Tuesday, February 21, 2012


There are certain life experiences that would seem to inevitably shape some political opinions. A nasty case of food poisoning might lead to favoring some government intrusion into the food-service marketplace, while spending money to meet a frivolous and overly broad regulation might make one resent big government. (That said, I can’t think of how real-life experience in the modern Western world would make you a hard-core libertarian.)

In the last couple of months, my father’s health has deteriorated, consuming a large amount of energy and attention and money from me and my family (and curtailing my ability to blog). As I’ve noted, he has an advanced case of Alzheimer’s disease; over the holiday season, this was complemented by episodes of “severe rectal bleeding” leading to plummeting blood pressure, dehydration, weight loss, two trips to the ER, a hospital stay, and a couple of months in a Skilled Nursing Facility ("SNF," pronounced "sniff" by those in the know). He has just left the SNF, and is now at home, in a room that we have filled with rented medical equipment; he also has the round-the-clock presence of home health nurses.

Things could be a lot worse; he has health insurance from his former employer, long-term-care coverage (also through his employer), as well as access to Medicare and MediCal, and VA coverage for his stint as a private, first class. His insurance situation is the fruit of a long career of hard work at a single institution, and is excellent by American reckoning.

This is not to say that things could not be better. I’ve spent the best part of the day on the phone with his doctor, the doctor’s office staff, the SNF discharge counselor, the SNF insurance and billing coordinator, two medical equipment rental services, the long-term-care insurance company, the long-term-care insurance company’s record collector, the doctor’s group’s record service, the home health nurses, and the home health nurses’ agency. Yesterday was similar, and I and both of my brothers have had plenty of other days along the same lines. With few exceptions, none of these entities seems to be able to communicate with any of the others. I’m left wondering what will happen when my father has another acute episode. I’m also left wondering why in the world this country, supposedly so advanced, doesn’t have a single-payer health insurance system for all.

The Real Doctor, it should be noted, works for a government-run single-payer system that works for a certain segment of the population that is neither especially healthy nor wealthy. It is not without flaws, but it provides affordable and generally good care with an endurable wait. The system is nationwide and uses a paperless record system, making communication within this system relatively speedy and simple. (In contrast, a couple of the players I’ve been dealing with today haven’t been talking to each other because one only uses fax and the other only uses snail mail. As a result, simply beginning the process of processing the long term insurance claim has been held up for weeks.) The Real Doctor is of the opinion that for-profit health care is a road to immorality.

The Real Doctor deals with some bureaucratic headaches, but she knows from experience it could be worse. She no longer has the quivering nightmares that were brought on by the ethical compromises necessary when she worked at a for-profit HMO, which had its own well-padded bureaucracy. She could be earning more if she worked for her own private clinic—but that would mean the stress of being an employer, expensive malpractice insurance, and even more pressure. As one of her colleagues (whom shall remain unnamed, but who she describes as “one of the most thoughtful out there”; if you really must know who, send me an email) wrote on a message board,

Most glaucoma docs want to make a reasonable income – reasonable by most people’s standards. But to do so requires seeing LOTS of patients. I have heard of ophthalmologists that see more than 80 patients a day. Assuming they work for 8 hours seeing patients (8 hours seeing patients usually means at least a 11-hour day), they will spend about 6 minutes with each patient and not eat or urinate. If they actually see patients for 7 hours (which is probably considerably longer than characteristic for most ophthalmologists) they will spend 5 minutes with each patient. I cannot conceive of any way I can learn what my patients need to tell me, examine them and then counsel them appropriately in 5 minutes.

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So, like I was saying, I can’t imagine thinking, as I boarding an aging, oil-leaking Soviet prop-plane piloted by a kid chewing khat,

“I am so glad that the good people who run this business are able to compete, completely free of burdensome regulations, and that I have so much freedom to choose which carrier will work for my extremely limited budget! I shall very likely cherish this freedom for the rest of my life!”
Likewise, I can’t imagine anyone having any significant experience as a receiver of medical care in the United States going through the process with the thought
“FREEDOM! Yessir, freedom of speech and religion, freedom from want and fear, and best of all the freedom to spend an entire day on the telephone being passed along like a counterfeit buck in a vain attempt to get reimbursement from a for-profit insurance company that is working with a for-profit HMO! I shall very likely cherish this freedom--and this icky hold music and my depleted bank account--for the rest of my life!”

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