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Updated Thursday, October 22, 2009 11:29 AM

What I want out of healthcare reform

As the healthcare debate chugs on through the halls of Congress, I've been thinking about how this affects me.

Yes, that's a selfish look at national politics, but that's how most of us tend to look at things, how do they affect me.

Until I had knee surgery two years ago, I didn't really think about healthcare too much, which I imagine, is like a lot of people my age. The only time I go to the doctor is when I'm sick, and then I want something to make whatever's bothering me go away -- and if you've got something to make me feel better while that's happening -- I'll take a prescription for that, too.

During my preparation for knee surgery, I learned something I didn't want to know, that insurance companies don't have my welfare as their primary concern. My doctor sat me down and told me he would need $600 prior to surgery because that was the amount needed to reach my deductible.

This part I understand. The next part of the conversation I didn't understand, but over time it became very clear.

Then, my doctor told me the insurance company was going to deny my claim. I asked him why, and he said because your insurance company always does, and it will probably happen twice.

He was right. And they worked very hard, in my opinion, to prove that my knee was a pre-existing condition, even making me go back to former employers in order to document continuous insurance coverage, and list doctors that treated me in the past.

My surgery took place in November, and my doctor didn't get his check until March -- four months he had to do without money he'd earned because the insurance company was trying very hard not to pay.

It's not an uncommon problem in the medical industry. I talked to one doctor who is a general practitioner, who has a line of credit with the bank so he can make sure his staff gets paid because, he says, insurance companies have a habit of waiting until the 58th or 59th day of a state-mandated waiting period to deny a claim, so the insurance company can buy another 60 days it doesn't have to pay the doctor's office for a claim.

I'm sure that line of credit comes with interest payments, that help increase what he has to charge to make a living.

After dealing with my mother, who is on Medicare, I'm wondering why can't I have health insurance like that?

She doesn't pay a copay at the doctor's office. Prescriptions cost $4, and she hasn't been denied any care, and she's had two life-threatening illnesses. From what I've seen, her care has been wonderful.

She pays a monthly premium, but still gets her choice of physicians. There hasn't been any "death panels" or bureaucrats telling her what she can and cannot have. As far as the payments go, according to what she is sent, charges sent in are generally paid out the next month.

So you all will have to forgive me if I laugh when I see retired people protesting to get the government out of healthcare. It's not like there are a lot of private insurance companies lining up to insure senior citizens.

In my mother's case, Medicare has been there when she's needed it, and it's shown me that a public option for healthcare could be a good thing. Maybe it will give private insurance companies the wake-up call they need to change the current healthcare landscape.



Comments ... 2 found!

Helth care : 11/5/2009
It is sad that so much money is made from human misery. There is no bigger sin but we have to come to tolerate it. Sad indeed ! Then again, go to Walmart and it is the same issue. Our products are inexpensive because someone else works hard to produce them for miniscule wages !

Das

I realize this is heresy in these parts... : 10/22/2009
But I agree with the author. I don't think it is anyone's preference that the government get more involved in healthcare but the fact is, the private sector has failed. We spend far more on healthcare than any other country per capita, and our infant mortality rate is on par with Cuba's. If nothing changes, the costs will just keep going up, taking more and more money out of our wallets. The funny thing is, the government is already involved in healthcare. It provides tax breaks to employers for subsidizing their employees' health plans and, as Todd mentioned, Medicare. I bet if people paid the true cost of insurance (i.e., sans subsidies from their employer), there wouldn't even be a debate. Furthermore, I wonder who anti-healthcare reform folks think foots the bill for all of the uninsured in our emergency rooms. It isn't the insurance companies or the hospitals. It's you and me, the people with insurance. Think about that the next time you see a hundred dollar Tylenol on your hospital bill.

Concerned citizen
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