US healthcare, or lack therein

[thebratqueen]

justhuman did a post about healthcare in this country and a few things in the comments about US healthcare, national healthcare, and the idea of government involvement in healthcare in this country got me up on my soapbox.

I didn't want to co-opt JH's thing so I hauled my comments over here. I think there needs to be some kind of government intervention on the healthcare system in this country, though what kind is definitely something that's up for debate. Lord knows I'd be a little leery of whatever healthcare Dubya's camp would come up with. Not that they'd ever come up with it, but in bizarro world where they do it'll probably require things like no woman is ever allowed to have birth control.

But the way the system is now is horrible, and if the government doesn't stop it I don't know what will. I deal with insurance companies every day. The hoops they make people go through to get what little amount they're allowed is ridiculous and the excuses they'll use to completely reject a claim are absurd. (Believe me, I'm happy to cite examples.) You know how I know the end of the year is coming? Because the insurance companies start delaying and rejecting claims with more frequency because that best suits their end of year reports.

On top of that there's a standard of care that insurance companies try to enforce which is FAR below the standard of care that is actually recommended by anyone who actually has knowledge of that field. You might need a crown but they'll pay for a filling - and an amalgam filling at that, so here's hoping you didn't have a problem with the mercury inside. And we all know the stories of how insurance companies, not your doctor, get to decide how long you stay in the hospital.

Can it be worse? Sure! Let's talk about companies that are known for giving comissions to people who work their "dial a nurse" hotlines. Comissions for what? If they can convince you not to seek treatment, they get a bonus. Nice, huh?

In the office I work at alone we get so many patients every month who can't get the treatment they need because their insurance won't cover it and they can't afford it on their own. And this is dentistry. I know it's worse on the MD side of the equation. Hell, I've been on the MD side of the equation. So have most of my friends. When you're at a certain economic level in this country not having insurance means you don't see a doctor. You barely have enough to pay for where you live and what you eat. So if you get sick, you just get sicker.

But you know the even more beautiful part of that? Part of the reason why doctors cost so much isn't just malpractice insurance and frivolous lawsuits, much though Dubya et al. tried to paint that picture during the last election. It's also - you guessed it - insurance companies. Insurance companies dictate how much something can cost. Now if you have insurance this is great. But if you're a doctor this actually sucks, because your expenses have nothing to do with the insurance industry. You have to answer to labs and vendors who could care less if an insurance company will allow you to charge enough money to recoup your costs. So you know who makes up the difference? Yup, the uninsured. Because there isn't a single organization in the country that will force doctors not to gouge out the pockets of people who don't have an insurance company behind them.

I can write out the math on that one for anyone who wants the example, but for ranting purposes the point is that thanks to the insurance you don't have you're really getting screwed over in two directions.

Then there's the other way the less than rich get screwed: good ol' economics. Supply and demand. If you supply good services you can demand higher prices. What does that mean? The crappier your insurance is means you are pulling from a pool of doctors who couldn't get paid any other way. Sure there's some good hearted ones in the bunch who aren't in it for the money, but this is still a business. Rent's gotta get paid somehow. Electricity isn't generating itself. So if the loss isn't in quality of doctors, it's quality somewhere else.

Know why the receptionist working at your doctor's office never returns your phone calls or keeps forgetting to fax your prescription to the pharmacy? It's because she's doing the work of two to five to ten people. That doctor's office needs more help but they can't afford it. So here's hoping you didn't need those pills right away - or for that matter an extra hand processing the paperwork for your insurance claim.

Know why you wait five hours every time you see a doctor? It's because they double and triple book. It's the only way they can hope to recoup costs. Sure, some of that is against the inevitable last minute cancellations, but the rest is that they have got to shove as many people into those exam rooms as they can. Insurance pays the same regardless of how long you were in that room. So a doc can do one exam for one patient that lasts an hour or he can do 10 patients at six minutes each. Which one do you think he's more likely to pick?

Is the answer to this a national health care system? I don't know. But this system sucks. It's not run by the government or by doctors. It's run by companies, and these companies couldn't give a flaming fuck about how sick you are. They're in it for the bottom line, and if that means all your teeth fall out, you die of a heart attack, and your remaining family loses their home and goes bankrupt trying to pay off the cost: so be it. That's your problem, not theirs.