My friend, Matt Gibson, currently in medical school, has posted this interesting blog post about health care, and asked for people’s opinions. This is my response to that entry.
I am going to start by saying this is going to be a long comment. The most important thing I have to say is that I am a primary consumer of the health care system, and because of this, I think I have a lot of stake in this debate. I have biliary atresia (which you might already know Matt), a pediatric liver disease that affects 1 in 20,000 children. There is a surgical procedure, known as the Kasai procedure, that can help elongate the child’s ability to have his/her own liver, but most children either die, from not being diagnosed soon enough (the symptoms are similar to baby jaundice), or have a liver transplant young in their life. Most adults who are my age do not have their own livers. This makes me a medical rarity. Because of the excellent STUDENT health care that my parents had when my dad was a graduate student, the price of the surgery and massive hospitalizations I went through cost only this: the price of the booties my mother bought in the hospital gift store. Amazing to see how health care has changed in the last 22 years (and not for the better).
My medical bills run about $29,000 every time I go to the hospital, which is about 1-2x a year. I have many suggestions about how to change the health care system, starting with the fact that I think it should be free (through the increase of taxes, which benefits all, because honestly, anyone can get sick at anytime). However, idealistic as I am, I realize that this is probably never going to happen in the US, because another great stakeholder, the insurance/pharmaceutical companies make money. I, as a patient, and a social work student, will never make money, just spend health care monies. No difference that the work I will do and am doing is changing the world (I digress).
I would like to state some of the things I would like to see (would like to DEMAND to see) change in health care ASAP.
1) Pre-diagnosed conditions/major disease diagnosed later in life should be covered. Isn’t that the point of health care? I am dropped from my parent’s health care in April. At that time, because my parents are part of group insurance, I will have the “luxury” of going on COBRA, the unemployed health insurance, for 18 months, which is $500/month. After this, if I become too sick to have a job, or get a job that does not provide group insurance, I will have to go into the high-risk insurance pool, which is $14,000/year. No biggie, right. It’s not as if that’s more than I pay for a year of college. Ridiculous.
2) Deductibles/insurance charges should be appropriate and affordable. The way insurance charges now, even people who CAN pay for it, are having a hard time affording it. On expensive medicines, my insurance only pays 40%. That means, if I have a med that’s $500 (which I’ve had), I still have to pay $300 out of pocket. That is obscene. To coincide with this, insurance companies should be severely regulated, especially in the billing departments. Hospitals can choose to bill something however they want, and depending on this, insurance can choose to pay whatever they want. This is how an ordinary lab draw suddenly becomes outpatient surgery (trust me this has happened). Insurance providers need to be open and clear with their clients about prices, and both hospitals and insurance providers need to have a regulated pricing schedule. No surprises and no making bullshit income off other peoples’ misery.
3) Moreover, on the regulation, insurance companies need to stop being so awful. My current insurance requires me to not only make sure that the hospital/doctor’s office is covered by my insurance, but also ANY practitioner that touches me is covered (including surgeons, anesthesiologists, and nurses). I’ve had situations where everyone in a surgical procedure has been covered except a nurse (we checked before hand), and the insurance didn’t want to pay for ANY of the surgery. That’s appalling. If the building/agency is covered, everyone in that agency should be covered. And stop doing bullshit like “lab cards” where you can only go to certain labs, or certain doctors. That’s what so many people are afraid of with government run insurance, but most insurance already do this. Insurance companies make staying alive a hassle.
4) I want to reply to a comment below, written by Nicolas Frisby, which I found a little disturbing.
First: “Primary care physicians should be paid more than specialists. Sure, specialists paid more for their education and are favored by supply-and-demand and such, but this is mucking up the system. It’s upside down: specialists have the least contribution to a society’s health, and yet they are rewarded the most.”
I think that’s easy to say if you’re mostly healthy. When it comes down to it, my primary care physician isn’t going to save my life. I hardly see my primary/general practitioner, but see my specialist frequently. The only people who have saved my life, and made it so I am almost 23 and have my own liver have been excellent GI specialists, and they SHOULD deserve extra pay. THEY KEEP PEOPLE ALIVE. And isn’t health care to the benefits of those who are sick, not those who are healthy?
Second: Most radically: don’t spend tons of money treating dying people or people with extremely rare diseases – it’s just not as useful for the society, nor fair to the other people in that risk pool.
That’s super offensive. The purpose of health care is to keep everyone alive. If they had this mentality a century ago, how many people would have made it now? How many diseases would they have said were too “rare” and never would be cured? I have an extremely rare disease, and money should be spent. Health care is for those who are SICK. Thus, those who are sick, even if they are sick with something rare, should be helped, and money should be spent on them.
Okay, that’s all I have to say for now. I might come back to this. Please post any comments or questions you might have. I’d love to hear from you.