Wednesday, September 30, 2009

One Man’s Case against Healthcare Reform

“The trouble with always trying to preserve the health of the body is that it is so difficult to do without destroying the health of the mind.”
G.K. Chesterton


I come to praise the healthcare system in the United States, and not to bury it. Mine is a story filled with all the trappings of a Hollywood medical drama, one that involves a mysterious, undiagnosable illness, a sports injury that refused to go away and got aggravated across continents, midnight trips to the Emergency Room, 911 calls and a myriad of specialists in various fields of medicine. Last year, almost the day after I quit my job, to take time off to travel and spend with my wife, family and friends I developed a sudden breathing problem. Of course, for the 37 years of my life that went before this, I had pretty much managed to stay away from doctor’s offices and hospitals. And the truth is that I rarely ever fell ill despite always having great medical insurance, which I cried about never really putting to any good use or getting my money’s worth; little did I know that in one short year I was about to make up for the last 37.

The week I handed in my resignation letter, we made our first trip to the ER courtesy of a hospital hospitality vehicle known more commonly as an ambulance. Yes, my wife actually called 911. I am not a hypochondriac, or someone who panics about things, ever. So, naturally when I started to have trouble breathing one night, and it got progressively worse to the point where I was leaning out our fourth floor window gasping for air, unable to speak while slowly turning blue, my wife made the call. I was discharged a few hours later after a series of test that included a chest x-ray, an EKG and blood tests, all of which the doctors said were clear. Their best offer of a diagnosis was a bronchial spasm, resulting from a recent case of the flu. I was asked to report to my General Physician for follow-up. We left the hospital without so much as having to part with our co-pay, having been told that they would bill us later. Rather wonderful, I thought to myself, not only the ER’s thoughtfulness and hospitality, but also this insurance coverage of mine. Because I was painfully aware that a trip to the ER in New York City is far from cheap. In fact, it rivals a night at the priciest 5 Star hotels in the world, without even including the added luxury and cost of getting there in an ambulance. I am reliably informed that the total cost of such a trip can be as much as few thousand dollars – again I say thank god for insurance. Now, this is not to say that I was never going to be billed any amount. In fact approximately a month later I received a notice from my insurance company saying that the hospital was entitled to bill me $100 for my share of the co-pay and they also informed me that they had paid 15% of the total cost submitted to them by the ER. Again I marveled at the fact that I had such great insurance. Not only was my share of the cost less than 2% of the total, but my insurance company was also refusing to submit to daylight robbery and pay the hospital the true cost of my care. Bravo, I say. In fact I had to make two additional trips in the months that followed, and am still to receive a single bill from this hospital, one and a half years on.

The other gratifying thing I learned in my subsequent trips to the ER is that nobody is turned away or denied care. A number of people in the ER waiting room said they did not have any insurance, and instead of being turned away as one would have expected, the hospital attendant said that it was not a problem and that once they filled out a form stating a lack of insurance, they would get access to the care they needed for free. While I was still pondering this it dawned on me that this might perhaps be the reason my insurance premium is so high, and continues to increase each year even though I have not availed of it in the years prior. Perhaps, I am paying for the poor families who cannot afford insurance (and out of work actors, unemployed graduates, couples who just chose a more expensive mortgage over insurance, etc.) and that would certainly explain the high cost of my premiums and continual increases over the years. This realization made me feel all warm and fuzzy inside, as I sat there clutching my Gold plated insurance card, waiting to hand it over to the registration clerk, confident in the knowledge that I was doing my bit to help society.

Anyway, my story and praise for the current system is far from over. Another great relief with the current system has to do with the safety net they provide when one becomes unemployed by accident or by choice. This marvelous little provision is known as Consolidated Omnibus Budget Reconciliation Act or COBRA. Anyone who was previously covered under their company’s group insurance is eligible and cannot be denied continued coverage for a period of eighteen months. The only difference is that the cost of the premium, that was being covered by your employer, must now be paid entirely by you. Due to this the monthly increase is roughly two to fourfold depending on how generous your employer was. There are those who grumble and complain about this increase, they say that it comes at a time when you can ill (no pun intended) afford extra costs, now that you are no longer receiving a pay cheque. But I say pish-pash to them, for one has to pay for such privileges. And besides, it is only in moments that one is less busy that one typically has time to linger on ailments that otherwise may never have surfaced. As a result, one can argue that unemployed people are more susceptible to health issues, as they have more time on their hands to dwell on small ailments, making of them bigger things and thus spending more time visiting doctors and hospitals. I am a case in point. I had been to the doctor maybe 12 times in last 37 years and the moment I quit my job I must have made, without exaggeration, at least 37 visits in less than 12 months. It would have been grossly unfair for me to expect my previous employer, the government, or worse yet, the poor taxpayer, to have paid for my health trespasses. My GP directed me to visit an ENT, who sent me to a pulmonologist, who in turn directed me to a gastroenterologist and so on. After each one conducted a battery of tests, often repeating the same ones done by the previous specialist, they ruled out a number of things, but none of them could figure out what was causing my continued breathing problem. Oh, and did I mention that along the way I even had to meet with a foot specialist? Not that this was in any way related to my mysterious breathing problem.

