Recently I was diagnosed as having sciatica, a.k.a. a “slipped disc” in the spine, a common ailment that (they tell me) ought to be fixable. The orthopedic guy who diagnosed me prescribed physical therapy, three times a week for a month. Yesterday I got a letter from Empire Blue Cross saying they were overruling the doctor. I need only two weeks of physical therapy, they said.
I’ve had one week of therapy already, and I am doubtful just one more week is going to fix me, but I guess I can continue to do most of the exercises by myself. As medical aggravations go, this is hardly a tragedy. But this is the way life is for most of us. If you aren’t wealthy, the medical treatment you receive is what your insurance provider, not your doctor, decides you should have.
And that’s if you are lucky enough to have insurance. At least I could go to a doctor and get a diagnosis, and now I have some idea of what I need to do to take care of myself.
One of the most persistent myths on the Right is that health care is too expensive because we are indulging ourselves with too much of it. The persistently stupid Jeff Jacoby writes in today’s Boston Globe,
With health benefits tax-free if they were employer-supplied, tens of millions of Americans were soon signing up for medical insurance through work. As tax rates rose, so did the incentive to keep expanding health benefits. No longer was medical insurance reserved for major expenditures like surgery or hospitalization. Americans who would never think of using auto insurance to cover tune-ups and oil changes grew accustomed to having their medical insurer pay for yearly physicals, prescriptions, and other routine expenses.
We thus ended up with a healthcare system in which the vast majority of bills are covered by a third party. With someone else picking up the tab, Americans got used to consuming medical care without regard to price or value. After all, if it was covered by insurance, why not go to the emergency room for a simple sore throat? Why not get the name-brand drug instead of a generic?
I think righties must be blessed with unusually good health, since clearly they’ve never had to deal with health insurance.
First off, although it may be different in Massachusetts, many years ago insurance companies stopped paying for emergency room visits if they decide after the diagnosis that the medical problem wasn’t an emergency. Although exactly why anyone with insurance would choose to an emergency room for a non-emergency eludes me.
But what happens if you think it’s really an emergency? Is the sudden chest pain a heart attack, or heartburn? If you pick A and go to the emergency room, it turns out to be B, you just ran up a several thousand dollar medical bill that the insurer won’t pay. If you pick B and it turns out to be A, you could die. Coin flip?
Same thing with generic versus name-brand drugs. Most insurers simply will not pay for the name brand if a generic is available. The consumer has no choice.
Also, in New York a “routine” office visit is somewhere in the $100-200 range, and even “generic” prescriptions can cost over $100 a month. Lots of people on limited and fixed incomes will not spend that kind of money just because. They’ll wait until they are really sick. But a lack of preventive care is one of the factors driving up health care costs.
When patients think someone else is paying most of their healthcare costs, they feel little pressure to learn what those costs actually are – and providers feel little pressure to compete on price.
Jacoby has no clue how the system works. Health providers aren’t pressured by consumers to compete on price. They are pressured by the insurance companies to compete on price. Then insurance companies compete with each other to provide the lowest costs to employers. So the company that puts together a network of cheap doctors can offer a better price to the employer, but in my experience the employer doesn’t give a bleep whether the doctors know a spine from a sock. Quality is optional.
De-linking medical insurance from employment is the key to reforming healthcare in the United States. McCain proposes to accomplish that by taking the tax deduction away from employers and giving it to employees. With a $5,000 refundable healthcare tax credit, Americans would have a strong inducement to buy their own, more affordable, insurance, rather than relying on their employer’s plan.
Unfortunately, since the actual cost of a year’s worth of health insurance is a hell of a lot more than $5,000, only very well-paid employees will be able to use the credit. And, of course, if you have a pre-existing condition, in most states you can kiss off buying insurance at any price.
BTW, after the elections I may be asking for donations so I can pay for accupuncture. I figure it’s worth a try. I’d like to be able to take walks again.
Update: Jacoby’s email address (published in the Boston Globe) is [email protected].