Yesterday I was at Ground Zero of the American health care catastrophe.
I spent the day with my friend who is an oncologist and surgeon.
Eight hours with a busy doctor is an eye opening and valuable look inside the belly of the beast.
This is the American health care story circa 2006.
This is what many of our fellow citizens experience when a trusted doctor recommends a surgical procedure--or an expensive medication.
My friend, the doctor sadly explained that even his well insured patients often "cannot afford to get sick."
Having insurance even "good" insurance frequently guarantees not much of anything. It makes you feel good to be insured, but God help you if you need to use it. Certainly, any of you who read my diary about Blue Cross of California terminating enrollees who file claims understand that insurance is very much a "here today, gone tomorrow" sort of affair.
This doesn't surprise me. An insurance agent recently told me that I was fortunate to be insured with a particular company because they were more lenient with their approvals than most.
So what happens when a doctor tells you, that your medical condition requires a certain medication or worse, a surgical procedure?
In America, the insurance company has the last word. According to my friend many insurance companies are engaged in a dangerous game called practicing medicine without a license.
Even though there are alleged appeals procedures available, the system is designed to make the sick patient jump through hoops and if the insurance company gets lucky, the person may even give up.
Imagine fighting with a large, impersonal bureaucracy in the best of health. Imagine interminable waits on the phone to speak to a human being when you're healthy. Now imagine doing that as a sick person.
This is our America in 2006.
Yesterday, one patient had what doctors politely call a "suspicious mass."
This is what happens when a doctor recommends surgery.
You step inside your doctor's office and either you or his secretary puts in a call to the insurance company to request--some would say plead for an authorization.
Often the insurance company will demand voluminous medical papers. Frequently you, the doctor or his secretary will be speaking to a woefully untrained bean counter. A bean counter charged with preserving the bottom line. If the person on the other end of the line is responsible for medical decision making and that person is not a doctor, this , my friends, is called practicing medicine without a license.
Then what happens? If you're among the lucky few, the insurance company will authorize the surgical procedure. Often, getting the authorization involves expensive and time consuming discussions between you, the doctor, his staff. All this costs lots of money.
Anyone care to guess how many of our health care dollars are spent in this bizarre, uniquely American dance of death?
Another patient having her blood drawn explained that she was denied both medication and several diagnostic tests ordered by her doctor. She is now taking third tier drugs after her insurance company refused to pay for the first and second selections. She and her doctor are continuing to fight to get her the tests she requires.
At the end of the day my friend turned on his computer. His emails included several from patients asking for additional help (medical papers, diagnostic tests, etc.) getting surgical approvals or requesting different medications after having been denied what he prescribed. All of this once again, time consuming and expensive.
This kind doctor then dropped a bomb. He is assisting several patients who have filed a criminal complaint against three insurance companies. I asked him why they had to resort to such a drastic remedy, he stiffened and said, "insurance companies are practicing medicine without being licensed, this is a criminal matter."
I'll be writing more about this in the near future.
Stay tuned.