Some Random Thoughts on Health Care

Maybe it is because everybody else is doing it, but I thought I would reflect upon the medical health care I have. I have good health care because I have socialized medicine. I have medicare. But I also have a supplement which is expensive and I have to buy insurance for my wife and that is expensive.

But that private health care does not give me and my doctor solo responsibility for my health care nor my wife's health care. The first major problem for us is the health care's constant pressure to use generic drugs when they do not work for my wife. Betty, my wife, has constantly complained that she and her doctor talk about her problems. The doctor gives her a prescription for a drug and the health care program demands that she try the generic. It does not work or has side-effects which are not acceptable. There is then a major fight wiht the insurance company for her to be able to use the original drug and to have the insurance company cover it.

The second way in which my health care is not a decision made by my doctor and me is that there is this long list of pre-approval procedures. Again the insurance company refused to pay on first submission a procedure that the doctor ordered for Betty because we had not gotten prior approval. Why should the doctor's orders have to be checked with the insurance company? The insurance company is interfering with my health care decisions which ought to be between me and my doctor.

The third way in which my health care is already controlled by forces outside of the doctor-patient relationship is that there are some procedures and operations that they will not cover. I am not talking about cosmetic or vanity procedures. There are major health treatment programs that the insurance companies consider wasteful and therefore they will not cover.

The fourth way that my health care does not allow me complete freedom of choice in my health care is that they tell me that there are certain doctors who are "in network" (which means they will accept the insurance's pay schedules) and others who are "out of network". If I go to a doctor of my choice who is out of network, then I have to pay more of the costs for that treatment. So that the idea that I now have absolute freedom to choose my doctor is a myth.

My socialized medicine, Medicare, has not given me the same restrictions as my private insurance. The argument that a public option program would limit and restrict my choices is one of those lies that is meant to make me believe that my current system is free choice and it certainly isn't.

Those are ways that the current system already has other powers between my doctor and my health care. From the hospital's and the doctor's perspective I can not understand why we have all this pretense about the surgery costing $10,000 (an example) but the insurance companies have worked a deal where they will only allow half of that and they pay 80% of the amount they allow. What kind of game is that?

There are a number of problems which I have never had to face. I have never had to change jobs and worry about what that change did to my insurance. I have never had to apply for new insurance with a "previous condition." I have had friends who had to decide whether to get a cancer treatment done at a hospital which was forty-five minutes away, and have that treatment covered as a hospital visit; or get the medicine from a drug store and give it to himself and have it covered as a prescription. The difference in each treatment was about $1,000.00

There are a few basic facts for me: 1) Our current health care system is not working. We pay more per person than any industrialized country for health care. The costs are rising faster than the cost of living. The health care is not that much better (and depressingly low in some categories) than those other countries. 2)We have known and talked about the need for health care reform for more than 60 years. How long does it take us to solve a problem? 3)We need to return the medical practice to the doctors, not the insurance companies. 4) We need to find a way to hold medical people accountable for major mistakes without the risks of multi-million dollar law suits. 5)We need to find a way to cover all people with a basic medical policy. Now it is the time. We need to get it done.