Serious Studies

Whatever You Do, Don't Get Sick

Cough

In the national debate on health care, which of course is front and center now that we have an election on hand, there is a lot of justified thought being given to the problem of insurance. A lot of Americans have none, and that certainly is a problem that needs a quick and humane solution.

Somewhat less discussed is the fact that even if you have health insurance you still can't get a doctor. Where have they all gone? Perhaps they're hiding.

Most of the people I know, thank goodness, have coverage provided by either their company or their spouse. Whether these insurance companies ever actually pay more than lint balls on actual healthcare costs is a matter that we will not discuss here, except to say that I want to congratulate my health care provider for finding a place that will do an MRI for $24.95, the approximate reimbursement they calculate for that test, I believe. This, of course, is better than nothing, and well worth the eighteen month wait for their check.

They also excel at providing a rationale for these kinds of paybacks. Unfortunately, they are printed in such small type that they cannot be read without special glasses I cannot afford because the eyecare part of my coverage believes that glasses still cost $4.99 and you get an extra pair.

Anyhow, that's not the point. What's amazing to me is how many people I know don't really have doctors per se. Most of my friends in California go to one form of mass clinic type thing or another, as in Kaiser or their local emergency care facility associated with a teaching hospital. One friend of mine whose spouse pays in the neighborhood of $12,000 per year for his health care got sick last weekend and went looking for a doctor. No local offices were open." It's like trying to find a vet on the weekend," she said. Considering that the problem involved the bite of a deer tick, time was of the essence. So she had to go to the intake room of a very highly regarded local hospital. Once there, she found some 50 people hawking up phlegm in the lobby of the place. She left. "I'd rather have Lyme disease than TB," she explained.

The next day I spoke to my daughter, who sounded like she had lost the use of at least 1.5 lungs. "Go to the doctor!" I screamed at her with I hope the proper amount of sympathy. "I don't have a doctor," she said. "I don't even know a doctor. And I never think of getting one until I'm sick, and then it's too late."

That's the thing. You can't call a doctor if you're sick. You have to be well and dedicate several weeks, at least, to the effort, at which point you may be granted the right to visit the physician several weeks hence, if you can schedule your illness to fit within that time frame.

A pal of mine was feeling poorly for one reason or another and called a GP whose name had been given to him by his insurance provider. "I'd like to come in," he said to the all-powerful gorgon who guarded the doctor's appointment calendar. "How's three weeks from Thursday?" said the amanuensis.

This may not be a bad thing altogether. I find lately that whenever I do manage to get in to see a doctor, I have exactly the ailment of which he or she is a specialist. That's not a good thing, no matter what the specialty is.

The bottom line, I think, is that our health care system doesn't really want you to see a doctor, unless it's to write out the prescription for the medicine you saw on TV.  We don't treat sick people. We treat well people. As a business, that makes a whole lot more sense, when you consider which part of the system has the highest margins.

27 Comments Add Comment

The most scary movement I've noticed now is "concierge" service from local doctors. For a mere $1000-$2000/yr EXTRA, you get to actually SEE the doctor. It's almost like a retainer for a doctor!!! Doctors justify it through their pitiful payouts from insurance, but the ones getting the shaft are the patients. God forbid someone actually gets sick and needs to use insurance.

being witty about the hmo problem doesn't solve it - the salvation would be less greed and arrogance on the part of doctors - all of whom only specialize and no one does the basics - greed and money are the denziens of the situation and there is no cure for either of those illnesses

Hey, hopefully none us will
need Medicaid/Maedicare, because
these programs are slated to
consume 100% of GDP by 2070.

Actually, given that congress
continues to avoid cutting the benefits to these programs,
it will be a lot sooner than that.

Maybe every family should send
one of their children to Med school. Then everyone would have a real family doctor!

You hit it on the head! The health care system in country is seriously broken. My wife had pain in her abdomen. She had blood tests, ultrasound, MRI, etc. The good news was they found nothing wrong. The bad news was over $3,000 in medical bills after health insurance payments (our premiums, about 900/month). The worse news is that she still has abdomenal pain, sometimes serious.

Not only that but as a nation, we're spending 16 cents of every dollar we earn on health care, so where do you think the money's going?

Bing, my wife is a PA-C with one of those large medical groups in California that you mentioned in a ENT practice. She agrees to work many patients into her already busy daily schedule on short notice, who are sick. I think you would find many like her in the practice of medicine.

I guess I'm one of the lucky ones - kind of: I have a doctor I can get in to see fairly quickly. He can usually tell me what's wrong and prescribe medication or a test of some kind (including the MRI you mentioned), but that's where my luck runs out: the HMO won't approve most of the prescriptions or the tests he prescribes, due to "insufficient medical justification." What I haven't been able to figure out is why a doctor vetted and approved by the HMO isn't qualified to prescribe medications or tests to the HMO's satisfaction....I feel as though I've entered an endless (and quite frustrating) "do loop" - and both my annual deductible and my co-pay rates just went up by nearly 25%! But I guess I'm better off than many....kind of.

Thanks for the story. I feel exactly the same. For all the touting we do that we have the best medical care, unless its an emergency, its really difficult to actually find the care!!!

