The other day I ran across an article in the Atlantic Monthly that perfectly illustrates something that seems could happen only in America. I literally had to shake my head.
writer, Olga Khazan, explains how the convoluted American insurance-based
health care system is rife with pitfalls even for folks who have what is
normally considered adequate insurance. For someone like me, who doesn’t have
to deal with this sort of thing, it was an eye-opening read.
main thrust of Khazan’s story was that fully covered Americans can still face unexpected
medical bills, hassles with hospitals, and legal tussles with their insurers,
all due to the byzantine nature of the American system.
of the cases Khazan cites involves a Texas woman with a history of heart
disease who began to have chest pains one day. When she and her husband became
alarmed enough to seek medical help, they first shopped around. Finns reading
this might be puzzled, but that is exactly what the couple did. They used a
smart-phone app provided by their health insurance company to find a local health-care provider that would accept the woman’s insurance.
is the approach reportedly advocated by some health-care experts and
high-profile conservatives. Jeb Bush, the stealth GOP candidate for president,
recently touted the “there’s an app for that” approach as the optimal
alternative to Obamacare. The thinking is that what works best is a completely
market-based system, where choosing medical treatment, even emergency
treatment, is just like any other consumer choice – just like finding the shampoo
or deodorant that suits you best.
the help of her phone app, the woman in Texas settled on a particular “stand-alone”
emergency room, not a hospital, to treat her chest pain. Stand-alone ERs didn’t
exist when I still lived in the US, and I’m sure we don’t have them here in
Finland. I recall seeing one in a shopping center in my hometown on one of my more
recent visits to Georgia. It’s like a branch of a bank, a smaller facility conveniently
located for suburbanites. As such, I guess it’s not a bad idea, but they seem
to share some of the unfortunate business practices of much larger facilities.
for the woman in Texas, there was nothing wrong with her heart, as was borne out by
an EKG and some blood tests. Her visit to the stand-alone ER was short, but it
came with a hefty price tag. When totaled, the bill came to $4600 (€4100),
which seems staggering enough to me. Only half of that was for any kind of
medical procedure (for example, the EKG was $300). The other half ($2258, or €2030)
was just for the use of the ER itself, “facility fees” similar to those charged
by full-fledged hospitals.
her insurance covered most of the invoice, she was still on the hook for $500,
which she was evidently able to reduce by negotiating a lower sum with the bill
collection agency (hired by the ER to get its money).
Apparently, when you’re
sick in America, it helps to be a persistent haggler, as well as a smart
story Khazan shared in her article involves a Dallas man who suffered two strokes
within a period of six months. The hospitals he was taken to in both cases were
“in-network” for his insurance plan, meaning they had existing agreements to
accept the man’s insurance. There was no worries about whether his treatment would
be covered. Or, so he thought.
individual doctors working in American hospitals often can charge separately
for the care they provide to the hospital’s patients. And, they don’t have to
necessarily accept the same insurance plans accepted by the hospital itself.
This appears to be why the Dallas stroke victim received completely unexpected
bills for “out-of-network” care not
covered by his insurance. Three years later, the man is still in the midst of taking
legal action over the extra charges.
heard of many stories similar to these. For many people, coming home from the
hospital is often just the beginning of the next hardship to overcome, a protracted
fight with insurance companies and bill collectors.
very idea of this way of doing things seems alien to me after living so long in
a country with a completely different approach to health care. Perhaps the best
way to show what I mean by this is through a little example of my own.
years ago, I experienced a very minor health scare. Normally, I don’t like to
share such personal (and let’s face it, trivial) details, but I’m trying to
make a point here.
was a Monday in July. I had just had an ocular migraine, in which your vision
is temporarily obscured by shimmering “lights”. This in itself was no big deal.
