I had a strange experience today that left me with a clear view of many of the factors causing our health care crisis. As a healthy, active, college educated middle class person, I've been able to do well with a Medical Savings Account (now an HSA) over the past decade because I haven't needed much medical attention other than routine check ups.
A few weeks ago my doctor, who is off the grid and does not take insurance BTW, recommended an ultrasound to diagnose the cause of a problem I was having. The ultrasound clearly indicated what was wrong and I was sent to a specialist to have minor surgery. I was told by both doctors that this needed to be done right away.
First the person handling the surgeon's practice gave me the impression that I would be having the procedure in the doctor's office the following week. I had to INSIST that the report from the ultrasound doctor should be sent over. The other lab would not release the actual images, only the written report.
Question 1: What good would they be to anyone else and why wasn't I allowed to have them shared with the other doctor?
Then when I arrived at the doctor, it turned out that I wasn't having the procedure but I didn't find out until AFTER they brought me inside. It seems that the report showed that the procedure would have to be done in the hospital. The doctor was very apologetic that his nurse? receptionist? had given me faulty information. He said his office would call me to let me know when the procedure would take place sometime in the next two weeks.
Today I received a call from someone from the hospital's financial group. I'm not totally sure because her accent was so heavy that I couldn't understand everything. On top of that the information she gave me was all from the insurance company's perspective, not mine. She knew what the insurance company said was my outstanding deductible (not a reflection of my actual out of pocket costs for medical care but what the insurance company will allow.)
She wanted me to show up on Thursday for the procedure with a check for $1300. Then she said they would send me a bill for some amount that represented 30% of the balance. When I asked how much, she said she didn't know. After lots of pressing, she said she would have someone else call me in the next few days with an estimate of how much I will have to pay.
Questions 2 & 3: How are people supposed to agree to pay for a procedure when they have no idea how much it will be? I have savings to draw upon, what would a person who lives from paycheck to paycheck do?
Then I called the surgeon's office and asked them if I had been scheduled for Thursday. It appears I had (even though they hadn't told me). So I asked what time? The answer: "I don't know. We won't know until some time on Wednesday afternoon." Apparently, I'm expected to have someone on call for the entire day AND they would not have bothered to tell me until the day before if I hadn't called them.
One of the reasons I picked this fellow is he's supposed to be very good and he's one of the only surgeons who will take my kind of insurance. There are not a lot of options and I'm supposed to have this done quickly so I can't really start shopping around since I don't have any idea what the procedure will cost to know if I can afford the alternative.
Questions 4-6: Is this any way to run a market-driven business much less a medical practice?
What if the person isn't educated and is too afraid to even ask the questions?
Why are average Republicans so worried about a single payer system with an insurance provider that isn't focused on maximizing their profits and denying coverage?
From what I understand from my doctor and various news reports, costs are rising because there are a lot of unecessary tests and procedures being prescribed, yet good internists/general practitioners who spend time actually talking to the patients and don't order expensive, wasteful procedures, are reimbursed only tiny amounts and earn very little. Malpractice insurance costs are up, payments to wronged patients are down. Pharmeceutical companies engage doctors in contracts to promote their products. Medicare and the VA are good examples of efficient operations that optimize for service delivery instead of denial of coverage, though for the former, payments to doctors are very low.
Question 7: Why are corporations in other industries so determined to protect the insurance industry even if it makes their own businesses less competitive in the global marketplace?
I know that politicians are afraid to touch this issue because of the beating that Hillary took when she tried to tackle it but there must be a way to make the numbers visible. I also think that if the Democrats position it as good for business as well as the right thing to do, it could have a lot of traction with voters.
Any thoughts?