Just before she started back for what we hope will be her last year of herding pre-kindergarten kiddies the darling was working the phone on her end of the desk while I sat in my corner doing my usual morning read of the news/blogs, though only with half a mind as I was also listening to her end of the conversation. She was working her way through the health insurance labyrinth to question a $375 bill she got for a bone scan that had never been authorized; undertaken, apparently, at the whim of the tech. ‘Course settling this was no simple thing, requiring as it did the work of a sleuth through byzantine administrative offices with each new contact necessitating yet another encounter with the recorded menu like bashing through the line of scrimmage at a football game. She’s a wizard at doing this, having learned first from her sister who worked as the insurance gal for some doc clinic, then gaining immeasurable experience with my ongoing encounters. She knows the language, the right questions to ask, and the proper attitudes to cop, and she is relentless–she’ll keep a $20 discrepancy going for months (‘why the hell should they get it?’). I’ve never wanted to be the guy on the other end dealing with her. She has saved us at least thousands over the years.
But it takes, as mentioned, a degree of knowledge–there’s a corporate language there that’s every bit as esoteric as sailing lingo, and if you don’t know it you’re in trouble. You gotta know the process, too, and have the courage to say I want to speak to your supervisor with the discipline to stay calm. Not to mention that it takes an enormous amount of time. Of the five hours I spent in surgery on my hand following the saw encounter, she spent three on the phone arguing with the insurance company about the hospital where the surgery was currently underway. Her most recent settling of the phantom scan took two hours, but she’s not certain it’s over.
And we’re fortunate: we have fine health insurance, provided by the ELCA Board of Pensions–for whom I have come to have tremendous respect–contracting with (currently) Blue Cross. The BOP folks maintain a patient advocacy office or something like that to assist when the insurance company is pulling the old razzle-dazzle. They’ve straightened things out for us innumerable times, and are even polite and pleasant in that Minnesotan brogue (yah). I’m really grateful for this.
And I grieve for those who don’t have it; or who thought they had it and were paying for it and discovered when it was needed that by some prestidigitation of the insurance company they didn’t. Sue and I are highly educated people, and even we need help getting through it. What about the poor sap with a high school education just trying to do the right thing for his family with no knowledge, time, nor advocate to stay at it? How badly have these folks been plundered by the rapacious greed which is the standard of the industry?
Following my heart bypasses surgery in 93 it took me a year and a half to clear up the medical bills which included dealings with debt collection agencies about wrong billings, etc and eventually work with the credit ratings people ’cause the debt collection people had screwed with me there, so that I was nearly as stressed out when it was over as I was before I had the surgery. Then I tended to shrug it off as morally meaningless, one of those gordian knots human systems tie themselves in. I assumed that businesses and corporations essentially desired to behave ethically, at least out of free-market self-interest if not actual laws. And I thought the fuckups were aberrations.
How embarrassingly naive was my trust on that score, eh? Turns out it’s been the intentional and standard policy of the health insurance industry to addle and delay and deceive and deny and delete in order to maximize profits, as it’s been called, ‘death by spreadsheet.’ Healthcare is rationed by profit: if I can’t make a profit off of you, you ain’t gettin’ it. The three hours Super Sue spent on the phone while wondering (yet again) if I’d make it through surgery were not with medical personnel but hireling apparatchiks trained in and rewarded for their success at denial tactics, the specific rubric in this case being ‘out of network hospital.’ Not to mention as well the number of times she’s initially been denied ambulance payments because she didn’t use the right one (‘So you’re telling me when the hospital emergency room determines to transport him to a more appropriate emergency room I’m first supposed to go to your website and find the right ambulance company?’). That’s why we gotta have an advocate’s office. It’s like intentionally planned evil, and that amazes me. I feel like Pollyanna in a whorehouse.
It depresses me that as a nation we don’t understand the moral imperative of establishing decent health care as a basic right of citizenship. In fact, the conversation doesn’t even start there; it starts with ‘making health care affordable.’ Why ‘affordable’? And what does that mean, anyways, when two-thirds of personal bankruptcies are brought about by medical bills (with 80% of them having–they thought–health insurance at the time), so that even solid, middle-class folks are being plundered and destroyed by the system? It gags me as a Christian: “Then Jesus reached out his hand to the hemorrhaging woman who’d spent all she had trying to get well and said ‘I’ll take a credit card and your house.”
