Seven dollars and forty cents hardly seems like an amount that should erect a barrier to health care.
In fact, when Mr. Koch (all names are fictitious) called to complain about this bill for seven dollars and forty cents, my first reaction was, “You should appreciate how lucky you are that you have a health care plan that pays most of your bills. Why are you quibbling over $7.40?”
Of course, that is not an appropriate customer service response.
But listen to Mr. Koch. “This bill is for two pain pills that were given to me when I was admitted to the hospital for an emergency surgery. Medicare won’t pay for the pills because they were “self-administered.”
Our insurance plan won’t pay, because Medicare won’t allow payment. (a common Medicare complementary policy). The hospital wants its $7.40. I must have been semi conscious when they gave me the pills, because I do not remember it at all. Why should I pay for pills that some nurse made me swallow when I was semi-conscious?”
Mr. Koch’s total pharmacy bill for this hospital stay was over $8,000 Who is the one who is quibbling over $7.40? And the issue has little to do with whether the two pills cost $7.40.
In fact, it is more likely that the hospital knows full well that the two pills only cost $0.20 But they calculate that it will take at least an additional $7.20 of bureaucratic labor to collect that $0.20. The bureaucracy needs to be fed.
Think about the effort to maintain these bureaucracies. Somewhere in the bowels of the CMS (Center for Medicare and Medicaid Services) someone has crafted regulations that stipulate that Medicare will not pay for certain medications that are self administered.
The logic is apparent Before Medicare Part D, CMS did not pay for prescriptions outside the hospital or physician office. “Self administered” appears to fairly delineate the boundary between those drugs that can only be administered in a hospital or physician office setting, from those dispensed by a pharmacist.
Instead of focusing on Joe the Plumber and his tax phobia’s, perhaps the presidential candidates should talk to Jesse the Artist and ask him or her about health insurance. On Sunday, October 19th, I visited the Bethesda Row Arts Festival in Bethesda, Maryland. I did just that. In a very unscientific survey, I talked to a number of the artists about their health insurance.
Why should anyone else be interested in artists? Because they are small business people. They are also very creative. It is this creative entrepreneurship of small businesses that candidates like to support because it is the economic engine that drives the American economy.
Artists as Small Businesses
I was curious whether health insurance was a barrier to entry for these artists. Two of the artist referred to a study (but could not name the source) that 83% of artists had health insurance. That was consistent with my own unscientific study. I talked to close to 20 people. Only three had no health insurance. But, on the other hand, only three paid for their own health insurance.
Perhaps they asked the wrong question.
Approximately six months ago our office began receiving stacks of paper claims for prescription drugs. The drugs originated in various Veterans’ Administration medical centers around the country. They were for drugs that members in our Plan had received at VA medical centers.
It was obvious that there had been some sort of new policy at the VA that required the VA to obtain payment from other payers when veterans had other coverage. The problem in this case is that our Plan had just changed pharmacy benefit managers effective January 1, 2008.
So think about this. Until recently, a veteran who also happened to have other coverage went to a VA medical center and received care. The VA paid for the service and somebody figured out how much it added to national health expenditures. Our health plan did not pay for the services and therefore nothing was added to national health expenditures, other than the cost of keeping that Participant enrolled in our Plans.
Then someone in Congress got the idea that the VA could save money by finding someone else to pay for services. Ignore the macro perspective that it increases the total cost to the system. Now a layer of bureaucracy is added to find who is liable for payment and send the bill to that payer. Remember the card game Old Maid? Who is going to be left holding the poison card? That’s what our health care financing system has come down to.
Amazing seems a most appropriate word to describe the financing and delivery of health care services in the United States of America.
According to Merriam-Webster’s Collegiate Dictionary, 9th Edition (OK, I have an old dictionary) amazing is derived from a French word meaning “to confuse”. Obsolete meanings include consternation, bewilderment and perplexing.
Yes, health care in the US is truly amazing. Rube Goldberg could not have invented a more illogical maze of non-systems. Lewis Carroll’s might have added an additional chapter on Alice’s efforts to get those pills that made her big and small. Kafka might imagine a special Penal Colony for those responsible for this maze.
I should be careful on this last point, since I am part of that system. I administer the benefit plan for approximately 25,000 participants. I like to think that we do our best to help our members navigate what is all to often a daunting and perplexing maze.