My irregular musings on city life, politics, baseball, roller derby, and whatever happens to be getting my goat today.

Tuesday, September 01, 2009


Yesterday I went to the doctor to have my shoulder looked at. This is very unusual behavior for me. Normally I avoid doctors the way a pickpocket avoids the police. I don't think they're going to do anything really bad do me, but there's no reason to go looking for trouble. So evidently (and I'm really not "in touch with" my body, so I don't have much more to go on then you do) I was in a great deal of pain on Thursday when I actually called the doctor and asked for an appointment. My regular physician directed me to call a sports medicine guy directly and make an appointment, and foolishly I believed this meant I should call the sports medicine guy directly and make an appointment. So I did.

ntense nausea inducing pain aside, there was no way they could see me before Monday, so Monday it was. By Monday the pain had subsided quite a bit, but I'd already asked for part of the day off and couldn't bear the thought of actually working instead (it's been an intense month at the office) so I went anyway. At first i did a double take when I was given the address, since it was the street address of my son's pediatrician and I had never seen any trace of a sports medicine specialist loitering around the waiting room amongst the snot-nosed toddlers and desperate looking couples huddled with their tiny baby-in-Graco-pods. But I went there somewhat secure in the belief that my doctor would not send me on a complete wild goose chase.

Sure enough, when I walked through the front door, I noticed that the small "airlock" anteroom between the automated glass doors to the outside and the automated glass doors to the waiting room, there was an elevator door. This struck me as odd, because before yesterday I would have sworn up and down that the doctor's office was in an ugly modern one story brick medical building. But I pressed "up" which was my only choice, and rode the old creaky elevator up to another floor. It deposited me in a hallway with no markings. I walked down to the end of the hall and found a medical practice, but not the one I was looking for. Walking back to the elevator, I noticed a black sign with tiny white writing on it next to the elevator door. My sports medicine guy's name was one of those listed, and the number 202. I looked back down the hallway, the place I'd found was marked 210. About a third of the way down the hall was the only other door, which was so nondescript I'd assumed it was a supply closet. But when I peered in, I saw a small waiting room with a receptionist sitting behind a glass window. On the window was a small sign that read simply "202." Next to the window was a door that led to another hallway and more offices and examining rooms than could possibly fit in a supply closet on the roof of of the pediatrician's office. This had to be the place.

I thought I was doing well, arriving ten minutes early and having already downloaded the requisite paperwork from the Web and filled it out in advance. But I was greeted by an attractive and exceptionally tall woman of indeterminate Central Asian ancestry who informed me that while I had been referred here by my doctor, she hadn't given me a referral, which meant that I was missing a specific piece of paper in my file. She told me if I didn't have that specific piece of paper in my file before the doctor saw me then my insurance company would refuse to pay the bill. Since out here in the real world the only reason I came to the magic sports medicine closet was because I'd been told to by my doctor, I had to assume that the only purpose for this specific piece of paper to exist was to create a frivolous pretext for the insurance company to deny a certain number of claims. I ended up sitting in the waiting room for about an hour while the two doctors' offices called back and forth and debated exactly which piece of paper would convince the insurance company to reluctantly pay its bills.

Before I found out about the paper scam, I had believed that the mysterious elevator and magic sports medicine supply closet were only visible to patients with a referral due to a spell cast by demonic insurance company lawyers. But that was clearly delusional thinking on my part. I mean, seriously, why would the insurance company do that? It would go against their entire business model. They want you to see the guy without a referral, precisely so they can deny your claim! No, it's clear to me now that the Sports Medicine Genie has cast a spell on his own magic supply closet to conceal himself from potential patients whose insurance companies won't pay him. An elaborate scheme to be sure, but easier that trying to collect on medical bills from public employees whose insurance plans have denied their claims.

Speaking of the Sports Medicine Genie, he was a shorter, friendly, shaven headed man also of indeterminate origin, but probably not the same indeterminate origin as his lovely assistant, who interviewed me first. After I told her the story of my injury (which amounts to "my shoulder hurts, I have no idea why or for how long"), she left for a whild and then brough in the Genie and repeated my story to him, verbatim, as if I were not there. After which he poked and prodded me for a while and made me perform what amounted to Stupid Human Tricks for a few minutes, some of which I'm convinced he was just doing to make me look ridiculous so the two of them could have a laugh at my expense after work when the walked down the street to have a beer at the Old Town Ale House. In the end, he told me I have a rotator cuff sprain, an injury I associate with pitchers who have just been signed to multi-year deals with no-trade clauses, not with thirtysomething men who pull their flailing two year olds out of the carseat the wrong way. I need physical therapy to make the ball of my shoulder joint stay in the socket the right way, or so I'm told. That sounds painful, but if it makes my shoulder thing go away I suppose i'll do it.

