aTypical Joe: a gay New Yorker living in the rural South

Wednesday, April 04, 2007

Sick

Doug’s on his way to buy Prilosec at Wal-Mart. Yes, yes, I know. Wal-Mart.

He’s going there because our insurance - the best in the area and negotiated by the state for 19 institutions covering 40,000 people - won’t cover the prescription medication the doctor ordered.

When a doctor bill comes I typically have to call three places; the insurance company, the doctor’s office and the entity (lab, hospital, specialist) doing the billing. I’ve learned not to pay bills in the first 90 days. It takes that long to get them sorted out.

The first bill arrives before the insurance has paid its share. The second usually lists the insurance company rejection of something they’re supposed to cover. Three, four, five calls and 90 days later, I pay some amount that I experience as “small.” And relative to what the first bill said, it is small, even if hundreds of dollars each adding up to thousands of dollars a year.

And I’m one of the lucky ones. This small rant was precipitated by a TimesSelect preview of a review to appear in this weekend’s Book Review of Jonathan Cohn’s Sick: The Untold Story of America’s Health Care Crisis - and the People Who Pay the Price:

In “Sick,” Jonathan Cohn, a senior editor at The New Republic, lucidly shows how America’s system for financing medical care helps determine who gets proper medical attention - and who doesn’t. He tells this story through the experiences of ordinary people, like Cynthia Kline, a 55-year-old teacher in Cambridge, Mass., who suffered chest pain one afternoon and knew from prior experience that she was having a heart attack. She phoned 911, and when the paramedics arrived, Kline told them to take her to Mount Auburn Hospital, a nearby facility known for its intensive cardiac care unit. But since the emergency room there was full, the paramedics sped her to another facility, even closer than the first, only to discover, as Kline herself evidently suspected, that she needed an emergency catheterization - a procedure the staff at the second hospital was not able to perform. Two and a half hours after dialing 911, Cynthia Kline was dead.

This true-life story, at once disturbing and illuminating, encapsulates the larger drama of a failing system. “Overcrowding in E.R.’s, according to most experts, is actually a symptom of other systemic problems now plaguing medical care,” Cohn writes, “from the downsizing of less profitable hospital services such as psychiatric wards ... to the swelling ranks of people without health insurance, whose untreated chronic conditions are more likely to become serious medical crises.”

“Sick” is an account of the author’s listening tour, which took him across the country. In Austin, he met a young mother whose managed-care provider refused to cover physical therapy for her developmentally disabled toddler. In Deltona, Fla., there was a self-employed woman with diabetes who fell prey to an insurance scam. In Chicago, a former nun living in poverty told Cohn how she tried but failed to obtain charity care at a Catholic hospital.

By the end of Cohn’s narrative we’ve run the gamut of woes: the hopeless fragmentation of the mental heath system; staggering medical debt; the dependence on job-based insurance; frayed social safety nets; lousy (or no) guarantees of preventive care; selective access to medications. Lack of insurance is a meaningful problem, too, especially for the mentally ill. But since 80 percent of all emergency room visits in 2004 were made by people who had at least some form of coverage, the problem can’t be pinned solely on insurance.

Apparently Cohn proposes the “largely single-payer” French model as a solution. Sally Satel of the American Enterprise Institute is the reviewer. She likes the book, but is not sold on national health insurance as an answer.

I am.