That the U.S. has the best health care in the world is, of course, a myth, though we might have the best trained medical personnel and the most lavishly equipped temples for their priestly work; certainly they’ve kept me alive, and the private hospital rooms come with room service, a far cry from the barracks sick bay I spent ten days in when I collapsed during basic training from some brutal virus with 50 other guys in the room being whistled out of a feverish stupor into a line by some nco every couple of hours to go fetch our kool-aid. But in terms of our society, we rank somewhere in the thirties compared to other countries in the world; so, for example, we rank 37th in terms of infant mortality. 37th. I’m not even sure I can name 36 other countries, and we’re worse than all of them. What we of course best the rest of the world in is the astronomically higher costs, in a kind of walmartian inversion: pay more, get less, but the difference still goes to the obscenely wealthy and powerful .01% of our population. Regardless of the number of actual human lives sacrificed, profits must be driven ever higher. I’m thinking of Leonard Cohen’s line in “The Story of Isaac”–’you who build these altars here to sacrifice these children, just according to whose plan? A scheme is not a vision. . . .’ Just according to whose plan is America the best health care system in the world?
The commercial stakes in the national debate are unfathomably (at least, to me) enormous. And the commercial interests are big and powerful and fabulously wealthy with a vested interest in maintaining the status quo, not for the sake of the people of this country, of course, but for the sake of profits. They use their vast wealth to buy off members of congress at both the federal and state levels. They use their coffers to develop publicity campaigns, first, denying a problem, then admitting some glitches, then wheedling a plea to ‘do better in the future,’ while at the same time carrying out a disinformation campaign that would put the Father of Lies to shame though parentally proud of it. They spend millions rounding up the most ignorant lunatics in the country to attend local town halls not to participate in the discussion but in the name of free speech to destroy the civic dialogue processes of democracy itself by screaming down and bullying and intimidation. They stir up the basest most primordial instincts of the prehistorically tribal reptilian brain. It’s like peeling an onion of shit: every insane filth uttered by their mouthpieces becomes a mob mantra and leads inexorably to a next level of shit. Their republican leaders–who hold the greater burden–won’t disavow their behavior but in fact pander to it. The democrats run around like tiny keystone kops trying to lasso jabba the hut. And the media inadvertently or not legitimizes this shit by giving it more air time than it deserves. Before the town halls started in August, tv reporters were told that the only stories that would be aired would be of conflict and disruption. So that’s all good ol’ Joe Sixpack sees on the news and gains the impression that the whole country is exploding when the real case is that they were aberrations, like cockroaches in the daytime.
This is the work of evil: to sow fear and discord and confusion and hatred. And that’s what we see as the business ethic of the health insurance industry. It’s all a diversionary tactic to maintain the deady grip of the industry over the American people in service to greed.
‘Course, most of the folks working in the industry are not themselves aware of it. That’s how evil systems work: they hide themselves from their participants. I was fascinated by an interview Bill Moyers had a while back with Wendell Potter, who left his successful career as head of Public Relations for Cigna–one of the nation’s largest health insurers–to speak out against the industry. (http://www.pbs.org/moyers/journal/07312009/profile.html) He enjoyed his work and joined with the rest of the industry in fighting off threats from the likes of Bill Clinton and Michael Moore because he believed his own myth about the best health care in the world. On a whim while visiting his father one weekend he drove over to a little nearby W. VA town to see their locally advertised ‘health fair’, expecting to see blood pressure stations and such as that. What he saw instead was a full-fledged medical/dental clinic using the horse stalls of the local fairgrounds as treatment rooms where plastic tarps kept out the rain in which people stood for hours waiting to get treated. His astonishment–’wait! this is America!’–led to the realization that he could no longer be part of that system, but had to oppose it. His bubble had burst, for as he said, ’til then he’d seen health care only in terms of dollar signs and profits and never in terms of human faces: ‘When yer gettin’ ready to talk to the investments firms, you’re not seein’ people but numbers.’ After awhile back at work, he could no longer see the numbers without the people, and that ended it for him.
Which leads me to the idea that perhaps we ought to pass a law that says that for every million after the first million in salary the big bucks guy’s gotta spend one week living and working among those who have to stand in the rain waiting for care in horse stables so he can catch the company jet home.
At least he’d meet Jesus.
Larry
