The Severed Cortex

Link: http://www.amazon.com/Sick-Untold-Americas-Health-Crisis/dp/B0013L8B6U/ref=pd_bbs_1?ie=UTF8&s=books&qid=1220374231&sr=8-1

It's tough to read when you have vertigo and can't focus your eyes well. I didn't think I'd miss it all that much but I did. I started reading another tome before I noticed that Nancy had this one and was going to return it to the library. Since I work in health care (indirectly via I.T.) I thought I should read it. Let's just say it was somewhat mind opening. When I went to work for a behavioral health insurance company I felt much better about myself, thinking of course that I was helping people get the services they need. At least I thought it was much better than leasing truck trailers. Yes, you can say that leasing trailers to companies who get products to consumers 'just in time' is a vital cog in the American transportation and distribution system, but it wasn't a direct link to helping people like my current job is. And now that I've read this book I have to question whether I am doing more harm than good, especially since my team is integral in reporting and mining huge chunks of data looking for correlations, trends, and inefficiencies. While I like to believe that some of those inefficiencies are solved by us finding better ways to proactively treat patients, and I know for a fact they are, there are also many facts uncovered that ultimately limit the amount of treatment an insurance company is willing to pay for. Although not a big surprise to those of us in the business, one of well known 800 pound gorillas in the room is that a large percentage of the health care dollars are being spent by a significantly small number of patients. While I understand that from the point of view of the insurance company that they want to avoid those patients, I never really thought what the implications of avoiding, or foisting off, those patients would be. This book points out some of those things.
Sick is basically a compilation of true life stories of the people who fall through the cracks of our health care system. There are a lot of cracks and believe it or not those cracks also include those who actually are insured. As it turns out, every one of us is vulnerable to becoming financially insolvent due to one serious health scare. I definitely counted myself in the group that believed everyone has access to health care regardless of income level. That is true to a certain extent. No hospital will turn down a patient. They have an obligation to treat whoever reaches their door. What happens before those people get to the doors, and what happens after they leave, if they do leave, are the parts that I did not think about that thoroughly. If someone like me who has an understanding of the health care system can gloss over the effects of what we are doing today, I guarantee your average person does too. I tested this on one of my friends and he was equally surprised to learn that one serious health risk in his family may result in him living in a van down by the river.
Look, I understand that the author cherry picks the stories for the book, and I definitely understand that telling the sob stories of those less fortunate pulls at the heartstrings and manipulates people. There isn't a single story in here praising the health care system and the good it has done people, and you shouldn't be fooled by the stories in this book. There are probably hundreds of stories where the American health care system has saved someone. Medicine in America is some of the finest in the world despite the fact we are ranked near the bottom of developed countries in terms of providing health care for our citizens. Not the quality of the care mind you, which is typically very good, but the quality of care compared to how many people are actually receiving it. That's really the crux of this book. Those who have employer based insurance, or even government backed insurance like Medicare or Medicaid, receive excellent care. That is, as long as you don't get too sick. If you get too sick, insurance companies don't want you because you are breaking the bank. That's why there are limits on the amount of coverage you actually get. Read your policy very closely. A lot of times it's not the surgical procedure that's the issue. Instead it's the post operative rehabilitative care or the pharmaceuticals associated with maintaining a patient with a high quality of life that cost the most. And when you reach that limit, you are cut off. From that point it's a steep precipice downhill.
First of all, if you can find alternate coverage it will be unbelievably cost prohibitive. That's if you can find it. Don't have a pre-existing condition though. If you do, you're completely hosed. So, when people don't have access to health care or don't have the money for health care they do what normal people would do in those situations. They cut corners on their health care. Which, of course, means that their health deteriorates to the point where they have no choice but to see a health care professional. Normally this is for a treatable illness, but because it has been put off so long it becomes an illness that is past the point of treatable. Which puts the person in expensive long term care that they cannot afford to pay. Or worse, dead, as was the case with several examples in this book. (Part of why they can't pay is because the rates for the uninsured are typically 4 times higher than the negotiated rates a managed care or HMO can agree on with providers). The hospitals then are left to pass that non-payment on to you and I in the form of higher health insurance premiums. It's a vicious cycle and with fewer employers offering health care insurance to their workers it doesn't take long to see that we are circling the drain.
Most of the people in this book played by the rules. They had jobs. Most had jobs that included health insurance. The ones who didn't have health insurance were small business owners or entrepreneurs. They are the kind of people that are normally rewarded for their ingenuity, ambition, and drive to succeed. I remember when we used to put people on a pedestal for creating jobs for themselves and others. All it takes is one illness to tear it all down. That's the scary part about it. If you or I have health insurance and we, god forbid, contract some long term disease, the prognosis for recovery is dim. Medical recovery might be fine, but economic recovery is spotty at best. First your insurance runs out, but you won't qualify for a government program. You'll have to sell your assets and blow through that money first before you'll be considered indigent and eligible for government health care. Truly it takes living in a van down by the river for you to get some health care in this country and that's a sad fact.
The book doesn't have any answers either. Universal health care is not necessarily the answer. Perhaps the German system, a hybrid government/private insurance model is the best the world has to offer. One thing is for sure. The system we have will not last much longer. Perhaps the collapse of it is the only thing that will fix it. I just hope I don't get sick while they are trying to fix it.