Wednesday, May 21, 2008

It Shouldn't Be This Hard

Thanks for waiting, Mr. J, doctor will see you now

Nope, not a warning tale about what to do if you are, err, "excited" for more than 4 hours after taking Viagra, but instead a diatribe against how damn difficult it is to get even simple things done in and around the US health care system these days.

Problem statement: we're off to Africa in July and so I need to get a yellow fever shot in order that my organs don't liquefy at the first insect bite when stepping off the plane. Fair enough. Should take no more than a call or two to arrange, throw in a quick jab and we're done, right? Wrong.

Step one: try and figure out where to go. Seems to be two choices. (A) go to a clinic specializing in such things or (B) have an inane conversation with your doctor's receptionist who is clearly still cutting out the coupons in order to pass the cornflake university course necessary to qualify. Luckily, I had Susan do this part and so choice (A) was that of least resistance, though likely not lowest cost.

Step two: call clinic and find out that they have to have a prescription faxed to them in advance for yellow fever anti-viral in order that they can get it and have it ready for when you come in to their office. Nope, they can't just dole it out, you need paperwork. OK ... so move to step 3.

Step three - and the one where I get involved now: call doctor's office. Speak to receptionist who claims I have to go through public health services in San Jose to get this done. Say what? I repeat the request thinking she may have misheard, but got the same response. I have to hang up before I start shouting at the phone like Grandpa Simpson. Clearly, the only way to resolve this will be to go to the office myself in the hope of locating someone with an IQ that exceeds their age. Rats. History tells me that this won't go well.

Step four: stop at the office on my way to work. Find same receptionist I spoke to on the phone and get same response. I get very quiet and speak very, very slowly. "No, I do not need to go to the public health department. I am going to a Travel Medicine clinic in this same building and you need to Fax them a prescription for yellow fever vaccine." Must have worked because she gave up and handed me over to someone else who, though being no brighter, at least was willing to be more compliant. Or so I thought.

Step five: "Oh, well we can't just write a prescription, you have to see the nurse." Okaaay ... but of course nursey was busy, so I'd have to wait.

Over the next hour, people come and people go. I counted three drug reps who, of course, just breezed right in and, surprise, surprise, met straight away with this near-mythical nurse I'd been told about. Clearly, I was not worthy, having failed to bring with me the necessary offerings of free pens and copious samples of drugs to fix stuff you have never heard of but have seen on TV so it must be good for something, right? I mean, they went to all the trouble to find a drug just to cure restless leg syndrome (fidgeting?) so there must be millions of sufferers and I do have to say I've felt the odd itch down there myself so probably better get it checked out while I'm at the surgery.

Step six: meet nursey. Finally, the home straight. Weighs me, takes blood pressure (100 over 60, which is lower than it's ever been so either my heart had just stopped or they couldn't even get that done properly) and temperature. "You are fine, now go and sit in the consulting cupboard and wait." Err, ok ... I suppose I could do that. Is writing on a pad something that has to be done in private now?

Step seven: read yet another magazine for a further quarter-of-an-hour. Finally the door opens and my doctor walks in, nursey having returned to the altar presumably. "What seems to be the trouble?", he inquires. I refrain from laying out, in minute detail, the charade that had just played out over the past 75 minutes, and instead cut to the chase. I NEED A PRE ... you get the idea. He scribbles on his pad and that's it. Done.

Far as I can tell, the only reason for making me see the doctor is that this causes a material billing event to be generated that they can send off to the health plan provider. Just having the nurse write on a pad wasn't going to cut it money-wise but now they have an honest-to-goodness doctor consult to bill for. Lovely money!

Almost 90 minutes lost to generate a single piece of paper, carrying now an overhead cost in billings and processing that will likely run into the hundreds of dollars. And all of that before I even get the vaccine and have someone else, who will also need paying, shoot me up with it.

The US health care system is in desperate need of root-and-branch reform. It's about the most expensive system in the world and yet seems less efficient than even the dear old NHS in the UK. Sure, if you are critically ill then there's no place better from a care or medical technology standpoint, so long as someone else is picking up the tab of course (ultimately US businesses, whose premiums cover all this stuff.)

But here's the real reason no one wants to touch this issue in Washington: there will be tremendous lobbyist back-pressure to change nothing because everyone does very nicely thank you out of the status quo, despite the fact that rapidly increasing costs will put the whole system into cardiac arrest at some point very soon. Change of any kind means winners and losers, and politicians hate to be in that situation, much preferring instead to play games where they can pretend everyone wins thanks to their insightful and brilliantly constructed legislative efforts. But surely a new president, especially a democratic one, will want to grab hold of this and do what's right for the country and the people? Not a chance. Certainly not GW Shrub mark II (yes, John, I mean you), and as for Hillary then she's still carrying the scars of grabbing that particular hot potato when Bill was first in the White House 15 years ago. Obama? Perhaps, but it's hard to tell. I haven't managed to decode his policy statements in this area given as how they don't go much beyond "cover everyone for everything" without any accompanying explanation of how a system already creaking at the seams would ever cope with such a massive influx of new patients except by driving premiums into the stratosphere.

If the divine trumpet should sound in the coming years, successfully summoning the dead back to life, the newly-resurrected had better make sure that their still-breathing relatives and descendants have kept up their health care payments whilst they've been snoozing underground. Because if not then woe betide them the first time they drop the odd tarsal here or there, or a dog runs off with their left leg. Regardless of social status when they shuffled off this mortal coil, hanging around the emergency room hoping Medicaid will pick up the tab will make them wish they were dead. Again.

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