Last week, I returned to Orange County, California, to visit my father for the first time since he was discharged from the nursing home where he was sent after being discharged from the hospital. He’s doing better overall, but we still have to fight to get him all the health care he needs.
As I’ve been saying all along, we’re just one of many stories of America’s broken health care system. So what the hell will we do to actually fix it?
What was in the denial?
As soon as I arrived at the house, my dad had a huge stack of letters and other mail waiting for me. It wasn’t my mail. It was his. However since he still struggles with his vision, he wanted me to help him read through it all.
It was overwhelmingly billing and approval/denial notices from his health insurance and his health care providers. Fortunately, the vast majority of the health insurance letters indicated approval for outpatient care. However there were a handful of denials, including denial of outpatient vision care at the third hospital where my dad had his heart surgery and treatment for his post-heart attack eye injury.
Keep in mind that I was reading these denial notices for him because he had a hard time seeing. And yet, he was still denied. His insurance is promising to “repeal and replace” with another optometry office “in network”, but he’s yet to receive any notice of a new optometrist waiting in the wings.
Why are we in denial?
As I explained last December, just because my dad has health insurance doesn’t mean it’s solved all his problems. As soon as the first hospital communicated with the insurance company, his insurance demanded that he be transferred to an “in network” hospital. Then after he was transferred from the second hospital to the third hospital for vision care, his insurance continued to insist that he be moved back to the second hospital for heart surgery.
Even when it was becoming increasingly obvious that the second hospital had no f–king clue what to do, his insurance continued to demand that my dad move back. It took his lead cardiologist and heart surgeon filing an insurance appeal detailing the medical need for immediate surgery in order for the insurance company to stand down and allow my dad to receive surgery at the third hospital.
In this light, I shouldn’t have been surprised that the insurance company would play hardball with my dad all over again as soon as he got home. Still, considering he has trouble seeing and continuing limitations in mobility, why are they picking this fight with him now?
We can’t deny this any more: This doesn’t “make health care great again”.
As we discussed in January, Americans already deal with rationed health care. The problem here is that our rations are mostly decided by insurance companies and institutions that seek to minimize costs and maximize profits.
America’s health care status quo marks a stark contrast to the U.K.’s National Health Service (NHS), where public officials manage the nation’s health care system and make rationing decisions on what’s best for patients and the overall public good. Our system even differs from standard operating procedure in other largely privately-run systems like The Netherlands’, where general practitioners (rather than insurance companies or other corporate entities) serve as “gatekeepers” to determine who needs specialized care.
As we discussed (again) earlier this week, President Donald Trump’s “great ideas” to “make health care great again” only threaten to worsen this already smoldering crisis. Even with the COVID-19 coronavirus killing 11 Americans and placing dozens more in harm’s way, Trump continues his counterproductive activities. And even though Congress looks set to reject Trump’s “great ideas”, such as cuts to Medicaid coverage, cuts to CDC funding, and wide-scale repeal of the Affordable Care Act (ACA, or Obamacare), $8 billion in “emergency aid” will probably only go so far to reverse the damage that’s already been done, let alone advance efforts to contain this viral infection.
We can’t deny that this is scary.
While I was with him last weekend, my dad did his best to go out and move around with his walker. And really, he’s making great progress in adapting to this new reality. And yet, he’s (very understandably) afraid of the future.
He worries he’s becoming permanently legally blind. While he can see some shapes and colors, he almost certainly can’t drive any more. And again, he needs help with daily tasks like reading the mail.
His health insurance occasionally sends nurses to do check-ups and physical therapists to help him improve his mobility. It’s certainly not nothing, but it also doesn’t address all his needs. It’s just another example of how priorities are so warped in our health care system.
We shouldn’t deny that we must do better.
Now that the first Nevadan has tested presumptively positive for COVID-19 coronavirus, it’s really hitting home. The danger we’ve been fearing for weeks is now closer than ever. And as we discussed on Tuesday, too many Nevadans are too afraid of the cost of health care, whether it’s a hospital bill or a doctor visit copay or even losing a paycheck over calling in sick.
Yes, we must keep washing our hands and taking other basic precautions. And yes, we need to realize that it will take way more than just plenty of thorough hand-washing to wash out the threat of greater harm from coronavirus.
We need to make health care more affordable and more accessible for everyone. Yes, that means everyone. Yes, that means we need to stop telling heart attack survivors that they must jump through a ton of insurance paperwork hoops in order to obtain the care they need. Yes, that means we need to start reassuring those at risk of contracting COVID-19 coronavirus that they won’t lose their job or go bankrupt if they seek the care they need.
I’m sick and tired of seeing this country so sick and tired. This status quo is unsustainable, and it shouldn’t take a worldwide viral infection to force us to acknowledge this awful reality. It also shouldn’t take my dad’s seemingly nonstop wrangling with the insurance company for us to take further action and finally do better for our people.