Friday, July 17, 2009

...between you and your doctor?

One of the primary arguments made by right wingers opposed to public health care is that they don't want the government getting between you and your doctor. The idea is that if you allow the government to run health care, suddenly health care will become this big bureaucratic nightmare, and it'll take forever to get, say, something as simple as a prescription for antibiotics for a sinus infection, let alone to get approved for a major surgery.

God forbid, right?

Here's the thing. We have that level of bureaucratic nightmare already. The for profit health industry, made up of HMOs, insurance companies, for-profit hospitals, pharmaceutical companies, and the army of lobbyists they send to Capitol Hill, already stand between you and your doctor. We're always hearing horror stories of an insurance company that refuses to approve a major and necessary surgery. We're always hearing about people with employer-provided health plans that still leave them with huge out of pocket costs. We're always hearing about people being bankrupted by hospital bills because they either don't have health insurance or their policies are so full of holes that they really aren't covered for anything. Not to mention the thousands of Americans who literally can't get health insurance because they had the nerve to get a “pre-existing” chronic condition, like cancer.

But what about the other end of that “don't want the government getting between you and your doctor” argument? The side that says that simple things, like, say, getting antibiotics for a sinus infection, would become a nightmare?

Three weeks ago, I went to see my doctor because I had a head cold of some sort. That went pretty smoothly. I have an HMO. I called the central office, they called my doctor, and somehow the layers of administrative staff figured everything out and I got my appointment. Fine. My doctor said that I probably had a virus and he didn't want to prescribe me antibiotics at that point, but – and this is the critical bit – if I were to develop symptoms of a bacterial sinus infection, I should call him and he would call me in a prescription for antibiotics.

Cut to three days ago. My partner and I had been kind of passing the bugs back and forth between each other, and they had finally decided to settle directly in my sinus cavity, causing one side of my head to throb like the dickens.

I called my doctor. Ok, no, I didn't call my doctor, because I can't. I called the phone number on the back of my insurance card, and spoke to a medical receptionist...somewhere. Since it was after hours, the only person I could really speak to was a medical advice nurse, which would mean spending 18 minutes on hold. Or I could get a call back the next day. I asked them to call me back.

In what was to be the last pleasant surprise of the whole ordeal, I did get a call back from a nurse the same night. I don't know who this nurse was, or what connection she had to my doctor, but she did call me back, ask me about my symptoms, and promise to pass a message to my doctor's office to get me some antibiotics. But it certainly wouldn't be until the next day, and since my doctor was going to be out of the office the next day, it might not be then either.

The next day, I got no call from anyone at the HMO. I decided that if I wasn't going to get any antibiotics, I should at least get some pseudoephedrine from the pharmacy down the street from my work. It was at that point that I realized that I live in the only state in the union where pseudoephedrine requires a prescription from a doctor.

So I called back the HMO, spoke to another medical receptionist, who passed me to another nurse, who promised to send a message to my doctor's office. We're now 48 hours since I tried to use my insurance to get something as simple as antibiotics, and now – pseudoephedrine. And I have neither.

This morning, after suffering through another night of having a sinus infection, and breathing in steam, and shooting salt water up my nose, and taking ibuprofen, I decided that I'd had bloody well enough. I called the HMO back, spoke to several people, all of whom promised to send an urgent message to my doctor, and promised to call me back. Finally, somehow, I got through to my doctor's office, and I basically complained at the woman until she told me that there was a prescription for pseudoephedrine waiting for me at the pharmacy down the street.

Oh, here's another layer of bureaucracy. Because I have an HMO, I can only get my prescriptions filled (if I want my insurance to pay for them) at one of several facilities controlled by my health plan. If they send the prescription to a different pharmacy, it's not covered.

So anyway, I had them send the pseudoephedrine to the pharmacy down the street (because how much could a bottle of Sudafed cost), and the antibiotic to one of the HMO's facilities that's convenient for my partner to swing by on his lunch break (because I didn't know how much that would cost, and I wanted it covered if it was going to be expensive).

Three days. Three days to get a prescription for antibiotics and pseudoephedrine, after already having seen my doctor and having him tell me to do exactly what I did – call him if I develop symptoms of a sinus infection so he can call me in some antibiotics.

So riddle me this, right wing loons who trumpet the “freedom” of market-based health care. What freedom do I have right now with regard to my health care that will be removed if I go to a government-run system?

The illusion of “market-driven” health care rests upon the fallacy that the consumer has a real choice in where they get their health insurance. The reality is that, for most Americans, if they have health insurance, it's the health insurance that their jobs offer them, take it or leave it. They can't really shop around, because the open market is prohibitively expensive, which is why the employer system exists in the first place. Because consumers have no real choice in the matter, there's no real incentive to provide good service, beyond that necessary for the insurance companies to turn a tidy profit. And the bureaucratic nightmare of multiple payers and payees in the system means that nobody is properly served, really.

We have a system right now where people are not getting necessary procedures, tests, and where health care is rationed based on arcane insurance rules that create loopholes in coverage and bankrupt people and destroy lives. We have a system right now where something as simple as getting a prescription for antibiotics and pseudoephedrine takes three days and countless phone calls and headaches.

So how is this better?