Editor's note: A version of this was published in this morning's Business to Business, a monthly publication of the Bozeman Chronicle. Besides, isn't it time for me to rant again about the U.S. health care system?
Why is it that every dealing with the U.S. health care system—or at least the paying for it part—leaves me frustrated to the point foot-stomping anger and/or tears?
I can’t speak for physicians or employers—whom I know feel the sting of rising costs and unwieldy patient loads keenly—but I can speak for the semi-privileged American Joe. One with health insurance. Comparatively, in a country with an uninsured rate hovering around 15 percent—that’s one in six Americans, according to the U.S. Census Bureau—I’m lucky. Yet I still find myself—blood pressure on the rise—trying to navigate a bureaucracy straight out of a Kafka novel.
Here’s an illustration. I saw a new doctor last week to deal with some health concerns. I chose this doctor because of the reputation of the practice and her expertise in the specific problem I was having. The appointment was great. She was knowledgeable, understanding, compassionate, and whip-smart—everything you could hope for in a physician. I left with a new prescription (for which she provided some samples) and a refill for an existing one. That’s when the fun began.
My insurance company requires certain drugs to be ordered through their mail-order pharmacy. Knowing that this can take time, I started the order process last week. I’m still waiting this week. In the meantime, my doctor’s office has had to call, fax, re-call, and then fax again to try to get this new prescription established. I’ve been doing the same thing. Every time the doctor’s office or I call the insurance company, we’re faced with an impenetrable automated system that requires callers to first punch in the (I’m not exaggerating) 18-digit customer number and then follow the various prompts to try to reach a human who then must hear the sordid tale—again—and start over from scratch, all to procure for me a medically necessary and legitimately physician-prescribed medication, for which I will have to pay full price anyway.
It’s no wonder that doctor’s offices feel under siege. Not only do they have to provide the care that is their charge, they also have to fight Big Insurance to do it. One medical assistant at my new doctor’s practice wiled away what I’m sure were many unhappy hours trying to solve this for me. Is this what we’re paying our health care providers to do? To sit on the phone punching in numbers for an operator-bot? My guess is that employers, too, would be unamused to know how much time their employees are wasting—probably work time, since the insurance companies keep 9-to-5 business hours—trying to access their health care.
The whole thing makes for an interesting comparative exercise from which I will let you extrapolate your own meaning. In September 2003, I took a taxi to Bulovka Hospital in Prague, the capital of the Czech Republic, to give birth to my son. My husband and I had been living in Prague for about three years at that point, and—like every Czech citizen, though I was not a citizen but a long-term resident—we were eligible for national health insurance through the government by virtue of a premium paid out of monthly wages.
I stayed in the hospital for five days after the birth, which is a standard length for a routine, non-Cesarean birth in the Czech Republic. I had a private room, and my son had to spend some of that time being cared for in the nursery. The food was terrible, but the room was spacious, with a private bathroom and an entrance leading onto a terrace that overlooked most of the city. My husband could come and go as he pleased, and the care that my new son and I received was, on the whole, excellent. Plus, as a bit of a novelty—the American Lady Who Gave Birth in Prague and Screamed Really Loudly in Delivery—I think that I got extra-special treatment.
When it came time to check out, we waited in dread for the inevitable bill. Finally, as we were walking out with our son in his carrier, the ward nurse ran down the hall. She needed us to pay for our stay in the private room. The cost? About $120, which we paid in cash. Counting the cab ride, it had cost me about $134 to have a baby. We asked incredulously when we would get the bill for everything else and she looked at us as if we were nuts. “Of course the national insurance covers giving birth!” she said. She scrawled a small receipt for the private room fee, and we were on our way. It felt for all the world like we were stealing a baby.
You can draw your own conclusion here.