Being the parent of a newborn means never straying too far from the medical system. Today was our son’s first pediatric appointment outside the hospital. Alexander Daniel is on a gold-plated Blue Cross policy so cost is not a concern and we have our choice of physicians to see.
After a short wait and some paperwork, we bounce between the doctor’s office for discussion and an adjacent exam room. Every time we go back and forth or need to adjust an item of the baby’s clothing, the doctor runs out to see a patient whose visit is running in parallel. I’m not sure if this is standard procedure, but given the paltry amounts that insurers pay for office visits (see this 2010 posting about my doctor billing $510 and collecting $83), I can’t think of any alternative for the doctor.
The pedi does apologize that things are a little slow/chaotic on this particular today. How come? “We’re just installing a new electronic medical record system. And to make it work we had to get new computers because the system didn’t support Windows XP.” Was he going to run Practice Fusion, the free Web-based system? “No. We have to run eClinicalWorks. It is required by Mt. Auburn Hospital, with which we are affiliated.” Was he then upgrading to Windows 8? I could see how that would throw the office into disarray for a few months (or years). “No. eClinicalWorks doesn’t support Windows 8 so we installed Windows 7. But on the other hand they are talking about switching everyone over to Epic so we might start over in a year.”
The doctor suggested that we get flu and Tdap vaccines, but since we are not technically his patients he cannot give it to us. So we’ll need another encounter with the health care system to get these.
Then I went to the neighborhood (old-school family-run) pharmacy to get a prescription filled. They had to do some compounding. “We can’t bill your insurance company,” the pharmacist noted, “because even though we start with an FDA-approved drug, if we’ve compounded it then it is no longer FDA-approved. You can submit the receipt to them and try to get them to pay it. Usually the deductible is so high that it isn’t worth it.” I handed over $45 and didn’t ask for a receipt.
I’m wondering why Americans are so confident that they need health insurance and that, indeed, health insurance is such a good idea that people who don’t want it should be forced to buy it. Food is more important than medical care since without food a person will surely die. Yet we don’t force people to carry “food insurance” and then have the food insurance company authorize particular food providers to serve meals at times and places of the provider’s choice. If people are poor we give them a debit card (SNAP or “food stamps”) that they can use at the supermarket of their choice, with roughly the same shopping experience as a customer using cash. Poor people are lifted up to enjoy a middle-class shopping experience. In health care, it is the opposite. Middle class people are dragged down to endure the same customer service experience as a poor person dependent on Medicaid. If we hadn’t been forced by convention and now law to hand over $20,000 per year to insurers for our family’s medical care we would have been delighted to pay $160 for an appointment with a doctor who could spend a calm 30 minutes with us, rather than $83 for a rushed 15-minute appointment. And the $45 bill for the prescription wouldn’t have bothered me at all if I hadn’t already paid for prescription drug insurance that, I thought, paid for prescriptions.
The pharmacist put it in terms of dollars and cents: “People think that they can save money by buying insurance. They never wonder how it is that all of the people who own insurance companies got to be billionaires.”