Health care

You can look at it from a sweeping national perspective or a personal I-just-need-my-blood-pressure-medicine perspective – either way our health care system needs to be reformed.

To get a glimpse of the big picture, spend a day in a busy emergency room. That’s what I do, one or two days a week as a social worker, and after six years, I am still amazed at how badly the system needs to be overhauled.

Yesterday during my shift at least half or two thirds of the patients we saw did not need to be in the emergency room. The toothache, rash, sore throat, cough or fever they came with could’ve been dealt with just as effectively – and a lot more affordably - at their family doctor’s office or some walk-in clinic somewhere.

A fair number of those people did try to get in to see their doctors, but were told there were no appointments available. A common end to that conversation is, if you think you’re really sick, “go to the emergency room.”

Another group of the people who really shouldn’t have been in the emergency room are folks without insurance who either can’t afford or don’t want to pay the co-pay doctors and walk-in clinics require up front. These “private pays,” as they are called, come to the ER because they know they will be seen without money up front. Some of them do, eventually, pay off their bill; most do not. And, since a large number of them have nothing for the hospital to take and/or no wage to be garnered, that is money lost – for the hospital, and ultimately, us tax payers, as well.

Why do hospitals see these people? Because they have to. There is a federal law requiring emergency rooms to see anyone who walks through the door, regardless of race, sex, age, nationality, chief complaint, insurance status or ability to pay. And, while ensuring that anyone who needs emergency care in our country gets it is a noble notion, the reality is a very expensive sinkhole of non-paid for, non-emergent care that is ever increasing because of rising health care costs and the bad economy.

A lot of people who used to have jobs and health insurance no longer do. Many of them have some medical condition, like high blood pressure or diabetes that requires basic care and a pill or two a day. Without insurance, even basic care is pretty expensive and without a job, paying for that pill or two a day can become nearly impossible. The result? After a month or two or more of going without health care and medicine, folks end up in the emergency room with sky high blood pressure or blood sugar so severely out of whack they can’t function.

Their lack of access to medical care and basic medicines results in a health crisis that becomes a legitimate emergency. Penny-wise, pound foolish – the whole system.

From a personal perspective, I only have one medical problem that requires medicine – high blood pressure. And, I only have to take one pill a day to keep it under control. But, when Mr. Clark was out of work and we had no insurance that became a pretty big deal.

Thankfully, I had the annual check-up just before Mr. Clark got laid off, so I didn’t have to pay the $150-$500 the office visit and blood work would’ve cost without insurance. Would I have had the check-up if I didn’t have insurance? Probably not; like some of those folks in the ER, I would’ve just stopped taking my medicine once the prescription ran out.

Paying for medicine once the insurance is gone is another challenge. The generic version of the pill I take costs $65-$120 per month. I know this because I called around. Finally I found a “mom ‘n pop shop” in Athens that sells my medicine for $14.90 per month. Had it not been for them, I would’ve ended up off my medicine for sure, because the $65-$120 the other pharmacies charge just wasn’t there. If there’s $50-$105 in profit wiggle room on one prescription, imagine how much room for reform there is in the whole system.

Because of my blood pressure, my doctor wants me to have an EKG and a chest x-ray each year. I waited to do that until Mr. Clark’s new insurance kicked in because my co-pay for both was only $20. My blood pressure shot right up, though, when I got my “explanation of benefits” statement from the insurance company and saw that if I didn’t have insurance, I would’ve been charged $583 for those two very routine tests. Apparently my insurance company was able to negotiate a rate of $154, so that’s what the hospital got paid. That $429 in profit wiggle room, again, seems like an awful lot.

There’s a lot of talk about how we can’t afford to reform our health care system; my question is, how can we afford not to?