September 08, 2009
My colonoscopy saga-1: So where is this freedom of choice I hear so much about?
(For previous posts on the issue of health care, see here.)
In anticipation of Obama's speech on health care this week and as a coda to my long series on health care, in a four-part series I am going to write about a recent experience I had with the bureaucracy of the health care system in the US, not for any serious illness, but to get a 'routine' colonoscopy.
I recount my story in detail not because it is tragic (it isn't) but to show how even seemingly simple things are made enormously complicated because of the private profit-seeking system that we have. The absurdity of it is that what I went through is so common in the US that people think that it is the only way to do things, unaware that in other developed countries, people do not have to go through this nonsense.
But rest assured. Unlike Katie Couric, I am not going to show images of my colon or other details. The saga is entirely about my dealings with the bureaucracy that one has to go through with private health insurance companies. Almost anyone who has had any experience with the health industry in the US has been given the run-around, with mind-numbing paperwork and endless struggles with the health insurance bureaucracy. Why people are not outraged amazes me. Perhaps it is because that most people have no idea that this is not normal, that when people in other countries need health care, they simply go to a doctor, get treated, and are done with it.
A colonoscopy is used to detect and remove 'polyps', which are small growths on the colon that can become cancerous. All colon cancers begin as polyps though not all polyps become cancerous, so early detection and removal is advisable. It is recommended that people over the age of 50 get a colonoscopy exam every ten years to detect and remove such polyps. I had dilly-dallied over this for many years but my mother's diagnosis of colon cancer finally pushed me to actually get one. I then came face-to-face with the Kafkaesque absurdity of the US system that Uwe Reinhardt, a professor of political economy at Princeton University describes:
Well, I once did a dumb thing: I asked an insurance executive "What do you pay in New Jersey for a colonoscopy?"
And he just laughed at me and said, "What a silly question. There is no price for a colonoscopy. We have a different price for every hospital. And for the same hospital, we might have six prices depending on the insurance product, is it an HMO, etc."
So I said, "This is mad. How many could there be?"
He says, "There could be 30, 40 for us, but then with Aetna, they could have another 30, and everyone has a different contract, so a hospital might receive 60, 80,100 different prices for a colonoscopy, depending on which insurance company and what contract it is. So when you say 'What are the private market prices?' there is no price."
That was exactly my experience. The system was so complex and confusing that even for a routine colonoscopy, even the insurance people did not know what the rules and costs were. Is it any wonder that doctors' offices have entire teams of people simply to do the accounting and try and figure out who should pay how much for what? And that even then they have to often guess? And that patients and doctor's offices have to fight with insurance companies?
First of all, let me say that I am one of the supposedly 'lucky' ones in the US when it comes to health insurance. Both my wife and I are employed and have allegedly 'good' health insurance offered through our respective employers. We chose to be covered by one of my wife's company plans, which seemed the best suited for our needs. At the end of every year we have to go through the dreary exercise of comparing all the plans offered (since the benefits and prices and lists of approved doctors and hospitals of each can and do change each year) to make our choice for the following year.
So when I decided to have a colonoscopy, I checked the plan we had that year to see if it was covered. It was and said it was free. Terrific news! Of course, aware as I am of the tricks of the private, profit-seeking health insurance industry to try and squeeze extra profits by exploiting loopholes, I know that nothing is ever that simple and so started looking into all the fine print that is buried in the policies. My policy says that a routine colonoscopy is free but only if it is done by doctors who are on my plan at only the authorized facilities on the plan.
Americans will not be surprised at this because this is what they have grown up with but it alone immediately puts the lie to those who claim that the current US system gives you more choices in doctors and hospitals than single payer systems in other countries. In reality, the choices you have here are severely restricted to the ones given to you by the insurance company, whereas in single payer countries there is no such restriction. If I were in France or Canada, I could go to almost any doctor who was willing to take me on as a patient.
Next: When routine does not mean what you think it means.
POST SCRIPT: Matt Taibbi on health care
Some time ago, I referred to a Matt Taibbi article in Rolling Stone on the horrendous state of health care in the US and Obama and the Democrats' sordid role in preserving the system. The article was not available online then but it is now and reader Heidi has kindly sent me the link.
Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It's become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn't be equal to dreaming it up on purpose.
The system doesn't work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation.
The cost of all of this to society, in illness and death and lost productivity and a soaring federal deficit and plain old anxiety and anger, is incalculable — and that's the good news. The bad news is our failed health care system won't get fixed, because it exists entirely within the confines of yet another failed system: the political entity known as the United States of America.
Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.
He also looks at the role-playing by the Democrats to hide the fact that they too are in the pockets of the health industry sharks.
In many ways, the lily-livered method that Obama chose to push health care into being is a crystal-clear example of how the Democratic Party likes to act — showering a real problem with a blizzard of ineffectual decisions and verbose nonsense, then stepping aside at the last minute to reveal the true plan that all along was being forged off-camera in the furnace of moneyed interests and insider inertia.
It is a terrific article. You should read the whole thing to see how the government really works and who it really works for. But be warned: it is not pretty.