I have these ever so often. It’s not painful, but you essentially lose much of your
vision for a few minutes due to something happening inside your brain.
time, however, immediately after the migraine subsided, my left arm went completely
numb and I had some pain in my chest. I was not even able to lift my arm above my
head. That had never happened before, though in the past I have had occasional numbness
in my arms due to pinched nerves.
was sufficiently freaked out by this combination of events that I decided to
see a doctor right away.
didn’t shop around first, but I did need to make a call to decide where to go. The
default choice would be the Paloheinä Tervyskeskus, the city-run health-care center closest
to my home (about a mile away). Paloheinä is closed in July, however, when many services are scaled down in mid-summer when Helsinki almost turns into a ghost town, so I called a central health-service number
to find out which other nearby clinics were operating. I was directed to go to Maunula, less than three miles away. I know the place well, since that's where I usually see the dentist.
I got there, a nurse checked me out and did an EKG, which showed nothing
alarming. As it was near closing time, she asked me to come back the next day,
a Tuesday, for blood work. On that second visit, she performed a second EKG
(which seemed a bit unnecessary, to be honest). No change from the day before.
Wednesday, I got a phone call from a doctor at Maunula with the results of my
blood test. Nothing to worry about there, either. Still, he wanted to see me
and booked a time for me the next afternoon. When we met, he explained that whatever
had caused my symptoms, it wasn’t heart-related (a relief) and was most likely
due to the kind of neck problems I had needed surgery to correct back in 2005. Thinking that this previous condition might have again deteriorated, he made an appointment for
me with a neurosurgeon at Meilahti Hospital.
six weeks later, I had an MRI done at the hospital. People who have undergone
this procedure know that patients often have choice of music to listen to while
encased in the incredibly noisy MRI machine. As it was a Sunday afternoon, I
asked the technician to tune the sound system’s radio to Yle Mondo, which I
knew at that time of day would be broadcasting National Public Radio from the US. Lying
inside that huge machine, in a space the size of a coffin surrounded by
powerful magnetic fields, I listened to the familiar soothing voice of Garrison
Keillor on “Prairie Home Companion”. That is how I like to spend my Sunday
consultation with the neurosurgeon a few days later was short and sweet – no
drastic changes showed up in the MRI. Nothing to worry about, and in fact, a
similar episode of sudden numbness has not occurred since. Knock on wood.
few weeks after all this happened, the bills started rolling in. The first was
for the visits to the Maunula clinic. It was €13.80. The next, from the
hospital where I’d had the MRI and neurosurgeon consultation, was almost double
that, €27.50. The total came to €31.30 (about $40 at the time).
two bills were basically office fees, comparable in some sense to the
2000-dollar-charge levied on the Texas woman for her brief visit to the
stand-alone ER. For the EKGs, blood tests, doctor consultations, even the MRI,
I was charged nothing. Zilch. This is what we pay taxes for.
back to my own experience on that July day, the differences to the American
system could not be more glaring.
didn’t have to shop around for the health center that would take my insurance. It’s a moot point. I don’t
have insurance. I don’t need insurance.
didn’t have to worry about sticker shock from unexpected bills because some of the
professionals providing me care don’t accept my particular insurance plan. As
said, I don’t have insurance. Don’t need it.
didn’t have to haggle with an insurance company or collection agency to get my unexpected
out-of-pocket fees reduced. There would be no insurance company to haggle with
anyway, and besides 30 euros was something I could manage to pay without undue
be sure, it is possible to buy health insurance in Finland, and there are
private health-care providers here for folks who prefer that and are willing to pay the higher costs.
Most people I know don’t use them, unless paid for by their employers. Most
Finns I know usually use the public, single-payer system.
it happens, the US Supreme Court is set to make a ruling any day now that could
be a major blow to many Americans who finally have health insurance thanks
to what Republicans, out of ignorance or naked ideology, love to call "socialized" medicine (a.k.a. Obamacare). It's not, not by a long shot.
though Obamacare is an improvement over what came before it -- and I do hope that the nine justices leave it untouched -- it’s good to remember
that many liberals consider it, in reality, to be a half-assed compromise that
relies on keeping the private insurance industry intact.
I’m sure many of us
would have wished that in 2010 Congress had instead enacted a single-payer system
like Finland has. I'd like to think most Americans, if they actually thought it through, would prefer the same.
maybe they just prefer making things really, really difficult.