I'm a 15 immigrant from Britain. Health'care' in the USA is a DISASTER. This has happened because Insurance Companies and the Pharmaceuticals have succeeded in lobbying Washington to accept their wish to profit from an industry that should be a right for each and every citizen. My wife has Breast Cancer...worrying about getting this paid for by our HMO is WORSE than dealing with the disease and the treatment!!!!!!

What we are seeing is the evils of a National Health Care System but none of the benifits. The bottom line is we have insurance for High probability of occurance and low cost events that the average citizen can and should self insure. If we have a single payer system it should only be for catastrophic events (low probability of occurance and high cost).

Bing, let me tell about the Medical industry,having worked in one for 23 years. The movie the "Hospital" with George C.Scott is right on cue. They don't want to know how sick you are, they want to know can you pay. I truly believe that the medical industry has a "cure" for most the diseases out there, but there is no money in a cure, when you can treat the disease with high costing medicines forever.

Maybe its just the super populated areas? I live in St. Louis, and can get in to see my doctor today (or at least one of his partners) if I am sick. Also, I can leave a message on his exchange on the weekend and get a call back within the hour from whichever doctor is on call from his office.

Well if you do go in when you are well you could do something like get a flu shot...oh right they "guessed wrong" about the flu shot this year so it was only 40% effective. I don't see anyone getting a 60% refund of their money to perhaps buy cough medicine when they get the flu. Oh right, the insurance companies only had to pay 25% of the amount charged for the shot (contract rates). The problem is that the health care system includes the medical professional and the insurance companies...not the people who need the care, we need to figure it out by ourselves.

I think it's less an issue of can't-find-a-doctor and more a case of the transaction-without- relationship that our consumerism has become. The doctors are still there, it's we who have left. No longer do we establish a relationship with our service providers. We seek the most convenient and cheapest, which changes every time. Surveys show less and less people have family doctors. Is it because the doctor is out, or is it because we just look for the doctor standing by to take our call?
When we grew up, we were to no longer act like teens as consumers. We weren't supposed to be flighty, afraid or hesitant. Our parents took us to the same doctor, same dentist, same Stride Rite store. Yes, things are a little more complicated with health care, but I don't see the point in doc-hopping.
When I moved to Central Virginia, one of the first things I did was find a doctor, a dentist, an eye doctor, a lawyer and an accountant. I asked around. Sure, I had to match my plan, but that's not so hard in most places.
I went to the doc at the first sniffle. I probably could have self-treated, but I wanted face time with the person that was going to ease me back to health one day.
I don't buy the too-busy or want-the-best-value argument. It's your and your family's health, whether it be financial or medical. There's no reason to approach it like you're buying a flat screen TV. We should know better.
By the way, I get an appointment with the doctor pretty quickly. Never have had problems, even when I lived in the DC area. You see, that happens when you form a relationship with some very important people.

Your friend's experience at the emergency room and your daughter's acknowledgment that she doesn't have a doctor are perfect examples of why we need national health care. The non-insured are using the emergency rooms as a substitute for a doctor's office and people with real emergencies have to wait behind them. People, like your daughter, are convinced they don't need regular medical care and consequently will not purchase insurance unless it is mandatory. Not that your daughter can't afford to pay for a doctor's visit but many adults can't and they become the tax payer's problem.

I pay 36 dollars a month for health care, last year I had a serious operation and spent 6 weeks in the hospital. I never whined about my health care deductions cause I knew that somewhere down the line, it would come in handy and it did. I have no health care bills as a result.

I've been seeing the same doctor for the past 10 years, and his calendar was booked up for two weeks, but when I told them that I was in a car accident and why I needed to see him they managed to double book me for the next day. If you have a relationship with your doctor you can get excellent service when it's really needed. They knew I wouldn't come in in a rush unless I really needed it. Sadly most people don't maintain a relationship like mine with their health care professional, but when you need it you'll be happy you cultivated it.

So true. I found out the hard way about TRYING to see a Dr. when you are sick. I got sick, had no Dr here in St. George, my husband said "call my Dr, he'll see you". I call, she asks "are you a patient? to which I answer no. She says "he can see you in 4 weeks". I scream "I'm sick right now, not in 4 weeks!".

So -- when I was well I scouted out a General Practicioner. Went to visit and get acquainted. Now when I am sick I call and usually get in that very day. It's all a joke. If my Dr talks to me for more than 4 minutes I'm lucky. Oh yea, don't even think about getting sick on the weekend. You will hang out in the Emergency for hours before they ever get to you. Healthcare here SUCKS!!!!!!!

I work for a major healthcare company. I wont say which one, but I work on the phones. You would think we would have excellent healthcare but it is much worse than any plan I take calls for. Recently at the beginning of the year we received an Email from our HR department. I will never forget what it said, I am dead serious about this. Though this is not going to be verbatim, this is 99% as close to it as it can be. "Congratulations we have just had our healthiest year ever in 2007! As you know this helps keep the cost of healthcare lower for all of us. However, in light of this successful year, we will be having to raise our monthly rates again and we will be dropping several plans ...". Try not to laugh too hard and be nice when you call your insurance company, if you complain about your plan being the worst you are preaching to the choir.

