Monday, May 17, 2010

Health Care

Back in my original country, some lunchtimes I would leave my office in the heart of the business district of the city and head for the nearest Subway restaurant. Inside it was a factory.

You would give your order explaining clearly what your desired toppings were, whilst your sandwich moved rapidly down the line to where three female employees scattered components over it in a constant and unchanging pattern. Hence what you actually ended up with had no relation to what you had ordered but it happened so quickly that you felt far too guilty about disturbing the smooth operation of the automated production line to complain. Eating for the first time in a US Subway was therefore a major revelation. The employee not only served me what I had asked for but placed the items on the bread carefully and in sufficient quantities that suggested they had considered my nutritional needs rather than what they happened to have in their fingers at that moment. Seeing my consternation my US friend explained that Americans expected good service and were not afraid to speak up when they didn't get it. Service providers therefore learned to raise their standards or could not expect to stay in business.

I have never seen the TV program Flashforward, and since it has been cancelled probably never will. However from observing my wife watching it I have gathered enough to understand that it depicts a moment in time when the whole population was put briefly to sleep and they woke up to find some terrible event or disaster would soon be upon them. After much reflection I have come to the conclusion it is a documentary which depicts the moment when the US Health Care system came into being. I cannot believe such a discerning nation could have done anything other than sleepwalked their way into such a terrible system.

My criticism is not of medical professionals, I have huge respect for their training and dedication. No, my horror is at the administration and insurance side of health care.

I have medical insurance. I count myself lucky in that regard. I also count myself largely penniless since on just about every occasion the medical insurance company wriggled out of paying for last year's claims.

How is it that a nation that can perform the miracle of getting the food they want out of Subway can lose all sense of judgement when it comes to their own health? How did they convince you that medical tests are something you should be paying for separately and not an essential and hence integral part of the medical visit? Are American libraries full of covers with no pages? When Americans buy a truck do they expect to get a separate bill weeks later for the wheels?

Whilst I still find it a little surprising to find sales tax is not integrated into prices, so a ticket says one price but you pay another, at least once you leave the checkout having made payment the process is final. With health care one never has any certainty over price thanks both to the financial gymnastics of the insurance companies and the deviousness of the invoicing process.

Just after Christmas I paid a short visit to a hospital thanks to a small infection. It wasn't a particularly long or complex visit, no tests needed to be done and the doctor quickly diagnosed me and wrote an appropriate script. A month or so later a bill for roughly sixty dollars turned up and we paid it. Recently another bill for the same visit surfaced this one for several hundred additional dollars. I was horrified but my wife was not surprised and assured me this was far from unusual.

I am no doubt that Health Care reform is long overdue and urgently required. I don't honestly know if the recent Act is a good or bad thing, it was so much amended and sabotaged by interest groups and bulked out with the pork which is a depressingly normal part of the political process here. I am sure it could be done with less words much more successfully. A simple provision giving the CEO of the medical insurance company 50,000 volts for every time they are found to have unreasonably denied a valid claim would work wonders for instance.

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