
Stir you up, let you fester, talk about it, use his name, sell more tickets. And, armed with knowledge that ol' Michael mixed in some of his own furtive imaginings, and overlooked a few facts... well, if you're concerned, if you're thinking, you probably feel just a teeny bit more confused after seeing his take, as well as pissed off. Riots are made of this. Constructive outcomes are not.
Any idiot could point out stuff that's wrong with medical care systems in this country, especially if he doesn't have to fix the problems. (Proof? - Why, I've been doing it for years.)
“Third party” payment schemes always fail. Company paid medical care, Social Security, Medicare, Medicaid, Welfare, and now a brilliant prescription plan. Each one becomes a ticking time bomb, they grow beyond our ability to sustain them. All great sounding programs when they were initiated; irresistible really. All end up hurting someone. (You know that prescription plan? - Want to guess how many tens, or hundreds, of thousands of retirees have been dumped from their retirement prescription and medical coverage already? Most of the major industries have already done it to their retirees. Imagine being in your late seventies or early eighties and receiving notice that you no longer have medical coverage as part of your retirement – after all, you've got Medicare, haven't you? Never mind that it costs you several hundred dollars a month to fill in coverage for the ever shrinking Medicare.)
And whatever happened to the old “family” doctor? You know, the guy who would come out to the house when needed. The one who actually got to know you, the wife, the kids.
My birth cost $75.00. We didn't have much back then. (I suspect that folks better off than we probably got a steeper price, and I suspect that Dr. Schnider asked even less of a few in tougher circumstances.) Dr. Schnider came to the house, before I was born. He delivered me at the hospital and saw to mom's care. He came to the house after I was born. More than once. And he saw us in his office, of course. For a year! $75.00! What's happened in 60 years?
“Health insurance” was virtually unheard of before WWII. Industry after the war began using it, as well as some other creative incentives, to attract and keep workers. Initially it was an effective, cheap, enticement to offer in lieu of increased wages. (After all, look at what we got for 75 bucks back then.)
Fast forward to the mid-seventies. I was in management for a major manufacturer. Could hardly pay for an ASPIRIN, that's how good the medical coverage was in the seventies. Got a back ache at work one day. Went to the local hospital emergency room. Got pain pills and muscle relaxers, exam and x-ray, not to mention admissions staff and nursing time. They were happy to see me (and my BCBS card) and I was happy to get the service. Never paid a cent. Didn't have a CLUE how much that cost, and could care less! I was entitled... it was part of my compensation package, I earned it, why the hell should I care? (Remember what I said about “idiot” above?) MEDICALLY ENTITLED! Life, Liberty, The Pursuit of Happiness, and Medical Care... I'm sure I saw it in there somewhere...
Increasingly over the past few years even the venerable General Motors is being crushed by the out of control cost of health care. All across industry the story is the same. Costs are ballooning. Services are shrinking (when was the last time you heard of a doctor making a house call? - when was the last time you got to see a doctor for more than a few minutes?) and medical coverage is smaller and smaller.
The industry response is also universal; insurance carriers are devoting more and more time to restricting what medical professionals are supposed to be doing (how else can they fight the cost). So is Medicare, Medicaid, and the rest. You're seeing ever more “cookie-cutter” medicine practiced – step by step procedures you follow when practicing medicine to reduce your “exposure” to civil tort, and increase your success at payment for time spent. Many, many unnecessary procedures are performed now. Many important procedures are being skipped.
Aside from the fact that the technology has grown so much, what is it that has changed? It mostly took people who really wanted to care for other people to practice medicine way back when. Seems increasingly difficult to find such today.
The Greatest Single Difference Is Third Party Payment. If I don't have to feel your pain when I spend your money, I'm probably going to spend more of it than you would! Ignorant? You're damned right! And boy how I and my contemporaries have reveled in being idiots. When that doctor sees that my insurance will cover a $3,000.00 CAT scan and tells me that, while it probably won't show anything critical, but-you-never-know, and it'll just be good to make sure, I'm for spending (someone else's) $3,000.00!
Answer (not to be found among Michael Moore's musings):
Return financial responsibility for medical care to the patient. When you've finished sputtering and choking, consider this: If you have to take the money out of your pocket to pay for a doctor's visit, you're going to become a little more selective. You, and most of the rest of us, will be looking for less expensive doctors, not more convenient. You, and we, will consider with more care what services we require. All of us will be more demanding as well. If I have to spend a couple hundred dollars to see a physician, I'll damn well insist on his time and attention. There won't be an insurance agent telling me or my doctor what to do, or not do. There won't be a government bureaucrat dictating when and who will treat me. Moreover, that doctor will save big bucks not having to chase insurance claims continuously.
Pipe dream you say? Well, about a dozen years ago congress passed legislation to allow for medical savings plans. Pretax dollars invested in a low premium, high deductible insurance policy. Unused funds accumulate with the same protections as a retirement account – in fact, at retirement age can be rolled into a retirement income plan. Money is invested at the discretion of the policy holder (it's your money). Funds spent on medical care remain tax free. Typical premiums carry $5,000,000.00 to $10,000,000.00 lifetime caps. For catastrophic injury/illness, nearly everything above the annual deductible is covered at 100%. (You don't lose your home, your savings, etc.)
The younger and healthier you are at the start, the better this approach will work for you. Many businesses have begun offering these plans as a realistic alternative to the ever more untenable conventional packages. Several million policies have been sold thus far and over the next couple of generations this approach could wean us off of the losing socialist system we've been pursuing.
Michael has his form of entertainment to offer, and he's sold some tickets. In the mean time, there are many more learned (and frankly I think, honest) people to consider when looking into medicine.
Thank you, Danogram, for this informed comment.
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