One of the most unnerving and interesting changes to America over the past couple decades has been the rise (and rise and rise and rise) of health care costs, a rise which can be shown to mimic the rise in “Health Maintenance Organizations” (HMOs) and various insurance company influences.
Of course, since the “stated rate” for health care makes it impossible for most Americans to afford it without insurance these days, it is deemed a “crisis” and most of the US presidential candidates are launching “plans” to fix it. Slate’s “Health Care Primary” column has been analyzing them, though what Slate’s writer really wants to see (nationalized health care) is something I’m pretty sure both Will and I don’t want.
After looking over some of the plans, I’m reminded a lot of things that have bugged me about the US’s health care system in years past - some of which can be blamed on HMO’s, some on insurance companies, and some on the complication of trying to navigate them all.
Where I grew up, there was an HMO referred to by customers in a not-quite-joking manner as “Family Death Plan.” It was sold off in the early 2000’s, after years of mismanagement and amid the disgust of many people who became trapped in its clutches (it gave lousy service, but also gave low prices to many businesses in its city). It was at FDP where I had a drunken stooge of a “doctor” prescribe medication (on a 6-month period before he wrapped his ferrari around a tree late one drunken night) for what a competent specialist before and after diagnosed as a benign, no-treatment-needed heart murmur. This would come to have later effects on my health care options. It also makes me ineligible for military service, even were I to apply.
The ongoing problems with FDP were:
#1 - It took at least a month to get a referral for anything. This included having my mother diagnosed with Lyme Disease and treated. Had the referral not taken so long, the disease would have done much less damage.
#2 - Referrals HAD to remain in-system.
#3 - FDP regularly switched specialists around, making it impossible to get consistent treatment from someone who knew the case beforehand.
#4 - FDP regularly dropped primary care physicians as well, meaning that every time one walked into the office, you were apt to get someone completely new.
Part of the secondary crock of the current system is that pricing for most things is inflated. Insurance companies / HMOs claim that they “negotiate” lower prices for procedures and care “within-system”; this is something akin to the old retail trick of marking something up 30% for a month, then putting it on “20% sale” to make people think they are getting a bargain.
The worst part of the current system - and something each “plan” addresses, though in varying levels of acceptability - is the difficulty that one has getting insurance (except through a large pool such as being a government employee or part of a very large company) if there is a pre-existing condition.
This is where “el drunko doctore” screwed me royally - were my condition always listed properly as a benign one, getting independent insurance when I was between jobs wouldn’t be a big deal. With the stroke of a pen from one drunken jerk who should never have been let near a patient, however, insurance companies almost universally want to reject me.
Likewise, my neighbor is going through a rough time getting insurance for her son. Their previous company dropped them because some incompetent boob mis-keyed their renewal and listed a 14 year old kid as being “alcoholic and suicidal.” The insurance company has now jerked them around for at least 6 months in the process of trying to correct this - and at the 4 month mark he was hospitalized and diagnosed with juvenile diabetes.
Another problem is the prevalence of “pre-existing condition” exceptions in most coverage (in my experience, the smaller the insurance pool, the longer the lead-in time). Someone changing jobs has to worry about making sure they have “continued coverage”, even to the point of paying insurance premiums on two overlapping coverage items (COBRA to the old, plus the new premiums) during the lead-in time (usually a year these days) or risk having an insurance company claim that something is “pre-existing” and refusing to pay. In many cases, this contributes to people not seeking treatment for something that could be treated and handled/cured early, but which develops into a much worse case by the time they think the insurance will pay.