19 November 2008

What Do We Need? Health Care Reform. When Do We Need It? Now.

The New York Times opines that the United States is "the wrong place to be chronically ill." At one level, I have no cause to complain: I have good health insurance, and my health costs, and those of my family, are well covered.


The Mate, The Offspring, and I all have chronic illnesses, and the co-payments start to add up. Between us, we take eight medications a day year-round -- more when things flare up. There's seldom a month when one of us isn't in a doctor's office at least once, and we're all too familiar with the emergency room. Fortunately, when The Offspring's breathing gets particularly bad, I don't have to worry about how I'm going to make the $50 ER co-payment.

Does the insurance company perhaps think they can discourage me from visiting the ER by making the co-payment five times the cost of a regular doctor's visit? If that's the rationale, it's just plain cruel. If I'm laboring to breathe at 3 a.m. on Saturday, do they want me to contemplate waiting until Monday morning to see a doctor? If The Mate has a seizure in the middle of the night and hits his head, do they want him to wait until morning to get checked out? Please.

The other problem involves getting the insurance company actually to pay for health care. In the end, they always do. But because I work in New Jersey and live (and generally seek health care) in New York, submission of claims always seems to be getting fouled up.

Last year, The Doc prescribed a new medication for reflux, since the one I was taking wasn't doing the job. Then he had to make a phone call to the insurance company to reassure them that I had already tried the first one. No, they wouldn't take my word for it.
(Yes, I've cut back on tomatoes, coffee, and citrus. No, I don't go to bed with a full stomach. No, I hardly ever drink alcohol, so there's not really anything to cut back.)
Once a month or so, The Mate spends at least half a day on the phone with health care providers, the insurance company, and collection agencies trying to get everything sorted out.

That's a lot of lost productivity, in economist-speak.

And another thing.

People (insurers, big pharma) shouldn't be making fortunes off of health care. That's just wrong. The money should be going into the system, not into executives' second and third homes.