He wrote a prescription that's only good at one particular clinic, at which his assistant is also employed. Now tell me how that works - doesn't it sound to you like he's referring to a business he also has a stake in? I'm not saying he's not right about my particular case, or that he personally is doing anything corrupt. I would never imply such a thing about a powerful genie who has an office in a magic supply closet. Who knows what other supernatural deeds he's capable of if aroused? But this kind of situation seems rife with potential conflict of interest, and incentives that perversely reward prescribing unnecessary treatment. No wonder the insurance gnomes are reluctant to pay. . .

I told you that story to tell you this one, as Bill Cosby used to say. (Still does, for all I know.)

Today I was reading blogs online (apparently I felt my blood pressure was getting too low) and I came across an excellent piece on health care in the Washington Post. And it ain't often you come across an excellent piece in the WaPo these days, not since they fired most of their reporters and replaced them with Random Non-Sequiter Conservative Opinion Piece Generator Software (sometimes referred to as "George Will") designed by the American Enterprise Institute. The piece is called 5 Myths About Health Care Around the World and you should read it, because there's a lot of babble and blather floating around the mediaverse about health insurance and health care reform, and you probably don't actually know as much about different systems of health care provision as you think you do. I didn't.

At the beginning of Page 2 I came across this gem:
In Japan, waiting times are so short that most patients don't bother to make an
appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic
clinic at Keio University Hospital to schedule a consultation about my aching
shoulder. "Why don't you just drop by?" the receptionist said. That same
afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an
operation. "When could we do it?" I asked. The doctor checked his computer and
said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

What huh? I try to imagine any American health insurance company allowing that. The mind boggles. And yet:
In France and Japan, you don't get a choice of insurance provider; you have to
use the one designated for your company or your industry. But patients can go to
any doctor, any hospital, any traditional healer. There are no U.S.-style limits
such as "in-network" lists of doctors or "pre-authorization" for surgery. You
pick any doctor, you get treatment -- and insurance has to pay.

Yet this system is cheaper than what we have in the United States, and results in a longer life expectancy and lower infant mortality. Like just about every developed country. But isn't the Japanese system, you know, all Socialist and un-American? Actually,
many wealthy countries -- including Germany, the Netherlands, Japan and
Switzerland -- provide universal coverage using private doctors, private
hospitals and private insurance plans.

Bet you didn't know that either. I happen to favor a "public option" as part of a health care reform bill, primarily because I think it will achieve the same result as subsidizing private insurance coverage, only cheaper. After all, insurance companies are going to find a way to turn some share of a public subsidy into pure profit by raising prices to match the subsidies, which will make publicly funded private insurance more expensive than it needs to be. But a fancy new plan with a fancy new name like AmeriCare isn't the point of health reform. It's just a means. The goals are:
  • Guaranteed Issue: this means insurance plans would have to let you buy in, and would have to cover "pre-existing conditions," which is a good thing gramatically as well as health policy wise. I mean, what purpose is that "pre-" actually serving there? Why not just call them "existing" conditions? And that's just one example of the kind of waste that's built into our current system that could easily be eliminated.
  • Community Rating: that means that plans would not only have to give you insurance even though you're sick, they wouldn't be able to charge you rates much higher than everyone else. But wouldn't they lose money on you if they had to do that? you ask. It's called risk pooling, people. Another word sometimes used for this concept is insurance.
  • National Minimum Benefits: Right now there is a patchwork of state regulations governing what kind of minimum benefits have to be included in basic plans. This results in a near monopoly in some states, but if you allowed for insurance plans to compete nationally without minimum standards on the national level, all the plans would just move to the states with the wimpiest regulations, like the credit card companies do. This would prevent situations like the one we had after my son was born, where we had a health care plan which had an annual budget for well baby care which was so small it was used up by the first round of immunizations. (We were able to delay the third round until after the new year when we could switch to a new plan. But I'm still pissed we had a year where we paid for a health care plan that refused to pay for any actual health care. I'm looking at you, Blue Cross PPO.)

These are the actual issues that the media should be talking about. Instead, they continue with horse race coverage like they did during the election. Who's up? Who's down? Who's cheating on his wife this week? Is it bias? Or is it just the result of cost cutting moves in which media outlets fired all their investigative reporters and replaced them with cheaper, easier to maintain evil robots. Or with bloviating center-right talking heads. So hard to tell the difference these days.

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