Free market, my tuckus.
Thu Jan 03, 2008 at 05:06:09 PM PDT
Amen sister! -Elisa
How many times have we all heard it? "The free market is the best for healthcare!" The typical conservative reaction to any mention of universal healthcare.
Well, I'm here to say, with an incredible amount of frustration, free market healthcare is a MYTH!
Now, I'm sure, 98% of us already realize that. Elisa certainly does. I have spent the past two days belatedly going through my outstanding medical bills, stupidly AFTER my open season at work had closed. As a government employee, I supposedly have some of the best healthcare in the country. That, ladies, is also a myth. But the worst part of it, as I realized today, there is no way for a consumer to make an informed decision about their healthcare insurance!
Free market economics is dependent on the consumer having access to the information necessary to a make a choice. There is no way, unless you are or are married to a human resources professional, to understand exactly what you are getting when you purchase healthcare.
I offer my story as the ultimate example. I have the hated Blue Cross/Blue Shield. When I looked at the information when I signed up, I saw the usual claim of covering out of network providers 80/20. Which I was used to. But this is where not having access to all the information bites you on the butt.
I had a miscarriage on September 25th, as some of you may remember. My ob/gyn, who I have seen for years, is out of network. When I had my first child, we paid all of $800 to have the baby. Guardian ALliance PPO paid every penny of the hospital bill, the anesthesiologist, and a true 80% of the doctor's bill. Pain free, easy. BC/BS is no Guardian Alliance. BC/BS DID cover the hospital bill (they actually paid the hospital MORE than the fee) and the anesthesiologist bill. But the doctor's fee was $1300. BC/BS wrote a check for a whopping $284. I'm responsible for the remaining $1,000.
So, what happened? How did the 80/20 ratio get flipped? All together now: reasonable and customary charges! Yes! Of course. BC/BS has somehow determined that the appropriate charge for a miscarriage at 8 weeks is $418. That's it. So they did indeed cover 80%-of the reasonable and customary.
So, I'm pretty pissed. Currently, we are covering two sets of insurance--mine and my husband's. Sadly, we both have BC/BS. So we're trying to choose. I want to stay with my doctor, despite the run-around last time. She knows my history, and she was very kind to me the night of the D&C. So my brilliant thought was to call our respective insurance and find out what they determined is reasonable and customary for a full term pregnancy. You need information to make a decision, right?
THEY WON'T TELL US.
The refused to answer the question. I have NO WAY to know what they would reimburse me for if I stayed out of network. I am so angry, I'm ready to scream. How is this a free market for healthcare? I can't access any plan I want, because if I could I would sign back up with Guardian in a heartbeat. I can't switch whenever I want, I have to wait until next November to exercise my "free market" choice. Dammit, I want to have a baby by next November, thank you very little. And now I don't have access to the information I need.
There is a way, in the spirit of the free-wheelin' Internet, to subvert this informational void. There's a website called OutOfPocket.com, where people are encouraged to post the details from their explanation of benefits. I plan on posting every single EOB I ever get. Go, check it out, and if you're so inclined, help it out. Its gonna take a while for the site to be truly useful, so it needs all the help it can get.
Free market economics for healthcare is nonsense. Give me universal, single-payer healthcare, NOW!
(I didn't even get into the bullshit about how labwork ordered by my in-network endocrinologist results in me writing a triple digit check because the lab was out of network. GRRRRRRRRRRRR!)
