In the theatrical musical version of Peter Pan, Peter leads the Neverland children in a song about (not) growing up. Toward the end of the song, Peter and the kids sing “We won’t grow up! We will never grow a day! And if someone tries to make us…we will simply run away.”
That strikes me as not wildly different from the attitudes of many Americans about “health care.” Although, it’s not about “health care” as such, it’s about billing: who will pay for doctor visits, hospital visits, and medications. I suffered through a local professional association meeting not long ago and had to listen to a state senator talk about how his foremost goal legislatively is to assure “access” to “health care” for all in the State of Washington. He also let slip that Washington State is the “most highly leveraged” state in the Union for “health care.” Then he went on to bemoan that the State of Washington doesn’t have its own printing press to make money like the federal government does.
If you will allow me to do what some might call a “pirate translation” of the above, let me suggest that Washington State – I usually call it The People’s Republic of Washington State – borrows more money per capita than any other state in the Union, from a federal government $37+ trillion in debt, to pay for doctor visits, hospital visits, and medications for whoever asks. The state bureaucracy to oversee this is paid for by ever-increasing taxes on the state population.
“Access” is not the correct word. Payment is the correct word. Well, actually, freedom from payment is the correct term.
Sometimes I hear a soon-to-become-former patient of mine – occasionally an already-former patient of mine – tell me how they hate it, but they can’t come to see me any more since I don’t take their insurance. No, that’s incorrect. I assure you, you can come see me. But, because your insurance is a big pain in the neck for a single-doctor office like mine, I will not do the paperwork and take the discounts that they require to get any pay for my work. In fact, I will be happy to see you in my office. But, you will need to tell us how you will be paying for the visit.
To add some perspective to that, my independent one-doctor office has one-and-one-half full time people primarily billing insurance companies. Although three or four companies are involved, the majority of people in the State of Washington have some form of insurance through the State via one of those companies. That is, people who would never admit to this openly or even to themselves, are essentially on welfare with the State of Washington borrowing, keeping their insurance payments lower than they should be.
Which brings me back to Peter Pan.
I don’t have any particularly embarrassing instances to share, but I have some vague recollections of my mother saying “Grow up!” after an errant behavior of mine. A great deal of growing up means you are taking responsibility for yourself and your actions. Does that include paying your way? If you are paying your way, you need to know how much something costs. When you are on welfare, that becomes irrelevant.
Ben Carson famously suggested his remedy for the “health care crisis” in 2013 at the National Prayer Breakfast. It took 43 seconds to deliver:
“We’ve already started down the path to solving one of the other big problems, health care. We need to have good health care for everybody. It’s the most important thing that a person can have. Money means nothing. Titles mean nothing when you don’t have your health. But we’ve got to figure out efficient ways to do it. We spend a lot of money on health care, twice as much per capita as anybody else in the world, and yet not very efficient. What can we do?
Here’s my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account [HSA] to which money can be contributed, pre-tax, from the time you are born to the time you die. When you die, you can pass it on to your family members so that when you’re 85 years old and you’ve got six diseases, you’re not trying to spend up everything. You’re happy to pass it on. There’s nobody talking about death panels. That’s number one.
And, also, you know for the people who are indigent, who don’t have any money, we can make contributions to their HSA each month, because we already have this huge pot of money. Instead of sending it to some bureaucracy, let’s put it into their HSAs. Now they have some control over their own health care.”
Because I live in the forward-thinking State of Washington, I had to wait years after HSAs were available in other states because HSAs didn’t fit the vision of the anointed politicians in Washington State. When they were finally available, my insurance broker told me I was too old – HSAs are for 20-year-olds to contribute to for years. So, I bought one anyway, and am still using the proceeds, even though we went through some lean business years where my contributions weren’t great. I would still be contributing, but I fell for Medicare’s threat that if I didn’t choose to join Medicare now, I would be fined in the future. I should’ve called the insurance guy before I signed up for Medicare – well, that would be the same guy who told me I was too old, I guess.
After falling for Medicare’s lie, I could no longer contribute to my HSA. Then I learned that my HSA was one of the allowed alternatives to Medicare. Too late. No going back. It’s government, after all. I was now on Medicare. Period.
Ben Carson said contribute until you die. That makes too much sense for Medicare currently. What I contributed pre-Medicare is all there is in the pot. In Ben Carson’s view, and in my view, I should still be allowed to contribute to my HSA. Every dollar I put in there is a dollar somebody else doesn’t have to pay for my medical care. I still have a few thousand dollars to use – as I wish – for healthcare things, and I know the price I pay each time. The biggest expense was some hearing aids. I started to lose a little sensitivity in my right ear, the side toward my patients. So, I jumped early on that to make sure I was prepared – with no out-of-pocket cost.
