On Health Care, Vegas-Style, Or, Figure It Out In The Ambulance, Chump

by: fake consultant

Tue Feb 09, 2010 at 13:43:04 PM EST

For us it wasn't a matter of life or death, but it is the kind of story that explains, perfectly, why we need to reform the health care system we have today-and for that matter, it's also a great explanation of why a single-payer system would be a giant step forward for everyone in this country, whether you're insured today or not.

It's also hilarious and sad and frustrating, all at the same time-which makes today's story a pretty good allegory for the current American way of doing health care.

So follow along, have a good laugh...and at the same time, take a minute to consider what could be, and how much less irritating things should be.

"There was never any thing by the wit of man so well devised, or so sure established, which in continuence of time hath not been corrupted."

--Charles Pratt, 1st Earl Camden, "Concerning the Service of the Church"

Several things have been happening over the past couple of months to prevent me from writing as much as I would like; among those a series of quite painful medical events that caused The Girlfriend to have to visit the emergency room three times.

Nothing life-threatening, as I mentioned above, but painful nonetheless.

She is a State employee, so she has insurance; the emergency room benefit calls for a $50 co-pay for an ER visit.

The bill has now come in...and much to our surprise, the "patient responsibility" is a bit over $300...for only one of the three visits.

As you can imagine, a phone call to the insurer followed...and this is where the story gets weird.  

The customer service rep told us that the emergency room cost is, indeed $50, as we expected-but the services of the ER doctors are not paid at all.

How is this possible, you might wonder?

The customer service rep explained that while the ER itself is "part of the network"...the physicians who work in that ER are not a part of the network.

It takes a minute to make sense of that, so if you want to pause to allow the whole thing to sink in, I'll understand.

Ready to move on?

The Girlfriend asked the obvious next question: how are you supposed to know, on your way to the emergency room, exactly who might be in the network and who might not?

The customer service rep came back with the obvious answer: there is no way to know...you just wait for the bill, and then you find out.

Our reaction, as you might expect, was something like this:

As of this moment we do not know how this is all going to turn out, but here's the point:

It doesn't have to be this way.

Canada manages to get patients in the front door and through the billing process with far fewer administrators, far less hassle, and at far lower cost than the system we have here-and that was the big attraction of a "near single-payer" approach before it was driven out of the reform discussion. (To be technical, a "Medicare for all" system could accomplish the same thing.)

Of course, it's not just our family that would benefit from reform.

Think about what a hassle keeping track of all of this is for employers.

The State of Washington has an entire corps of workers who do nothing but manage the insurance coverage for State workers...and I suspect your State does as well.

In a time when every State is trying to put as many dollars as possible into maintaining basic services (such as keeping the State Patrol fully operational), wouldn't it be nice to redeploy some of that money to someplace like the Office of Support Enforcement or Adult Protective Services?

Private employers would obviously benefit as well, as their own no-longer-required health insurance administrators could also convert to jobs that are "bringing revenue in the door"-just as they have done in Canada and the UK and...well, everywhere else in the developed world, more or less.

And that's today's story: a moderately serious problem has led to the kind of absurd situation that causes wolves' eyes to nearly explode; in the process, however, we've had a chance to think about how health care reform could make things much better, not just for those who have no insurance, but also for everyone who has insurance, for every one of our employers...and, on a larger scale, for the Nation as a whole.

Unless, of course, you're lucky enough to have the mythical health insurer whose approach to business truly incorporates the motto "the customer is always right", in which case you may go ahead and ignore all of this and return to your normal low-altitude recreational hang gliding over the cactus fields.