Which brings me to our world travels, during which time my right foot acted up, and I also needed to have emergency eye surgery. I knew something was afoot when my right ankle swelled up during a visit to San Francisco. We iced it and got an ankle brace and in a few days I felt much better. The next time it acted up again was when I played a round of golf in Rajasthan, a few months later, and then it finally came to a head while I was trekking in Bhutan. All this while I had managed to deftly avoid another doctor visit, but after the Bhutan trip, when I was walking with a knee brace, an ankle cast and a walking stick I could no longer avoid the inevitable. Now, as it happens we were in India at this juncture, where my insurance was neither valid nor accepted. I hobbled to the nearest highly recommended orthopedic surgeon, who naturally ordered a battery of x-rays and tests. At the very same time, again right after I quit my job of course, the sty on my eye had also reached a critical stage, and besides the pain my vanity was also now at stake. So we found a well-regarded local ophthalmologist who, upon his first examination of my eye, declared that I would need surgery to remove the now errant sty. The pain in my foot and eye both dissipated as I began to think about the strain my unemployed wallet was about to feel. Needless to say that I could not live without the services of my foot or eye, and opted to go ahead with both the surgery and the long list of tests the orthopedist had ordered. When I received the bill, for both the tests as well as for the eye surgery, I did a double take, because the total cost, including a series of x-rays, blood and urine tests and an outpatient surgery, were less than the cost of a single co-pay for a specialist in the United States. I thought at first that it must be a mistake, but then I realized that this was India. Of course, the equipment that these doctors use is probably much older and not the same state-of-the-art equipment used by the medical fraternity here. Plus, these Indian doctors don’t have fancy Harvard or Cornell medical degrees. And the biggest reason is that these Indian doctors are not made to pay for medical mistakes. Indians are generally quite a forgiving people and nobody sues a Doctor because they save lives, and are well meaning and only try to do the right thing by their patients. So, naturally with their older equipment, lesser degrees and more forgiving patients they can afford to charge much less for the same services. I realized that it was really not a fair basis to make any kind of comparison between the costs of care in these two countries, and besides, the issue had more to do with the people who sue at the drop of a hat, and not the fault of the private health insurance industry in America. So, I happily paid my 100% share of their bills and rushed back to the protective cover of my Gold plated insurance in the U.S.

The next few months I spent running from specialist to specialist, in-between my physical therapy appointments, which I had to do twice a week to heal my still injured right foot. Just around the time I could no longer bear the thought of another hospital waiting room or the sight of a person in a white gown, my wife suggested I try one last person, her allergist. Thankfully, I had enough breath left in me to see the man who finally diagnosed my problem, and sent me to the head of one of New York’s most prestigious hospital’s Otolaryngology Department, to ratify his hypothesis. I had laryngeal neuropathy. The new specialist prescribed the necessary medication and sent me to a Voice Therapist to help strengthen my larynx. With my breathing issue under control my right foot seemed to be getting worse. My doctor ordered an MRI as he said that x-rays do not always tell the full story and that it should have been well on the way to recovery by now. So I called the MRI place to make an appointment and set it up for a week from that date. The day I was supposed to go for my MRI, I got a call from the place and they told me not to come as the insurance company had not yet approved the request for my MRI. At first I was shocked and confused about why my insurance would deny something my doctor felt was necessary. Ultimately, after another week passed and my Doctor even called the insurance company to re-iterate the need to get one but to no avail. Instead, I got a letter from their cost consultants saying that after reviewing the necessary data on my condition (not sure what they looked at) they felt that an MRI was not called for and they added that this was done primarily for my benefit. It seems, in their experience Doctor’s often order needless tests, which ultimately wastes money, and only serves to raise the cost of my care. Gosh, not only was my insurance company looking out for my well being, from errant Doctors, but they were also looking to save me money, to say I was touched would be putting it mildly.

Based on my yearlong odyssey, I don’t understand what the entire hullabaloo is about, in terms of the Democrats’ urgency to fix the US healthcare system. I am living proof of the fact the current system works, and works rather well with all its meanderings, negotiations, graces, and non-billing after traumatic ER experiences. In fact it seems to work to everyone's advantage; except maybe the doctors, but then again we all know that doctor’s are overpaid anyway…right?

1 comment:

  1. Thxs for the additional paragraph regarding MRI’s. It's such a miraculously incredible invention that detects more than x-rays/sonograms yet this beast is always in question w/ insurance companies. I was told MRI's can detect more than a mammogram, yet its not covered by insurance for breast exams.

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