If Americans do manage to grow up and take responsibility for their medical care, it’s possible (probably not likely, says my dark side) that some of the things in our office lives might change for my staff and me.
First example: there are probably some Americans who think that the government knows the rules of how health care should be delivered. Let me disabuse you of that notion with the story of how Erica, my clinic manager and chief biller, straightened out the State of Washington on their rules.
A few years ago I got a call from our state professional association liaison, the association’s liaison to the State of Washington health care authority. He told me that state Medicaid was unhappy with how we were billing Medicaid for a service that the state didn’t pay for and absolutely wouldn’t pay for. They were getting lots of bills from us which were causing problems with people in Olympia because they had to deny each and every statement from us for what was acknowledged as a non-covered service. Why send the bills that we knew were going to be denied?
Fortunately, Erica heard the gist of the phone conversation, raised a finger and said “Wait one minute.” She ran and got the State of Washington healthcare billing instructions, turned to a page she had marked, and had me read a paragraph to the liaison. The paragraph said, in paraphrase, that if someone was on State insurance (Medicaid/welfare) and we were recommending a service that was not covered by the state, we had to submit a bill and get a denial of payment from the state before we could offer the service to the welfare recipient on a private-pay basis. Commonly, the patient or parents would appeal to extended family for help. What is family for, anyway? But, the state had to say “no,” before we could offer a non-covered service to the patient even if they had said they wanted that service, were willing to pay for that service, and we were willing to deliver that service.
The liaison asked for the page number and paragraph (since he also was clueless on the subject) and said “I’ll get back to you.”
Two weeks later I got the follow-up call. I’m told that I was laughing so loudly that adjacent offices wondered if we were back in the sonic boom days of the late ‘50s and early ‘60s. The liaison told me the lady in the welfare health authority office who had complained took the issue all the way to the State Legal Division office at the capitol to get her way, whereupon the State Legal Division authority looked at her and said “No, THEY’RE right.”
It was still a stupid way to do business – having to get a governmental “no” before people could choose to stand on their own two feet financially. But, the point is the people who make these rules don’t understand the rules they make. And, they have no conception or ability to care about our time, effort and costs in a stupid paperwork loop. It’s sort of institutional sloth complicated by individual arrested development, located in a tax-funded office at the state capitol.
The second example of something that could potentially improve with a change to HSAs happened just a few Sundays ago. I got a call on my cell phone from a patient who was seeing some signs that could mean a retina problem. I told her the emergency room probably has a retina specialist on call, but “take a lunch” if you go to the ER. She replied that she always ended up worse from an ER visit, so I agreed to see her before our usual opening time on Monday, which I did.
This was in December. Some time in November, her insurance had changed to not cover this type of visit…without telling everyone that. Or, at least without telling providers in bold print about the change rather than in paragraph 12 page 42 of some insurance missive. As I finished my exam and escorted the patient out, Erica, who had arrived and immediately hit the computer, informed me that the insurance had changed abruptly, so we couldn’t bill for my time (or my liability exposure). Another “sigh” moment that we label “church work” then try to not openly show anger in front of the patient.
Does anyone else notice the irony in these two situations? I get a call on a Sunday, don’t know the coverages like Erica does (that’s her job, after all), and I get to eat my fees for trying to help someone. A state worker doesn’t know the rules in her own department, steals my time, steals Erica’s time, and steals the liaison’s time. She gets corrected, but keeps her job with no additional costs to her. If it weren’t for double standards, we’d have no standards at all.
Frustration does sort of ooze out. It is absolutely the norm that we are supposed to somehow know all the coverages of all people who come into our office and by law let them walk when we’re late in finding out what the patient never bothered to know. Wrong information from the patient is our fault, right?
After this latest event, Erica and I discussed things and changed our phone message for when people call during non-business hours. Instead of giving them my cell number so they can talk with me, it now says if you have an emergency, go to the emergency room. It doesn’t include my sage advice to pack a lunch.
Here’s the deal in a nutshell: The day of the family doctor is gone. You are going to be referred to the ER over the weekend. Just go there. Save everyone the phone call. The part that you need to start to understand is that it’s your fault – the fault of the people of the United States. You sat and watched as people lied to you about “health care” savings and keeping your doctor. As Thomas Sowell said, who ever thought that when we don’t have enough money to pay for doctor fees, hospital fees, and medications that we do have the money to pay for doctor fees, hospital fees, medications, and a [slothful] government bureaucracy on top of it all? It’s your fault.
If you get a chance to grow up and take control of your “health care” by understanding costs and paying for things in some form, like what happens with a Health Savings Account, you might just seriously consider that. You also could suggest to someone on the federal level that you’ve grown up and want to take some control of your “health care.” At that point, we’ll all celebrate you stepping into adulthood.
You might not ever again be allowed in the Kids’ chorus for Peter Pan, though. Sorry.
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