Our Role in Our Health Care

Dealing with insurance companies can be troublesome, aggravating and the American public loves to tell the horror stories that come with having an HMO. My S.O. is like so many others with a story to tell. About 10 years ago my S.O. was in a horrific motorcycle accident. He suffered broken bones, first degree burns and a piece of metal pierced one of his feet. Within hours he was transferred from Concord Hospital to the nearest burn unit in Boston. After his hospital stay and while still recovering at home, he found himself at odds with his insurance company. First they denied his claim, telling him he had gone outside the "network" for his treatment. When he explained that he had gone to the closest burn unit, the insurance company held up the claim while they conducted research to confirm my S.O.'s explanation. Next they contacted him to find out if they could file a claim against the motorcycle company. They tried to talk my S.O. into admitting some sort of fault with the motorcycle and going along with them in suing the company. Being a mechanic by trade as well as someone who is disgusted with the sue-happy nature of our culture, my S.O. refused to comply. He explained that the motorcycle was well beyond any warranty time period and parts on a machine, any machine, will eventually wear out and/or corrode. It was an accident, plain and simple. Eventually, the insurance company paid the bill.

However, I must admit that my S.O. does not always use his best judgment when it comes to his health insurance. In the six years I have known him, he has suffered kidney stones on two occasions. Both times he drove himself to the emergency room, only to be referred to a urologist on an urgent basis. Both times he grumbled and complained about the long wait in the emergency room and the bills that came later. He just can't seem to get it through his head that if he had called his primary care doctor first, he may have been referred directly to the urologist, thus avoiding the emergency room visit and cost of using it altogether. Somehow he has the impression that he will receive quicker results by sitting in the waiting room of the ER than by having his primary care doctor send him to the specialist right off. At this point, he has become well established enough with the specialist that he probably could just call them directly himself. Being involved in the medical field, I have tried to explain this to him, but he still believes for some reason he will receive better, quicker care by going through the emergency room.

My S.O. is not the only one who uses the emergency room in this way. Emergency rooms are often overflowing with people who don't really need to be there. On New Year's day two years ago my S.O. and I made yet another trip to the emergency room. During my move from my apartment to his house, he suffered an accident in which two of his fingers were badly sliced open, nearly severing one. Although the waiting room was full, the nurse attending to my S.O. commented that he was the first real emergency she had seen all day. Concord Hospital opened up a clinic at the Horseshoe Pond complex where they try to encourage most people to go for "urgent care". This is their attempt to ease the burden of non-emergent patients on the emergency room facility.

Health care and insurance for health care are a hot issue. The system needs fixing. Chances are there isn't a single person in this country who would argue otherwise, including me. However, the problem isn't entirely the health care system, some of the blame falls squarely on the shoulders of the people who use it. We have become a nation that expects immediate, expert care with little or no cost. We refuse to play by the rules and insist that cheap, expert care is our God given right. Where else in this country can you expect, nay demand, immediate, expert service than tell the person providing that service that we left all our money, credit cards, check books and debit cards at home? (Try getting a burger or a roll of toilet paper with that line and see how far you get.) Our office encounters this everyday, even though we make it very clear with signage and verbal confirmation that payment is due at time of service. Even the people with insurance who come to our office knowing they have to pay a copay will stand in front of our signs and request we bill them for the $10 or $20 they owe. There are people who will come into a doctor's office stating that the doctor "has to see me". They may not be holding a gun to the head of the doctor, but the implied threat of malpractice is as effective.

It is the same reason so many people use the emergency rooms in hospitals. They count on the fact that they can't be turned away. Showing up there means they will be seen eventually, no matter their ability or inclination to pay. With the system set up as it is presently, they will get what they demand, but who ends up footing the bill? Hospitals, doctors and drug companies are expected to operate at the highest level of innovation, expertise, and customer service, but nobody wants to pay for it. We want insurance companies to pay the bill, but also refuse to pay for that insurance. We don't seem to have a problem paying for insurance on our big screen TV's and expensive SUV's, but we will grumble to no end about health care insurance. Young, healthy individuals are even less likely to pay for health insurance. It is not until they fall ill or have an accident that they will see the need, and than they face the issue called "pre-existing condition".

Our office also encounters clients on a daily basis who are paying for insurance, but have no idea what company they are dealing with, what their obligations are in terms of coverage and copays, and don't even bother to carry the card with them. The kicker is these same people become irate with our staff for not knowing either. It's like getting mad at the local radio station because they can't tell you how to set the radio in your car, rather than taking the time to look in the manual or asking the salesman who sold you the car. These people are paying for (and complaining about) a service that they don't even take the time to research and learn how to use.

All the while we continue to complain about health care. We complain that insurance companies have become unreasonable. We complain that the government isn't doing enough to "fix" the problems. We complain about drug companies and doctors charging too much. These complaints are well publicized and valid. However, while we demand every doctor, nurse, hospital, clinic, rehab and nursing home facility, drug company, pharmacist, politician, and insurance company take responsibility for our quality of health care, we refuse to take on any responsibility ourselves. We won't establish ourselves with a regular doctor. We complain about or outright refuse to pay a portion of the bill. We continue to practice bad habits detrimental to our health and against doctor's orders (ie: smoking, unhealthy eating, not protecting ourselves when involved in dangerous activities). And we threaten to sue if our demands aren't met or perfection not attained.

Should a hospital be sued because someone needing emergency care is overlooked due to a department that is over run with people who don't need to be there in the first place? I would be horrified to think that my visit to an emergency room for sniffles or a belly ache took away from the time and attention needed for someone who couldn't breath or were bleeding to death. Yet it happens everyday in every hospital in this country and so often we use the battle cry "I was here first" or "my time is important too" or "it's my right to be here". It is no different than an ambulance that can't get around cars that refuse to pull over for them. Who's to blame? Should it be the town for not having better control over traffic flow; the ambulance company for not being more assertive in their driving; or should the person mucking up the system hold some sort of responsibility too?

Yes, the system needs fixing, but some of the fixing needs to come from the people using the system. We are as responsible for our health care as the doctors, insurance companies and drug companies we depend on. We need to prioritize our needs. Is paying for a coffee from a fancy coffee shop everyday more important than paying for our health insurance? The $6 we pay daily to buy junky, fast food lunches add up to an extra $30 a week we could spend on staying healthy. Is buying a big screen TV with HD really that much more important than paying a hospital bill? If the priority is the big screen TV, than who are we to complain about the quality of our health care?

For years I struggled to make ends meet as a single parent often working two jobs just to keep up with the cost of living and the needs of my children. One of the things I decided was less important was going to a dentist. I hadn't been to a dentist in roughly 20 years when I finally felt financially able to do so a year ago. It was my choice to make my teeth a low priority. I am now paying for the years of neglect, and some of my teeth cannot be saved, but I don't complain. I find a way to pay the price and make no excuses for having made the choices I made. During those same years I did pay for health insurance and made sure I stayed healthy for my children's sake. I would do the same thing again. Perhaps our general health is a bit more important than our dental health (although my half-sister who lost a son to an infection that began in an abscessed tooth may beg to differ), but I don't understand why it is that the American public can't learn to prioritize, and take responsibility for the decisions and choices they make.

I am not saying there aren't people who need help getting insurance or health care. I know from my own experience that there are people who have to make the choice between a weeks worth of groceries and paying to see a doctor. I am not talking about these circumstances in this blog. There most definitely is a need and I am 100% behind the drive to improve our health care system and make it accessible to everyone. However, it is a far more complex issue than just asking our government to regulate and fix it. Quality, reasonably priced health care will require deep, drastic changes on many levels, including the expectations we as a society place on that system.