I have health insurance.
In fact, I have a Point-of-Service plan with one of the region’s biggest carriers, who is in the midst of a merger that will give it most of the local market for health insurance. Keep in mind, although my “insurer” runs an HMO, this is the POS plan.
Having recently moved, I do not have a regular doctor yet. I realize that this is something that must change, and that I’d rather do this while it is not an emergency situation. While you are sick is the time you need to already have a doctor, not be frantically searching for one. Luckily we live in the age of the internet; there is an url for the company website right on the back of my insurance card. And sure enough, with a few clicks in the right places — which was more confusing than it should have been but I did find it in a matter of moments — I was able to find a provider directory. I was even able to search by specialty and proximity. It turns out there are listings in the provider directory for over 70 family practice physicians within 15 miles of my zip code. I did notice that at least half of them were working at the HMO, but that a branch of a well-known local clinic chain just down the street was listed. I pass that office several times a week.
I picked up the phone, and called to get an appointment for a checkup. Once I navigated the voice-mail system to get to a human being, I explained my situation.
“Ok,” she said, “What insurance do you have?” Note: not how will you be paying, but what insurance do you have. This left the impression — false I hope! — that cash is not welcome. I told her what my insurance card said.
“I’m sorry,” she replied, “We don’t accept new patients from that insurer.” It was clear that there was no point in arguing that I had found their number through the insurer’s directory of physicians who supposedly accepted payment from them. She of course had no idea how long this policy had been in effect. She certainly was not in a position of authority such that she could have them removed from the directory.
It was abundantly clear that my options for medical care are the HMO, a charity clinic, or someplace that would actually take my money. If I go to the HMO — clearly the easy route — I run the risk that should something be seriously wrong, they will not tell me about medical options that are not covered, thus making it less likely that I will even know about treatments that could save my life and health. If I select a charity clinic, I will be taking up time and space that someone with no insurance and no options could be using, to say nothing of spending lots of time driving and waiting. And if I pay cash, I will get a look of scorn and/or pity from the staff, to say nothing of risking denied coverage of any conditions they may diagnose.
Let me reiterate: I have insurance; our family makes well over the poverty line; I face the same sorts of lack-of-coverage issues that I would face if I were far less fortunate.
When certain people try to scare you about “socialized” medicine (they never call it universal health care and they never dare say Medicare-for-all), one of the canards they throw out there is that some faceless government bureaucrat will be making decisions about your medical care, down to what doctors you can see. I am insured, and some faceless HMO bureaucrat has already made decisions about my medical care, including what treatments are available and what doctors I can see — and remember, I am not even a member of the HMO. How is this better?
So remember this story, and read this substantially more heartbreaking one. And then think about the fact that the “reform” options have been “more of the same” from the Democrats and “more of the same with bonus tax breaks for the wealthy” from the Republicans. This despite the fact that most Americans want Medicare-for-All, this despite the fact that as I write GM workers are on strike over the fact that GM wants to get out from under the estimated $1000 to $1500 per car that goes to employee health care expenses. Only 8% of Americans polled think the system only needs minor changes, yet almost every single candidate is proposing what amounts to minor changes!
It is time to permanently end the cat-and-mouse game of insurers trying to maximize profits by cherry-picking who they will cover and what they will pay. It is time to end the acrobatics that medical billing offices must go through to receive payment, only to get less than half what they actually billed. It is time to stop squeezing human beings between health care they need and health care bills they can’t afford.