Sounds Like a Job for Health Care Reform

     A patient called to cancel his appointment for a monthly infusion necessary for the rest of his life (or until a pharmaceutical company comes up with a new medication). He’s been getting it for a few years now. The infusion made it possible for him to go to college. He cancelled his appointment, because he can’t afford the treatment at this time. He is temporarily not covered by health care insurance.

     Upon college graduation, his insurance carrier changed. He missed several treatments while his new insurance carrier took months to review his prescription and medical history,  weighing those against the cost of the medication (it’s expensive).  Eventually, the insurance company gave in, and he resumed the monthly treatments.

     Things continued smoothly, until recently. He took a new job. Isn’t that the point of a college education? Anyway, now he has to wait six months for his new insurance coverage to begin, before he can request to have his treatments resumed, after it is yet again approved for authorization by the new insurance company. The medication is too expensive for anyone but the very wealthy to pay for out of pocket (and even they might balk). So now this patient tries to maintain his health without the medication, so he can continue to work and keep his latent health care benefit.

     If only there was a less expensive health care option available…

Another Observation From the Bedside on Health Care Reform

       My colleagues and I don’t discuss Health Care Reform at work much, out of respect for one another’s views.  Like most of the public, none of us is well versed in any of the issues under debate.

   I had a patient the other day (isn’t this how most nurses begin a story? “I had a patient….”) who has not met the specialist writing her treatment orders. Her previous specialist contracted with another health care system, and was no longer covered under my patient’s insurance plan. So she randomly picked a new one from a list of specialists who are covered by her plan. She has an office visit scheduled with her new physician a month from now. Her insurance provider told her who her physician couldn’t be, and she accepted this as part of her life as a patient.

     My point is, patients are already told who they can and can’t go to for medical care.

     Yes, I have the choice of choosing my own physician, from my insurance company’s preferred providers list, but I will pay a much larger deductible if I choose a physician not on the list. I don’t think this concept will change under Health Care Reform. Doctors set their fee schedules, then contract with insurance carriers. If the carrier and the doctor can’t agree on a  fee schedule, both look for other partners. If the doctor of my choice and my insurance carrier don’t agree on how much my doctor will be paid for services and procedures, I have to find another doctor. This has been going on for years, so I’m surprised when I hear people yelling at town hall meetings that they don’t want to be told who they can go to for their medical care. It makes me wonder if the people who are yelling this have ever been patients.

     Again, I don’t claim to be an expert on Health Care Reform. This is simply a personal observation from the bedside.

Thoughts from the Bedside on Health Care Reform

   Open your mouth for the voiceless,

For the rights of all the unfortunate.

Open your mouth, judge righteously,

And defend the rights of the needy and the afflicted.

Proverbs 31:8-9

 

The other day I heard someone ask if health care is a right.

   I don’t know, but it is certainly humane.

   It wasn’t the first time I’ve heard the question, but usually it’s worded more like Why should I work hard and get taxed so that people who’ve made bad choices get bailed out?

   That’s a fair question, and I don’t know the answer to it either. But I do know that most of the people I meet as a nurse, who are uninsured and in need of health care, didn’t necessarily make bad choices. Unless you consider being self-employed a bad choice, or being an artist, a cab driver, a waitress or waiter, a hair stylist, a laborer, a writer, a student…you get the idea. All of these people work, and work hard.

  Another population getting stung when catastrophic illness or injury hits, are people who worked very hard, made lots of money and managed it carefully, in order to retire younger than 65. Oops, here comes the cancer diagnosis or disability and now they are paying out of pocket for what their insurance doesn’t cover and they are too young for Medicare. They worry that they may survive their cancer, but not have enough money left over to survive retirement. They see their assets eaten away, even if chemotherapy, surgery and radiation are effective at preventing cancer from eating their organs. Or it’s the spouse who has the catastrophic diagnosis, and worries that he or she will use up all of their assets, die anyway, and leave their life partner penniless. As if diagnosis and treatment aren’t enough to worry about.

     Most insurance companies deny coverage for experimental treatment that is unproven or off-label already. Unless a patient can pay out of pocket for it, or qualify for a study, it’s a moot point.

     I don’t have data for any of these statements, they are simply observations of what I see daily at work in an outpatient facility.  I do know  a lot of my paycheck goes to taxes and our health care system is broken.  The money used for health care is spent inefficiently at this time.  I’m open to ideas to fix it.