Up Close and Personal about Health Insurance

Horror stories about American healthcare are rampant, so I thought I’d check in with the personal experience I’ve had, living these past thirty years in Prague, Czech Republic. The CR is a tiny country of 12 million residents, a nation that is only now recovering from 40 years spent behind the Iron Curtain.

For comparison, a news item from today’s paper about Russell Cook’s treatment in America

Russ’s daughter, Frankie, is a junior in high school and she wrecked the family car on wet roads. The car was pretty much totaled but Frankie was okay but for being knocked around a bit. After picking her up at the scene, her dad decided to stop by an urgent care center near their house to get her checked out. Good dads do that sort of thing.

(NPR) "'We don't take third-party insurance,'" Russell, says the receptionist at Atrium Health Floyd Urgent Care Rome told him, though he wasn't sure what she meant. "She told me, like, three times."

The problem didn't seem to be that the clinic lacked the medical expertise to evaluate Frankie, and the family does have good health insurance. But, when injuries are the result of accidents, another insurer, such as auto or home, may be primarily responsible for the medical bills. Health insurance, if it's on the hook at all, may kick in only after the other insurer pays.

Who knew?

U.S. health insurance is mostly about not being on the hook

Russell was told to take Frankie to an emergency room, which by law must see all patients regardless of such issues. The nearest one, at Atrium Health Floyd Medical Center, was about a mile down the road and was owned by the same hospital system as the urgent care center.

There, Russell says, a doctor looked Frankie over "for just a few minutes," did precautionary CT scans of her head and body, and sent her home with advice to "take some Tylenol" and rest.

Long story short—and I’m sure you’re not surprised—a $17,005 bill for services arrived. These stories are so common I’ll refrain from piling on others for dramatic effect.

So, here’s my experience in the little old Czech Republic

We have national health insurance here and I pay $100 a month for my part, which you’ll agree isn’t bad for a guy 87 years old. A few years back, during a regular checkup, my doctor noticed a lump on my neck just below my left ear. A needle-biopsy showed it was benign, but he suggested surgery because it lay directly over a complex of nerves on that side of my face. I thought that made sense and a time was set.

What followed was general anesthesia, five hours of micro-surgery, five days recovery in hospital, including all meals and nursing care (two person room, but no one in the other bed). The hospital was spotless, newly remodeled and all equipment up-to-date. The surgeon, considering that a mere nick of a nerve would have facial repercussions, was obviously highly skilled and he checked on me each of the five days recovery.

At the end I was handed a bill for 35 crowns ($1.50) and there’s a story behind that as well.  The 35 crown ‘surcharge’ on all medical visits was instituted a number of years ago to discourage oldsters from dreaming up symptoms to visit their doctor simply because they were lonely.

The darker problem behind American healthcare and Russell Cook’s outrageous bill

The American system is as profit based as a capitalist consumer society could make it and that has circumstances attached to it. Those caveats all seem to have fingers and, while caveats are not supposed to have such human attributes as fingers, they all point elsewhere when a victim (called patients in more civilized countries) looks for answers. American healthcare is much like Churchill’s description of Russia—“a riddle wrapped in a mystery inside an enigma.”

And it’s that way on purpose.

The end result of that enigma is that health insurers have entire floors of employees who are tasked with maximizing the charges for every item in care from bandages to cat-scans, as well as making sure those charges are listed on the invoice whether or not the service was actually provided. Additional floors are tasked with disallowing treatment for any possible hint of a pre-existing condition. It seems they are blissfully (and profitably) unaware that life itself is a pre-existing condition.

So where does this leave us?

The United States spends twice as much per capita as any other advanced nation in the world ($12,000 compared to $5,700) and yet ranks last in access to care, administrative efficiency, equity, and health care outcomes, according to an analysis by the nonprofit Commonwealth Fund. I’m not going to beat you to death with examples, but I am interested in what all that means.

1)    A little over 26 million Americans have no health insurance at all. Emergency rooms are no answer. An emergency room won’t treat cancer, heart conditions, childhood diseases or diabetes, so if you’re poor your or your kids simply decline until you are dead.
2)    If your company insures you and you lose your job for any reason, you and your family are at risk.
3)    Should you get lucky and find another job that provides healthcare, their insurer can choose not to insure you for any previous problems such as a mild heart attack or diabetes. That goes for your wife and kids as well.
4)    If you are presently employed by a company that covers you and you’re offered a primo job elsewhere at a big salary jump, you dare not leave because the healthcare jungle awaits and it’s full of lions and tigers and bears.
5)    530,000 families in America suffer bankruptcies each year that are linked to illness or medical bills.

But universal healthcare is socialism and we are not Russia

Yeah well, we’ve already got public schools to grade twelve, highways, bridges, national parks, Social Security, Medicare, prisons, courts and subsidies to farmers, ranchers, oil companies and who knows what else? When you call 911 to report a burglar or your house on fire, do you expect someone to come to your aid?

We are already a socialist country and if America had the outstanding health care I get in the Czech Republic, we could have it for a hundred bucks a month.