Monday, March 08, 2010

The Continuing Saga of Our Broken Healthcare System

Over the past several months I've continued to document my problems with our broken health care system, particularly focusing on the options provided by those who are either unemployed, disabled, or who work low-wage jobs in which their employer does not provide the option of coverage. My hope upon doing so is that more people will recognize the depths of the problem beyond just the soundbytes, the smears, and the distortions. I aim to record the truth, not the fear-based rhetoric that many accept as God's honest truth. What I have discovered is that the problem goes much deeper than a position statement and only modestly resembles the demonizing propaganda disseminated by those who would kill reform altogether. The real issues are just as troublesome, though they are far more ordinary and less inclined to high drama.

Today's latest hassle involves a matter of incorrect bill coding. An insurance claim for lab work was not processed properly, so I opened the mailbox Saturday to find an eye-opening bill for a mere $1,323. To say that I couldn't exactly pay it in full would be an understatement. Along with the bill was an itemized statement listing the cost of the twelve separate tests that were run. Those who have a chronic illness of their own recognize that upon seeing a new specialist or doctor, he or she will often order several lab profiles at first as a means of eliminating other extenuating circumstances that might complicate the treatment of a primary diagnosis. Sensible enough, except that many these tests are very expensive. A test for Hepatitis, for example, cost $366, and a full drug screen cost $217. Those with excellent insurance never blink an eye about the prohibitive cost, of course, because for them it is almost always covered in full.

For those with sub-standard or nonexistent coverage, however, the situation is quite different. As I have mentioned before, I have bipolar disorder, and as such take Lithium to stabilize my moods. Lithium is a notoriously difficult drug to regulate because the most minor changes in environment or other seemingly innocuous changes will cause the levels in the bloodstream to vary considerably over time. There is no other way to accurately measure its concentration in the bloodstream except through drawing blood and over the years I have gotten used to it, as best as one can under the circumstances. Still, I report with much frustration that even a simple Lithium serum level costs $64 without insurance. Someone who also has bipolar and is living in poverty could not easily afford to spend this kind of money and would likely choose to either go off his/her medication altogether, or stay on the meds and go months without having a lab profile, both of which are extremely dangerous options.

There are ways, of course, for low-income residents to obtain health care coverage. However, I note again that it took nearly three full months of frustration and persistence to even obtain coverage in the first place. What I ran into was another glaring example of a broken system, whereby I was provided a huge amount of incorrect information over the phone, and in person, by a series of different workers before finally getting in touch with someone who knew what they were doing. And even then, problems remained. As it turns out, the reason I got stuck with the bill in full was as a result of two specific reasons. First, whomever coded my lab work listed the wrong health insurance carrier. Second, whomever set up my health insurance in the first place, by either carelessness or human error, got the day of my birth wrong by one digit. Something that relatively minor one might think would be no big deal, but indeed it was a very big deal. I have observed that even those with superb health care coverage often get charged for procedures and tests that were either never performed or were totally unnecessary.

I called this morning to try to get the matter resolved and I certainly hope that it was. The question of the incorrect birth date remains problematic. Rather than have to go through another extensive, time-consuming merry-go-round to get the date changed, and also to file to receive a new card reflecting the correct information, I told the person I spoke to over the phone simply to leave it as it was for now. I suppose if I feel like it, eventually, I'll go to the additional trouble. Right now, however, I have no patience with the process, nor much energy for it. I note that what I have dealt with over the past several months is rather darkly comedic at times; this morning after I hung up the phone I was reminded of a particular Monty Python skit whereby a woman orders a cooker that she herself clearly ordered, though in actuality while it was sent to the right address, it was assigned to the wrong name. She signs the necessary forms under the wrong name anyway, since going to the trouble to get it changed would be more effort than it was worth.

I have the good fortune to not have to be constantly afraid of losing a roof over my head or having enough money to feed myself on a daily basis. Many people in poverty do not. They simply can't take hours out of their busy schedules and demanding, stressful, often thankless jobs to tie up loose ends. So if they seek treatment, be it for a chronic illness or a routine checkup, many don't have the means to sign up for coverage. Either they get stuck with bills totaling into the thousands to tens of thousands and above, or they refuse to seek necessary treatment out of fear of bankruptcy or losing the little that they have. I hasten to add that there is no reason at all that even routine lab work should cost hundreds, if not thousands of dollars in totality, just as there is no reason at all why a month's worth of prescription drugs should cost close to $800.

The opponents of health care reform can talk up a storm about socialized medicine and the auspices of scary big government, but they notably never address the greed factor. Government doesn't trouble me nearly as much as someone's patent and manifest desire to inflate costs beyond all sense of proportion while no one bothers to call their hand on it. So yes, I do see this issue as a deeply moral matter, but I also see it as a way to prevent the unconscionable abuses and offenses of large corporations. That we seem to have somehow gotten away from this crucial argument troubles me more than the supposed inefficiency of a public option or the creeping specter of socialism. Real people are suffering mightily and if our legislators delay this measure or allow it to collapse altogether, their blood will be their hands. Do pardon the theatrics for a brief moment. I wouldn't resort to them if I wasn't speaking the truth.

It's not enough to just set up a system. As I've seen for myself, it needs to be properly funded, must limit needless complications, and it must be set up to handle not just times of plenty, but also times of famine when more people will have a need to use the system than in other times. Part of the problem we are dealing with now across the board is that few businesses or government agencies ever considered putting money away for a rainy day or developing a plan of action when recessions or economic downturns hit hard. When times are good, it's easy to neglect thinking about the future, but much of the shock of any economic downturn is when those whose ambitions and plans have outstripped their finances find themselves having to make do with far less than normal. Businesses go under, government agencies grind to a halt, and struggling people become angry and start looking for targets upon which to project those feelings of agitation. It's well and good to focus upon the proper target, but it's another thing altogether to transfer that hostility into positive progress. An angry electorate rarely thinks beyond a purely emotional desire to destroy the status quo and with it a short-term goal of cleaning house. But with this understandable response must come specific goals. Anyone can play target practice. I would much rather us hold accountable our current elected officials and force them to pass the reforms we need than fume and hoist our pitchforks.

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