In mid-August, I had a mishap with a chainsaw. I fell while cutting a branch and the saw nicked the side of my head, slicing my right ear nearly in half. I ended up in the emergency room.
Three of them, actually.
The first emergency room was in Richland Center, near where the accident happened. I was there for more than an hour.
Of this, it took maybe 10 minutes to look me over, give me a tetanus shot and eventually wash and bandage the wound. About an equal amount of time was spent dealing with the person who took my insurance information and had me sign a form promising to pay whatever the hospital decided to bill, should my insurance not cover it.
The doctor at Richland Center thought it best to send me to UW Hospital, to see a plastic surgeon. I just had to wait for a nurse to lightly wash the wound. I waited and waited; it seemed to take forever. I was anxious, knowing I had an 80-mile drive ahead of me. I asked the person taking my payment information if she could ask what was taking so long.
She couldn't do that. Her job was not to provide care on any level. It was simply to make sure the hospital got paid. I encountered individuals with the same job duty at UW Hospital and the hospital in Hayward where I went the next week, while vacationing, to have my stitches removed.
In fact, the same thing happens whenever I go to a medical practitioner of any sort - a huge part of the process is dealing with billing and insurance.
Anyone can see the system could be more efficient, and also fairer. The hospital in Richland Center charged $646 for the 10 minutes of care it provided. That's three times as much as the plastic surgeon who cut away some frayed flesh and expertly stitched together what remained. UW Hospital charged an additional $566, mostly for the room. It didn't even have HBO.
The ER in Hayward got $279 for making 12 snips with a pair of scissors and pulling out threads. It could have been done cheaper by an ordinary doc, but my insurer said that, at my remote location, this would not be covered. Here the insurer's own stupid rules ended up costing it more money.
In all, my medical costs totaled $1,699.21, for about one hour of direct care. Of this, my share was $150 - $50 for each ER visit. The last bill just arrived, more than three months after the fact.
I'm not complaining about how much I had to pay. I have good insurance. What bothers me is that the entire system seems to operate on its own internal illogic. The problem isn't the providers' care; it's the nonproviders' impositions: deductibles, co-pays, co-insurance, Flex plans, mandatory preapprovals and the like. Who has not had enough of all this?
And yet, to hear the current debate over health care, you'd swear some of our fellow citizens - especially those running for president on the Republican side - live in a parallel universe, where people regard our health-care system as second to none and deeply fear changes that tinker with the status quo.
They wax hysterical about how the Democrats want to create "socialized medicine." Yet Medicare and Medicare - hybrid programs that use private providers - are hugely popular. And the highly rated (really) Veterans Health Administration is the epitome of what they pledge to fight against.
Canada 's single-payer plan, they claim, is so hated that Canadians come here for our superior system. "If we have HillaryCare," Rudy Giuliani joked, "Canadians will have no place to go for their health care."
Did you know that in Canada there is sometimes a wait before you can see a specialist? Good thing that sort of thing never happens here. (I swear on a stack of Katha Pollitt columns that while writing this I overheard a co-worker say, in a transparently frustrating conversation with a nonprovider, "I actually tried to get in to see the doctor, but I couldn't....")
Here in Wisconsin, Republicans shot down a plan that would have greatly expanded coverage while saving about $2 billion a year - because it would have cut into the profits of the insurance companies that purchase their allegiance.
The Republicans' top goal in this area is to help folks with lots of money set up individual health savings accounts. Rep. Tom Tancredo says these "put you in the connection" with "nobody in between" patients and physicians.
Excuse me, but our current system - with its vast inequities between those who can afford care and those who can't - is really all about putting meddling nonproviders between doctors and patients.
If our health-care system were to change, we're warned, we could no longer choose our personal physicians. Let alone that this isn't true, why do people think it's a good argument? I like my personal physician quite a lot. Nice guy, capable doctor. But, honestly, I'd dump him in a split second for a health-care system that covered everybody and drove private insurers out of business.
The truth is, we have the worst health-care system that money can buy. Ability to pay factors into every medical decision, and insurance companies are forever jerking people around in their determination to maximize profits.
Whose loyalty do they think they're earning? Put another way, who in this country would miss dealing with the nonproviders - the pencil pushers and money grubbers - who have become integral to our health-care system?
Are the Democrats hip to this? Do they realize their tremendous opportunity to tap into this discontent to bring about brave reforms?
Don't make me laugh. I might fall and hurt myself.
