Thursday, May 28, 2009

Fire engines and emergency rooms

If your house is on fire in the United States, firefighters come to put it out and save your life.

You don't receive any bills. You don't have to purchase a monthly fire protection service whose prices fluctuate according to market conditions and the demands of profitability.

You just get the service you need, when you need it. No red tape. No fees. No needless bureaucracy. Things are simple.

That's what happens if your house is on fire. But if you have a medical emergency, its a completely different story.

This is how things might go assuming you are not one of the 50 million Americans who has no health insurance at all. Imagine you break your arm and go to the emergency room. You get the immediate care you need and get released the next day. On your way out, you stop by a department of the hospital where you're to pay and fill out the appropriate insurance information (in the U.K., for example, such departments do not exist).

That wasn't so bad, right? I mean, even though you may be paying costly premiums, deductibles and co-pays, at least you're covered, right?

Until 5 months later you get a call from the hospital (or a debt collection agency paid by the hospital) demanding that you pay for your visit. You owe some ridiculous sum of money, they claim. Say, $10,000. "But I'm insured" you say to yourself. You check into things and find out that your insurance company doesn't want to cover the treatment because it was 'experimental' or because it derived from a 'pre-existing condition'. So they claim that they aren't going to pay. You press them, and they claim that they aren't going to budge.

Somehow, things get straightened out and it appears that the insurance company is going to pay for some of it. Whew. Glad that's over.

Until a year later you get a bill from the hospital demanding some smaller sum of cash that you still 'owe' them. It turns out, that the insurance company has refused to pay for 2 bandaids and a cotton swab totalling $100. The hospital, it seems, didn't send the bill in the correct format in the correct time window to the insurance company, so the insurnace company said they refuse to pay it. Since the insurance company is a huge, powerful, and attorney-fortified institution, the hospital has decided to pass the buck along to you. If the big insurance giant wont pay or will force a trial in order to cough up the cash for your bandaids, the hospital figures they might as well harass you to pay it. After all, you're not very scary and you aren't so likely to have a team of corporate atorneys at your disposal to dispatch such requests.

So the hopsital takes this outstanding balance that they're owed and sells it to a debt-collection shark. They sell it to the shark for 75% of what its 'worth', so the hospital recoups some of the cash they're owed and is absolved of having to deal with getting the money. So now you get calls from some shark demanding that you pay for the cotton swabs that your insurance company has refused to pay.

You complain to your insurance company that they should just pay this thing, but they don't listen. After persistent calling, faxing, letter-mailing, and emailing, they explain to you that they aren't paying because of 'company policy'. The company policy, after all, was drawn up in the interests of making the company maximally profitable. If you were to aggregate the amount of 'small sums' of this nature that they refuse to pay in a single year alone, it adds up to a decent chunk of money. This is how capitalist entreprises function: the bottom line is that they try to minimize costs and maximize returns.

Meanwhile you've got some jerk-off claiming that you haven't paid for cotton swabs used at a visit to the doctor that occured 3 years ago at a time when you were fully covered by what most people would consider "really good health coverage".

Invovled in this tragic comedy, are: two different health care providers (the hopsital and the contractors) who each have their own bone to pick with you, a massive insurance institution that is not 'on your side' but rather on the side of the investors who own the company, and a handful of seperate institutions that make their money by collecting debts and harassing people. If things get really bad, you can also throw your attorney and any other legal counsels fighting against you in a legal battle that might subsequently ensue, not to mention the court system, judges, etc.

Now in the United Kingdom health care works like fire departments work here.

When you get sick, you go to a hospital. You get the care you need. You leave feeling better. 3 years later you do not receive 5 different bills from 6 different bureaucracies. In fact, you never receive any goddamn bills. As a citizen and a taxpayer of the United Kingdom, you've already paid your dues. And what's more, whatever dues you did pay were proportional to how much money you made: the amount you pay for your health care isn't a 'one size fits all affair', but takes into account your ability to pay. It doesn't much matter whether you have a job when you go to the hospital, whether you're old and frequently ill, whether you are poor. You can come and get the health care you need all the same.

The United States Congress has been holding 'health care forums' recently in which they are claiming to be putting 'all options on the table' in considering ways to reform the unbelievably moronic health insurance system that the US currently has. But nothing remotely approximating the example above is being mentioned, let alone seriously considered.

The problem, after all, isn't that we have twelve different bloated bureacracies doing sixteen different tasks that have nothing to do with insuring people, but rather firguring out how not to insure the people that already paid for their insurance. The problem isn't that our system is inefficient and has too many different institutions doing the same thing poorly. The problem isnt that profiteers are in firm control of all the relevant institutions and run them according to the criteria of "let's make me as rich as possible". The problem isn't that these assholes made billions in profits last year while millions more Americans lost their insurnace coverage.

The problem, says Obama et. al, is just that 'health care costs are too high'. Right.

1 comment:

Anonymous said...

brilliant stuffs.

as a 54yr old female (min. waged, zero benefits) who lived 2 decades in britain, I can vouch for the difference.

I only had to use the british emergency room once (fingers slammed in door - ouch), I was x-rayed and received care and meds w/o being billed. . .

last winter, in america, I ended up with bronchitis/pneumonia - having never been seriously ill, I had no personal doctor, was new to the area, and called a local acquaintance hoping for someone to drive me to a hospital when my breathing became so difficult as to be frightening. SHE called the emergency services, which arrived before she did, a completely unnerving experience for me.

Despite repeatedly telling them I did NOT want to get into the ambulance, etc. they put me on oxygen, and 5 of them began hooking me up and "cajoling" me into the vehicle - 20min later, exhausted, I relented.

Long story somewhat shortened, I was badgered into staying overnight - told firmly by the "head" doctor that if I left the hospital I "might be dead by morning" - again, I was ILL - great way to scare someone into a hospital bed!

I relented, was awake the whole night in a nightmarish ward. . . and was billed over $8,000. for the experience. . . roughly what I would take home for 8 months pay.

and I now have the second stage of your story, the credit hounds, after me.

it's a racket, extortion pure and simple. harassment of those who can least afford the outrageous charges tacked onto bills meant for insurance companies. . .

(yeah, I got my courtesy bag as I left, complete with booties - I left it in the room next to the disgusting "breakfast". . . ^^)