We’ve had this ongoing, national discussion for a long, long time, about how we should provide healthcare and basic human needs to every citizen. It’s been going on since FDR, then LBJ. Those guys had some great ideas. FDR started the discussion with the New Deal. Helping those who needed a leg-up, providing for the young (labor laws), and seniors (social security), were just two of FDR’s ideas. FDR had a vision of a country that was a “we” country, rather than a “me” country. LBJ picked up the healthcare conversation and initiated Medicaid, for the poor, and Medicare, which was to provide medical care for retirees, many of whom lived on a fixed income and couldn’t afford to purchase private medical insurance. But there was a longer-term vision. Neither of these visionaries thought this was a fix-it-quick solution.
The longer vision of LBJ saw that each decade, the Medicare program would roll back the eligibility age for Medicare coverage by 10 years. The ten-year period would allow for growth of the infrastructure which would provide this care. Eventually, every citizen would have medical coverage through Medicare. It was a good plan, with extremely low overhead, but unfortunatey, it was never implemented. Instead, we continued on the road of private medical insurance for everyone except those too poor to afford it (Medicaid), and seniors (Medicare).
So here we are. We continue to argue about whether or not to provide a universal system of healthcare or to continue with our current, capitalistic “vision”, which has the for-profit insurance companies, sometimes granting access, for a fee, to healthcare. Remember, most of those insurance companies exist to earn a profit, to the tune of adding 30-40% to the cost of healthcare. Medicare provides access to healthcare for a mere 5-6% overhead, and they are not beholden to stockholders demanding a juicy slice of profit.
One of the common arguments circulating around, is that “we can’t let government get between us and our doctors”. Well. I have news for you, in case you haven’t already noticed: Your insurance company is already doing that job, and they’re doing it very well, with great efficiency. Many of you already know this. It’s why, when you get a referral to a specialist, you have to wait for 2 months to get an appointment. Remember, your insurance company is not in the business of seeing that you get healthcare; it’s in the business of denying claims and collecting your premiums, hence the profit. In order to bill for a new patient, the specialist must use a particular insurance company coding to bill for that new patient evaluation. And that takes a lot longer to do. Because the insurance company provides for all kinds of hoops that your provider must jump through, mostly in the form of paperwork requirements, in order to bill and be paid for that initial evaluation visit. It’s designed to be difficult.
But here’s the Granddaddy of all stories, demonstrating how your insurance company comes between you and your doctor. This story is true, only the names and places have been changed to protect the truly innocent victims of insurance company interference. I happened to be seeing my MD one day, and asked if, as long as I was there, he could refill a prescription. He said, “No can do, sorry.” “But, why?” I asked. He said, “Last year, I had $25,000 in unbillable visits. It’s an insurance company game called, ‘One visit, One problem’.” He told me the story of a patient who came into his office one day with two problems, both serious enough to warrant a visit to the doctor. She had probable strep throat, requiring an antibiotic, and she’d fallen and may have broken her ankle. My doctor had to ask her which problem she wanted him to treat that day. Because the insurance company would only let him treat her and bill for one problem per visit. And no, she couldn’t leave and come back later the same day. She could either go to the ER or come back the next day to see her doctor for the second problem. Otherwise, the insurance company would not pay.
So while we’re debating how to provide medical care for everyone, let’s keep in mind that sticky little thing called profit that has no place in services that provide for basic human needs. Like medical attention. And while you’re considering the horrors of the government coming between you and your doctor, consider what your insurance company is already doing.
©Janet L Mitchell