People are complaining about nothing.

I myself go to the emergency room whenever I have an urgent medical problem. I do not care how much it costs. I just want to get seen so I can feel better.

I probably have $40,000 in medical bills. I have no intention on paying. Why should I waste time trying to build a relationship with a doctor? I just want to feel better when I get sick.

All of this insurance talk is nonsense. People who have no insurance just walk in, get treated, and keep going. It's time for Americans to stop being wimps.

All im going to say is that i have a universal healthcare plan supported by the military and we all have a circulating joke. "Tricare... Stop giving us @#$%@^! motrin." this is because no matter what is wrong with you their cure is motrin. we need to set up a nation wide plan like Canada, and Europe.

I have a GP and he's the gatekeeper for all of my medical needs. I see him yearly (actually, more like every 14 months because the insurance company will only pay for one well-care visit every 365 days). When I get sick and need to be seen immediately, we get fitted into the schedule without any fuss. And when my mother, who wasn't a previous patient and on Medicare, needed to be seen immediately, they were very accommodating.

The insurance company, on the other hand, has always been a source of rectal agony for me. Instead of using the facilities that my doctor recommends -- even for routine labs -- I have to use their lab. Every few months, they change the formulary list for their meds, usually leaving me twisting in the wind when I go to the drug store only to find out that the insurance company won't pay for the medicine that I've been taking for months, but only for the generic-of-the-month.

Yeah, my boyfriend's work (he works for the county)switched healthcare insurance companies last year. That was a mess, they denied him over half of his medications, his doctor had to fight and revise which medications he could take to fit the insurance company compliance. My boyfriend had a triple by-pass last year and due to this mess had to go 2 days without his heart medication (over 400 dollars to purchase without insurance), not to mention his various other medications that help keep him alive.

To make matters worse, when he spoke to this new health care insurance provider over the phone about this situation while at the pharmacy on speaker phone, the rep outright said he didn't get paid to care about whether he (my boyfriend) died or not.

As for doctors, well, I don't have one either. I have insurance but can't afford the deductibles. I should go for a health check up and make sure I don't have high blood pressure or something.

@Gregg, Charlottesville. Your post about coming up with reasons to go 'visit' your doctor so they get to know you and give you better service, while good from a tactical standpoint, highlights what kind of waste has to occur in order for people to get reasonable treatment from their doctor.

You have to make unnecessary appointments (that are billed to your company's insurance and that collectively we all absorb in one way or another) in order for the doctor to start to see you as a profit-producing customer.

Yes, good for you that you can wastefully use the system to your advantage but this just highlights that the system is broke.

I'd say let's move to getting everyone on high-deductible plans that aren't employer sponsored.

We're with Kaiser Permanente, Northern California. It's a cradle-to-grave HMO, probably the closest thing in America (outside government) to a European or Canadian national health-care system. Everything from eye care to psychiatry to major surgery is done in-house. All your med records are in one place, all accessible at the touch of a keyboard. It's great because you choose your GP or pediatrician, keep him/her for years, and we haven't had any problem in seeing specialists, with only reasonable delays. (And the primary-care docs are obviously very busy people.) "Wellness" and health education are extensively promoted. In an emergency we can always get fitted in somewhere on the same day, and the couple of times we've had to use the ER on weekends, it hasn't been too bad. Best of all, we don't have to telephone, negotiate, beg, etc., with some insurance rep to try to get reimbursed, like all these horror stories I've read here and elsewhere, or seen in docs like SICKO. When I was in the hospital once for a surgery that became complicated and spent six days, my out-of-pocket charge was $100. Our particular facility is bright and clean. All our prescription drugs are $10-20 a bottle after a $250 annual deductible. There is no lifetime cap on coverage.

That's all the good news. The BAD, BAD news is that our health-care premiums have gone up by 60% in the past two years! (For everyone in our geographical area.) As self-employed people, we pay full freight. Another couple of years like that, and we'll be down to paying the mortgage, the health care premium, the utilities, and very little else.

Let me caveat my comment so it minimizes condemnation of my seeming wastefulness by the more pious readers. Anybody who doesn't sit down with their doctor the first time they ever see him or her and go over their medical history, discuss their preferences for treatment, etc. deserves the doc-in-a-box treatment that a good many people are using these days in an effort to cut corners. Insurance usually doesn't pay for this initial visit, and it is probably the most important visit one could make to the doctor. Waiting until you're really sick to see the doctor the first time is asking for instant gratification. As I said before, health is not a consumer product. By the way, that first visit used to be called consultation, and it was how you set up your medical history with the doctor.
I won't debate the insurance industry. I don't believe that was the point of the blog. I believe it was the frustration at trying to find a doctor in a timely manner.
My family and I go to the doctor less because of our proactive approach to health, yet pay the same premiums as others who maintain a Wal Mart approach to their doctors. Now who's wasteful?

If you don't want to get sick you have to use natural supplements and vitamins. Chek with your healthcre provider what is you need and you always be in a good shape.

Nature Sunshine

RELATED THINGS