• Adventures in Insanity – ctd.

    Getting lots of interesting feedback on my post from Friday. Some further things I’d like to get across:

    1. Many of you think that this is a payment problem only. I hope you note that none of my issues have yet to do with payment. I’m happy to give them my credit card. They haven’t gotten to that point yet.
    2. Many of you think that I could avoid these problems if I just paid for everything out of pocket. Well, maybe it would be a little easier. But you know what? I paid my insurance premium this month, as I do every month, and I don’t think it’s unreasonable to expect that I should get the benefits I paid for.
    3. Some of you think that I could avoid some of these problems by short-circuiting the system as a physician. Maybe. But that’s somewhat unethical. Moreover, it’s not an option for the vast majority of Americans.
    4. Some of you think that I should just walk into the nearest pharmacy and get the meds. As I said, they’re not readily available everywhere. They would need to be ordered. For that I need the prescription first. For that I need the labs. And you see I’m back to square one.

    Finally, can we please remember that I’m not asking for anything out of the ordinary. I’m doing everything asked of me, and I’m doing it on time. The system is screwed up.

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    • If it makes you feel any better we’ve had some similarly frustrating experiences here in Western NY. I

    • If it makes you feel any better – a lot of dual eligibles* have multiple chronic conditions, and often have disabilities and/or mental illnesses as well. Logistics to treat one chronic condition can be legitimately difficult to follow – it’s easy for the peanut gallery to say order your meds on time, but that ignores the reality of both human behavior and the fact that some health insurance plans are poorly run.

      Now multiply that by several times for duals. And wish the states luck, as fifteen of them enter into fairly comprehensive plans to streamline care and improve care coordination for duals, and many of the rest of them do smaller scale things.

      * Dual eligibles are eligible for both Medicaid and Medicare. They’re all poor. Many of them have multiple chronic conditions (including behavioral health conditions) and/or disabilities.

    • I think you need to understand that the function of the insurance company is to NOT pay claims. That is how they make money. If they just paid claims, the rich insurance company execs wouldn’t get their fat bonuses and they might stop “creating jobs”.

    • -2 is the result of a subjective decision to value a given amount of money more than a given amount of time, not an ineluctable feature of “the system.” I can get fast, convenient care under the existing system because I’m willing to pay slightly more for speed and convenience. If you aren’t, that’s both fine and certainly understandable, but there’s a difference between choice and necessity.

      • Jay–
        I’d argue it was a function of the adversarial role of an insurance company. Note that this started as a result of their policies: they informed him of the change in pharmacies at the last minute. If Aaron pays out of pocket, the insurance company will be rewarded for causing him inconvenience.

        Sure, this might be reduced if Aaron, not his employer chose his insurance, but basic dynamic would remain.

        Insurance is a stupid way to pay for health care.

        • -Couldn’t agree more with respect to a large subset of medical spending that’s currently paid for via insurance.

          -Having said that – the dynamic is a consequence of the plan design. There are plenty of large employers, like Whole Foods, that sponsor plans that would have alleviated all or part of the hassle he was forced to endure to make a fairly simple transaction.

    • -Just wanted to add that I can certainly sympathize with all of the frustrations inherent in that experience. Given the incentives of the purchaser (the university) and the insurance company, it’s hard to tell if rationing-via-cluster is a feature or a bug.

      In my experience, high-deductible/HSA linked plans over more cost effective coverage for the big stuff and way less hassle for routine expenses, but unfortunately (or fortunately, depending on your point of view), they don’t tend to be terribly common amongst public sector employers.