We’re coming up on the first anniversary of my encounter with the American system of health care, so I think it’s worth doing a little recap and asking a few questions. I’ll keep this as short as I can, but health care is a complicated topic, so I hope you can spare a few minutes to read it in full.
Back in 2010 I retired from the University of Michigan a few years earlier than most people can consider such a thing. The largest obstacle many of you will face in taking early retirement if you are US citizens living in the US is the question of how you are going to obtain health care. And let me explain that I didn’t take early retirement so that I could play golf or sit on my butt, my object was (and is) to see if i can do something with my life more in line with what I set out to do after college. For my first year out I spent time trying to help folks living with a mental illness and now I am engaged in teaching Biblical languages and literature at the University level. With a little help from the Almighty and my friends I might see the day when I complete the Ph.D. I started to write in 1979.
Back to health care. Shortly after I agreed to the terms of the early retirement, the University of Michigan informed me that I could continue to receive their health care plan, but the cost would be $1,400 per month. As generous as the retirement offer was, there would have been no way that I could have afforded to pay that out of pocket. The reason I could consider taking the University of Michigan up on an offer to retire early was that I have a supportive spouse who agreed to carry me on her health plan. And so, with health care presumably under control, I took the offer.
A year after I retired, my wife received an attractive offer from the University of Tennessee Knoxville (UTK). Since I was retired, it was easy to give the offer serious consideration and we ultimately decided to take it. I arrived in Knoxville slightly before Terri just after Thanksgiving 2011. And just after I arrived, I suffered a pretty severe injury to my left knee brought on by all the moving activity. I wound up in the ER of UT where they spent some time making sure that I wasn’t going to bleed to death or need an amputation, and then they sent me home with a referral and advice to follow up with x-rays, etc. That’s when the “fun” began.
At that time (late November 2011) I was fully covered by the health plan of the University of Michigan. Beginning on January 1, 2012 I was fully covered under the health care plan of the University of Tennessee. At no time, not one day, was I lacking health care insurance. Nevertheless, I found myself effectively deprived of health care for about six weeks. This is how that happened.
As soon as I returned from the ER, I did what I was supposed to do under the terms of my Michigan insurance. I called the plan to inform them of the injury and to request that they authorize the recommended care. They cheerfully informed me that less the deductible, my ER visit was fully covered. They also said I was welcome to obtain all the follow-up care recommended by the ER with my “primary physician.” I pointed out that I was living in Knoxville and the primary physician was in Dexter, Michigan. They recommended that I fly or take the bus so I could receive my health care. When I pointed out that the health care was supposed to be covered when I was living outside Michigan, they replied, yes, that’s true, but you have to prove that you have lived outside the state for three years before that kicks in.
I wasn’t going to leave my spouse to deal with all the moving issues as she settled into her new position in Knoxville, so I just “toughed it out” reasoning that I would soon be covered by health care via the University of Tennessee. On January 2, now legally covered by UTK, I called a physician who had been recommended to me here in Knoxville. His appointments secretary looked me up “in the system” and informed me that since I wasn’t listed (yet) she could not offer me an appointment. I was flabbergasted. Really? She went on to explain that the UTK policy was that claims have to be filed within two weeks of the appointment or they would be automatically denied. It can take two or three weeks for the coverage to show up, and so in the past they have lost the ability to collect their fee for service because of this policy. As a result, they adopted their own policy which is not to see anyone who doesn’t appear on the claims list.
I did not have to wait the month or so this would have meant. I had made a physician friend in the community and he called to ask me how things were going. When I explained all this to him, he called the physician directly and the following day, the appointments secretary was back on the phone to me offering me an appointment. Altogether, I was unable to see a follow-up physician after my accident for six weeks.
This is how it was for a person with some of the best health care insurance in America. And all of the barriers to care that I experienced can be chalked up to insurance companies. Had I lived in Canada, England, New Zealand or tiny Israel I would have received prompt, good attention to my medical needs without fuss or muss. But in America, with our vaunted health care as available to those lucky enough to have insurance, I was treated like a pauper begging for care. Actually worse, because a pauper might have been eligible for indigent care.
The political silly season is now upon us. I am unconvinced that the problems I have experienced will be ameliorated by Obamacare because I don’t think Obamacare does much to reign in insurance abuse. What I would like to know is what precisely Romney/Ryan will do to improve this situation. I understand they oppose Obamacare (as I do). But that’s not good enough. While I dislike Obamacare, I think it is better than the nothing we had before Obamacare. Getting rid of Obamacare only puts us back to an even worse situation. What is the solution to this insanity we have in our country? Under what clause of what Romney/Ryan plan would I have been able to receive medical attention in less than the six weeks it took?
Hi Ellen. I agree 100% that health care should be decoupled from employment. What sense does it make to say that only employed people can have access to health care? This is an artifact of the post-World War II era when employers sought to attract employees by offering what was then a very inexpensive benefit.
One of my chief complaints about labor unions is that they fought public option health care for years in order to protect their own plans, and now what do most blue collar workers have?
Private insurers have done a terrible job so far with cost control. Hospitals count every aspirin they hand out and charge $5 for a pill that costs a penny in order to leverage insurance payments. And why do you think it was so difficult for me to obtain the health care I needed despite having “full overage?” What answer could there be other than “cost control?” What better way to control costs than to simply deny coverage?
I’m not claiming that the only answer is government care for all. I agree with those that say that government should be a limited tool and that private companies can do a better and more efficient job of many tasks. So there is probably a government/private compromise of some sort that can efficiently provide excellent health care for all Americans.
In the last analysis, I don’t see the answer to my question. I’m not asking you what you would do–I know you have the best of hearts and would like to see every sick person receive care. I’m asking you to tell me what is in the RomneyRyan plan to achieve that.
Thanks so much for taking the time to read my long and rambling story. Now you have some of the details to explain why I’ve been hobbling up and down your road. 🙂
As to your question, though: I’m a fan of market-based solutions to cost control. I would de-link health insurance from employment entirely (which would have eliminated your problem). Then, I’d give health insurance companies the right, which they are now denied, to compete across state lines and offer tailored plans. Insurance would be individualized and portable, and costs would be lowered by competition. One of the awful results of both the ACA and single-payer plans is what we’re starting to see now … fewer docs willing to take poor patients, and fewer people willing to become docs in the first place, as their profit motive is denigrated and reduced. More primary care is being handed to less-trained people, and patients get further and further removed from the actual cost of services, resulting in overuse and abuse of services. Government-based solutions to problems always give us higher costs and crummier service.
Jack, I’m so exhausted after reading the details of your ordeal that I believe I’ll apply for rest home care … or not!! Sorry your welcome to Tennessee was so un-welcoming!
Hi Judith. I don’t disagree with you, that’s why I don’t particularly care for Obamacare. Having lived abroad for two years and witnessed how much better health care can be, I favor a single payer system. But my question is for RomenyRyan supporters: what is there in their plan that will fix this?
The Affordable Care Act is not universal coverage ala Canada, the UK etc. On paper, it offers many protections for someone in your situation. But until we, as a people, agree that health care is a human right and that equitible care is a valid social investment, it will be impossible to legislate solutions.