Friday, September 04, 2009

Let's Stop Yelling at Each Other

Yesterday I went to my dentist - a pleasant, capable professional with state of the art equipment in a spotless environment who just happens to practice in Matamoros, Mexico. I had my teeth cleaned, xrayed and examined. I needed two fillings, one of which was done on the spot; I will have to go back next week to take care of the other one. My bill for yesterdayís work was $77.50. I canít say for sure how much these services would have cost me on this side of the border, but I am guessing something like $300 - $500....

I have been entrusting my chompers to my Mexican dentist for 3-4 years now and in the process figure I have saved myself thousands of dollars. Was the care as good as what I would have gotten in the US? Canít say for certain, but so far so good. Is it better than what I would have gotten had I paid for what I could actually afford in the US? Most definitely. Because I probably would have had to let my teeth rot in my head had I not had the Mexican alternative. What is the reason for the huge disparity in fees between two clinics that are only a few miles away from one another? Not a clue.

So.
I have this friend who prefers to remain anonymous for reasons that shall become evident. Letís call her Betty. She is self-employed with no dependents and makes just enough of a living to meet her modest needs. After going for decades without health insurance, she decided to get coverage to prevent her family from having to bail her out in a worst case health scenario. She was relatively healthy for someone who had gone without regular medical care for so long, but she did have one pre-existing condition that made finding a provider difficult. It wasnít cancer or a heart murmur or anything terribly exotic. Just asthma - a condition some studies suggest as much as 10% of the US population has to deal with. When she finally found a company that would cover her, it was because she lied about the fact she had had problems with asthma all of her life - at the urging of the gentleman who sold her the policy.

She had learned to live with the occasional flare-ups by self-medicating with drugs she was able to purchase in Mexico without a prescription, and she had gone for years without having to see a doctor. But the day came when she was working out of town and caught a cold that sank down into her chest, leading to serious breathing complications. She went to a minor emergency clinic, but the staff there was unable to help her and finally convinced her she had to go to the hospital. She was in emergency for a total of ten hours, responded well to treatment and was able to get herself home. The total bill for her 10 hours in the hospital? Just a hair over $10,000. Yes, that is $1000/hour. For asthma. The bills were duly submitted to her insurance company and of course the adjustors were suspicious, immediately demanding all records for any doctor visits made over the previous 5 years. Since she had been self-medicating, there was no paper trail so the insurance company did in fact end up paying 80% of the bill. She was still out $2000 that she could ill afford but did finally manage to pay off.

Thatís the good news. Of course, the bad news is that now there _is a paper trail. She officially has a ďpre-existing condition.Ē Insurance companies no longer have any interest in competing for her business so she is essentially at the mercy of her existing provider. If this company raises the premiums to the point where she can no longer afford them or finds some other reason to dump her, she has to hope she can hang on long enough to qualify for Medicare.

Ladies and gentlemen, healthcare in America is broken, and it is not going to fix itself. Almost everyone can agree that some sort of reform is necessary. What shape that reform will ultimately take is in the hands of the people we elected to lead us. Letís tell them - respectfully and rationally - our concerns, and then step back and let them formulate a plan. They have the research. They know what the budget of the richest country in the world can handle. They have access to the experts and the most able problem solvers this great nation can produce. Letís give them a chance to fix this problem. If they fail, then we can elect someone else and it will be _their turn to take a stab at it.

And please please please letís stop yelling at each other.

2 Comments:

Blogger Sam said...

Isn't it something about all the "town meetings" where redneck conservatives have to lambaste the President (or any politicians) as socialists and commies? I mean get real, we need to fix a problem.

My daughter went into a hospital on a Sunday with strep throat and a high fever. "I have strep throat and a high fever." OK, she waits 4 hours. A doctor takes about 15 seconds and says "You have strep throat and a high fever." The bill was $582 for 15 seconds. No, they didn't even give her a shot or pill for the price.
sam

10:22 AM  
Blogger Joni said...

I have another story, let's call this person Jane to protect her privacy. Jane was covered by her husband's policy which was paid for by his employer (his family's farm) but the coverage was only good for doctors practicing in New York.

So, since she was spending a lot of time in another state and didn't necessarily like her M-I-L paying her insurance premium, Jane decided to find her own policy, particularly one which she could use across state lines.

Imagine her surprise the first time her application for coverage came back denied. She does not have high blood pressure, diabetes, or any other health issues to speak of. Unfortunately, she does exhibit much of her Italian heritage, she is short and tends to gain weight easily. Aware of this tendency she does try to eat healthy foods and knows she needs to lose some weight. But, it was a severe blow to her self esteem to be labeled "morbidly obese" and denied coverage.

What was more upsetting was to also be denied coverage by the next three companies to which she applied.

Finally, after some haggling with several providers she did find a plan - one of the highly praised HSAs - with a $10,000 deductible, a nearly $400/month premium, and with a rider stating that they will not cover any condition caused by obesity, which I assume could be anything.

My point is that all the people who are saying "leave my health insurance alone" or "Get a job and buy your own coverage" don't realize that even if money is no object it is nearly impossible to get an insurance company to issue a policy for an individual, say, past 35 years old.

Also, if there was a reasonable way individuals could be assured of getting insurance then it would take the burden for providing coverage off of small businesses and put it back where it belongs - as an individual responsibility.

So if "rationing health care" is the threat - I really don't see how it could be much worse than what we have now.

Sorry about the rant but it seems like there are a lot of people out there that just don't "get it".

12:10 PM  

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