HealthCare and some real reasons it's so screwed up

It's a national topic right now. Health Care is spiralling out of control. Costs are rising faster than wages. A single visit can put some in bankruptcy.

What do we do about health care? What is even broken? Does anyone even know?

I loathe the thought of "more government". More government means more inefficiency. Being an engineer, I like things to be neat, clean, tidy, well oiled and operating smoothly. But the health care (including health insurance) is broken. Something has to be done. I'm not sure I have the answer as to "what". I can only offer my limited view through a recent transaction with the health care industry.

In April of 2009, I went into the hospital with what started out as a pimple inside my nose that ended up swelling up and ultimately spreading to my entire right and left ocular and nasal areas. I had a staph infection.

The first doctor I saw (on Tuesday around 2am) tried oral antibiotics with an prescribed topical anti-biotic. Either of those those had little effect on the infection. A couple days later (Thursday) the doctor in the ER decided to do an intra-venus infusion of vancomycin. This infusion would last in my system for about 24 hours and started showing results within hours.

Once that dose wore off about 24 hours later, the infection stagnated until I decided to go back on Saturday around 3-4pm. At this point, the same doctor that did the last round of vancomycin decided to do another, AND I would need to stay at the hospital until I was cured. After about 2hrs in the emergency room getting the first infusion, I was transfered to a semi-private room around 6-7pm. Interestingly, I was told I would be given a shot of Heprin which is an anti-coagulant because I was laying down so much. I was rather shocked and asked the nurse if I could just get up and walk around with my IV. He said that was fine.

On Sunday, I was given 2 more rounds of Vancomycin as well as 2 more of the tubules of Mupirocin ointment for my nose.

On Monday, my last infusion of Vacomycin was supposed to be around 3am. No wait, that's 7am. Maybe it was 9am. The nurses all told me something different. When it finally did happen around 9am, this was the first nurse to actually set up a bag of Vacomycin AND a bag of saline. I asked her why the change and she said it was because Vancomycin was harse on the veins and should be flushed with every infusion. REALLY? THIS was the first time this had happened. (Although the nurse in the ER did flush my line with a small syringe of saline before I went up to my room.) In any case, the IV started and after about 45minutes my elbow was starting to really hurt, so the IV had to come out. To the nurse's dismay, only the saline was turned on. The Vancomycin was never started. I actually was just about cured already. So there was a question of if I even needed this last round. It was decided to ask the doctor if the last round should still be administered. When the doctor finally stopped by, the answer was "no". Apparently, I had more Vancomycin in my system than the recommended theraputic levels. (In layman's terms, I was overdosed.)

So the last bag of Vancomycin was never administered. I was sent home.

All the insurance procedures took some time, but eventually I got a bill with a single line that said to pay this amount. I was warned about hospitals billing for unwarranted items, so I called the billing department to get an itemized bill. I was actually concerned they would charge me for the Heprin shots even though I refused them.

Instead, what I got was a real-life glimpse into the scam artistry they is the health care industry.

Handling Issues:

NO! (well sort of)

On Dec. 9th 2009, I called my insurance company, Unicare (who recently sent me information regarding their retraction from some markets in Illinois - i.e. they won't cover people in Illinois anymore as it's too expensive for them) and when I explained the situation to an agent, I was told they just have to pay those bills. It doesn't matter if hospital charges seem overpriced and out of control. I was told Unicare is "legally" (as quoted by the agent I spoke with) to pay those fees. She did show interest in the Vancomycin I never received and forwarded my request to speak with a supervisor. I have yet to hear from that person.

So my next step was to call my local congressional represetative's office and explain the situation to them. THAT seems to be what it takes these days.

Conclusion:

As typified by all the stories of old that trying to figure out a medical bill is like trying to decifer one's yearly tax return (even though that tax form is many more pages and comes with detailed instructions), medical bills seem to be purposefully designed with obscurity in mind.

Contacting a hospital's billing department yields numerous conversations with agents who are obviously outside of their skills. The insurance industry is designed to take your money put it in a pool and pay it out to hospitals according to computer coded programs designed to remove as many humans from the accounting process as possible. Health-Care providers know this and apparently bill out whatever they feel like even though no other industry would tolerate these kinds of charges.

As far as I can tell from my conversation with my insurance carrier, there's no longer any accountability. The insurance carriers blindly accept bills from hospitals and just pay them. I can't imagine it would take the hospital system long to figure out this is going on and just start jacking up the rates or including unreasonable fees. Reading in the news how the industry cries and whines about all the costs soaring out of control seems to be a problem of combined effort on the parts of hospitals and insurance carriers. How many times have we seen what a lack of accountability can do?

What we end up with is a system that simply spirals out of control resulting in the current national dilemma.

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