Saturday, January 02, 2010

A Personal "Why Health Care Matters."

This is by no means an intellectual post about health care. I promise no "facts," "figures" or "data" to back up any kind of argument. This is mostly a personal reflection on why the health care debacle has seemed especially poignant to me.

A couple of weeks ago, we got two bills in the mail. They were both from CMC's ER. Now let me clarify. We didn't go to the ER for routine care. My son had a random seizure. We didn't really have a choice but to bring him. In fact, we called 911, and the ambulance driver kindly told us ahead of time that we could drive him and save ourselves the transportation fee. These bills were for two separate services. One was for the actual visit and the other was for sending blood work results to Umberto's doctor. The first bill totaled a little over $2,000 and the second was for $700 and some change.

Now here's the services that we paid $2,700 for. At the ER, we encountered a lovely nurse who threatened Umberto (who had just had a seizure I remind you) with an anal thermometer because it was going to be so difficult to hold the thermometer in his mouth for him. She only relented after I started to get Umberto redressed, and told her we were leaving for another ER, and her superior came and told her to hold the thermometer in Umberto's mouth (note: this is a children's ER at a special children's hospital). Then a resident came in, and questioned us about what happened. She took Umberto's pulse, and listened to his chest. After a 15 minute wait, another Dr. came, and told us "Your son had a seizure." (no shit). Then after another 10 minute wait, the resident came in, and took blood. We were there for maybe 45 minutes. The second bill involved the transfer of a sheet of paper to the Dr.'s office. I guess they pay their photocopiers a lot of money.

I just looked at the bills, and thought "Wow. And we wonder why we have raising health care issues?" Later I got another bill with the information that I still owed $700 after my insurance took care of the rest.

Couple this with the bill that came from Umberto's MRI: $3, 550. And we don't know how much the EEG is going to cost but we do know that we had to pay $150 in copays for just the Drs visits.

I don't feel like we had a choice in these medical decisions. Umberto had to go to the ER. He had to have the MRI. He had to see the Dr.s he saw. I mean, it's not like we were worried about a cold. Our child was on the floor having convulsions. And if we didn't have insurance, Umberto wouldn't have been able to have the MRI or the EEG.

While we go through this, we are also fighting our insurance company concerning the birth center. All we want to know is how much they are going to cover. The woman H spoke to was totally unhelpful. Her suggestion was that we go to a hospital in our network. H explained to her that this was simply not an option. And she still didn't really direct us in how we are supposed to go about filing our claim. What's stunning about this is that it's much cheaper to give birth at the birth center. The OB we were seeing was charging us $1200 after insurance. This doesn't include the hospital fee. Add to this that the birth center I'm going to is covered by SC Medicaid. The state's willing to pay for it but not my private insurance? And we're worried about a government plan? Seriously?

What really pisses me off right now is that we pay over $600 a month for insurance. We rarely go to the Dr. because we're pretty healthy. But this year we've run into things where it's obviously vital for us to have insurance. Yet even with the insurance we're still paying huge amounts of money. Our copay for a regular office visit is $30. Our copay for a specialist is $60. We have an individual deductible of $1,200. That's for each of us. This is what insurance gets us.

There is so much wrong with this picture that it's hard to even begin to explain it. First, our government is about to make it illegal to not have health insurance. But they're not doing nearly enough to protect us for the insurance corps. There is no guarantee that my insurance might not get jacked in preparation for this change. And I can't just go without or I'll have to pay a penalty. I don't have a public option so that I can be GUARANTEED a fare rate. And if they don't jack my prenium, they're likely to jack my co payments and my deductibles (this is what our insurance did this year...and we're talking state employee insurance by the way). So I face the real possibility of paying more each month and with each visit. End result is that I'm going to have be dying before I go the Dr.'s.

Then there is the issue that comes from the birth scenario that I think is in indicative of a larger problem. In Europe, all normal births are attended by midwives: both in home and in hospitals. OBs are only called in in risky circumstances, and even in those circumstances C-sections and inductions are rare. But here in the US, midwives are demonized, out-lawed, and run out of business even when they are allowed to practice. C-sections are prevalent despite WHO studies which show that they are dangerous. We have one of the highest infant/maternity mortality rates in the "western nations." So why can't I get my insurance to cover a cheaper and healthier birth? Lobbying. The GYN/OB associations in this country is a powerful force. Just like the insurance lobbyists. Decisions are not made on what's best for the country but on pockets being lined with money. And it's not a simple party issue. Both parties do it. When Obama said he was getting 95% of what he wanted in health care, I really wanted to throw up. As I face a mountain of hospital bills, I am not sure I'm getting 95% of what I even need. And for the conservatives who are bemoaning having to pay for the poor, let me point out that both H and I work.


Ernesto said...

Thank you for this post. It speaks louder than any spreadsheet data. Good luck and all the best...

The Bear Maiden said...

I have Medicaid, administered by HIP. They paid for my bunionectomy. But because Medicaid pays the cheapest rate possible, I had to go to the cheapest place to have the surgery which was nowhere CLOSE to where I live. I look at my EOB's when they come and they pay such a tiny amount to the doctors, it's no wonder the docs don't like dealing with Medicaid. And most docs in NYC won't take Medicaid. I had a dentist the Sun and I both liked... I found them when I worked and had insurance. Got Medicaid, and without thinking scheduled our annual. Got there and was told they wouldn't see us.

Medicaid used not NOT have copays... but now I have a copay as do my prescriptions. $6 each. S

Medicaid can be very hard to get, too. If you're in your early '20's, forget it. If you're single, forget it. If you're male, forget it. And if it's for a child they give you a hard time if the parent has no regular income.

But overall it almost sounds like I have the better deal.

The whole thing is a mess...