Friday, September 11, 2009

Need for Reform Finally Obvious: A Personal Commentary

I admit that I didn't watch the President's Health Care Speech the other night...I was busy doing the mom things that I have to do at night to keep everything on track. I also admit that my husband's job provides good health care (although VERY expensive for his small business), and that I generally don't worry about how to afford our medical care. In general, I agree with the need for health care reform, although I don't necessarily agree with the President's path to that reform.

HOWEVER...this morning, I saw the bill from my recent trip to the ER at Connecticut Children's Medical Center in Hartford when my 15-month-old bit completely through his tongue: $762.06. Sure, you say, you went to the ER. But, I say, all I got for that $762.06 was a dose of tylenol and a 3 hour wait. No doctor, no tests, no physical exam other than a 15 second attempted glance in a very bloody, screaming mouth. We got shuffled off to "Kids Express" (not the regular ER room) to see a nurse practitioner, and after her aborted attempt to look at the injury, she declared that there was nothing to be done and that I could go home.

I called billing at CCMC this morning and asked why I (really my insurance company) had paid so much. The reply I got was a bit astounding: "that's how much it costs to use the ER."

"But I didn't use it," I said. "I just waited for 3 hours, didn't even see a doctor, and you didn't do anything for my son except give him tylenol."

The woman's reply: "Oh, this bill doesn't include the nurse practitioner's bill. This is just for the privilege of using the ER - you had a Level 3 visit."

Apparently Level 3 is the "non-emergency" emergency visit cost. While I have a $50 co-pay for that, my insurance company paid $712.06 for tylenol, and it will also pay however much for the nurse practitioner's 15 seconds of "evaluating" my baby.

I don't disagree that having an excellent Children's Hospital is good for CT. We had a good experience there last year when my before-mentioned-child needed surgery at 5 months old. However, I am wondering about the 25+ other families that joined me that Friday night at 7:30pm. Given my experience, everyone else was at least a Level 3 or higher, so that means that every other family paid at least $762.06 to wait with me. If I had to make a crude assumption of health care coverage based on appearances alone (I know, this would be rude and based solely on gross stereotyping), I'd have to guess that not all the families there that night had the same coverage as me.

What's my point, then? I don't think the President (or Congress for that matter) can or should compel individuals to have health insurance, but I accept that some of you may disagree with me. I certainly believe health insurance should cost the same for any business, despite its size, because insurance company costs are spread out across ALL members of the insurance company, not just a specific business that buys insurance for its employees. And finally, let's get real about what hospitals are up to. Just as we're supposed to have "truth in lending" disclosure for mortgages, how about "truth in treatment" costs as well? I accept the concept of triage and separate facilities for treating lesser injuries. That's efficient and it makes sense. But there's no way that a single dose of tylenol and the "privilege" of waiting for 3 hours should cost over $700. No matter who is paying, that just doesn't make any sense, and we shouldn't tolerate it.

We can't put off "reform" for much longer, especially as the jobs that do provide health care coverage grow more and more scarce. Let's not be afraid of the word itself, for I see some very clear areas where we could start, and it wouldn't cost tax payer dollars to get started. My insurance company has no problem rejecting my chiropractor all the time: the poor man has to spend twice as much time justifying his treatment plan for my injured shoulder, down to the number of minutes he spends doing whatever he does. BUT, no one batted an eyelash at $762.06 for tylenol, so either I'm totally in the wrong business, or I stumbled across a really obvious place to support the President's call for reform.

7 comments:

fishmuscle (Stephen H. Devoto) said...

Thanks for illustrating an abstract and difficult to follow debate with a concrete and easy-to-understand example, we need more of those.

I too confess to being somewhat ill-informed about the issues (for similar reasons), but I think your example makes one of the best possible arguments for the government requiring everybody to purchase health insurance (just like it now mandates auto insurance). As I understand it, a portion of the $762 your insurance company paid for your visit was to cover the costs of the 25 other people in the ER who may not have had insurance.

Your cost would fall, perhaps dramatically, if they were required to have health insurance.

Their health would rise, perhaps dramatically, if their care was given in a non-ER setting.

Anonymous said...

If you were annoyed by your three hour wait, imagine what it will be like when thousands of people with newly acquired free health insurance bombard the ER's with every little tummy ache, scratch, or menstrual cramp.

Anonymous said...

Years ago, I opted for additional Blue Cross Blue Shield in Vermont for Maternity benefits,since I was hoping to have a baby! Having moved to Massachusetts before the blessed event occurred, I was denied Maternity benefits coverage there on account of having a pre-existing condition. Not being fond of the hospital experience, I chose a hospital with a homey birthing room. When the time came the homey room was under reconstruction so I settled for a less homey but adequate labor room where less than 24 hours later, we checked out and went home with our bouncing baby boy. When the bill from the hospital arrived, it appeared that i had been in at least four different rooms including the "delivery" room. When I, uninsured and aghast at the amount owed, protested that I had not used the rooms for which I had been billed, I was told that the fee for having a birth at the hospital would be the same even if the baby had been been born in the parking lot!
I said that I would see the hospital in court...unfortunately, I moved to Connecticut and the collection agency would not pursue an out of state deadbeat like me so I never got to speak up about the injustice of it all. But I did not pay, either.

As for the medical profession, I would prefer a system whereby physicians were salaried rather than being compensated in the current "fee for services" model.

Why does medical care have to be so expensive that no one can possibly afford it?

Judy said...

Hahahahah. I highly doubt the ER is going to be swamped with thousands of women with menstrual cramps.

Anonymous said...

If you were annoyed by your three hour wait, imagine what it will be like when thousands of people with newly acquired free health insurance bombard the ER's with every little tummy ache, scratch, or menstrual cramp.

Anonymous said...

Part of the beauty of having "the best private health care" from an employer-based insurance system is that you can not see your excessively costly private physician without making an appointment a few months in advance.LOL. So I think three hours is not too long to wait but it seems shabby, for what you are paying per month for this outstanding insurance, that your private doctor did not meet you in the ER or arrange for another doctor to take a look at your injured child.

Anonymous said...

Ever work on an ambulance, Judy?

Anonymous said...

And if we get that government run health care plan we won't have to wait nearly as long, right?