We can insure anything, in many cases the availability of insurance is expected. Sometime in the last twenty years, we started calling insurance by the name of what it insures, turning Health insurance into “Healthcare.”
That subtle change altered the way we see “Healthcare.” We certainly have the right to be seen by a physician, but do we have the right to have someone else pay for it? Free Healthcare sounds wonderful, until you realize that what was free was an insurance policy, a piece of paper. You still have to pay to see a physician. For insurance, whether directly, through an employer, or through a government agency, you pay for healthcare, then you pay for a physician.
I may be required by law to purchase healthcare insurance but it is not healthcare. Healthcare is a physician treating a patient, not the exchange of cash to facilitate treatment. The buzz is growing. Why are we paying for healthcare but not receiving it? We just have insurance policies, which may or may not pay for any part of any treatment.
In a sad sign of the times, when you ask for an appointment with a physician, the first question is “What kind of insurance do you have?” I recognize the obligation of compensation, but what other transactions require proof of payment before something as simple as an office visit? Would there be so many patients unable to pay to just speak to a doctor that allowing them service without guarantee of payment would bankrupt doctors?
So we have Insurance. Insurance companies pay differently for services, so does the doctor I need accept my insurance? And if they do, are there appointments available? I shopped carefully, making sure the drugs that are prescribed to me are covered by the insurance. I made sure they had plenty of doctors in the specialties that apply to me. Then I tried to make an appointment.
First barrier, you can’t make an appointment until the policy is in effect. To be clear, you cannot speak to the receptionist to make an appointment until the policy is in force.
Second barrier, is the doctor accepting new patients? Now that you can speak to the receptionist, she can tell you the doctor is not accepting new patients, or that the first available appointment is in six months.
Third barrier, some people do not have the luxury of being able to change insurance at all, or may be restricted to a yearly window in which they can change.
My partner recently tried to find a new psychiatrist, the doctor who signs the prescriptions for the various psycho-active drugs she has been prescribed for somewhere in the range of thirty years, and a psychologist, the counselor who provides “talk therapy” (which used to be the realm of psychiatrists). As she contacted doctors from the list provided by the insurance company, her first observation was that the list is horribly out of date, most of the doctors she contacted no longer accepted that insurance, a few didn’t even practice that specialty. Those that did were not available for an appointment within six months. Normally she would not be able to change insurance companies until roughly that time, six months from now. Her prescriptions would need to be renewed before then, as would anyone’s. The psychologist she had been seeing for years and was actually making progress on some of her issues was in another state, and her insurance stopped covering out of state doctors. Fine if you live in Texas but in the Northeast there’s another state within thirty minutes wherever you are.
This is one of many baffling facets of health insurance. The company must be licensed to sell insurance in a particular state, limiting the number of companies to consider. The company, which should do everything to increase the number of doctors available to me, has instead limited that number to my immediate surroundings.
She will be paying a penalty to change insurance companies, but after weeks of research she found one that had a psychiatrist that will be able to see her that also covers the prescriptions she already has. She is on total disability, allowing her the time to complete the research. I have no idea how an average working person would navigate the process. Once she sees the doctors she will be able to discuss why their indoctrination against the use of opioids does not apply to the case of a 53 year old woman who requires those exact drugs to survive.
The government wants to reduce the amount of drugs that are prescribed, forgetting that the drugs were invented because they had a specific purpose which was needed. Opioids are addictive, is their result addiction? An addict needs the drug for a non medical purpose, but when the drug serves to make the patient able to interact with the world, the physical addiction is still there. If she misses a dose she risks post addiction withdrawal syndrome, PAWS, which can be fatal. Every new doctor has to be guided away from the slogans and back to the reality.
It seems to me that if I am required to purchase something, that thing should work. Insurance companies cannot know what percentage of their customers may need a certain specialty, but when that specialty routinely has zero available doctors in a geographic area, the company should not be licensed to sell policies there. Perhaps companies could have ratings based on the number of available specialties in an area; no one wants to have physicians sitting idle. The alternative is patients going unseen. This is not an impossible task. If there are insufficient doctors in a certain specialty, the company could pay a higher percentage of the amount billed, enticing doctors to accept that insurance or even relocate to the area which pays better for their services.
Until these changes are adopted, we continue to waste health insurance dollars. Paying for insurance, whether directly, through an employer, or through a government agency, which cannot be used, has no effect on the average person who will never need the insurance. Finding out you’ve been paying for insurance which does not provide the healthcare you need, when you need it, is too late.
Of course, single payer health insurance will face the same problems. Any health insurance which does not actively promote doctor accessibility/distribution cannot be called “Healthcare,” because it doesn’t care about patient health.
KBlakeCash 