Every time I rub up against the American healthcare system I get a little more disappointed. And then the insurance company’s explanation of benefits comes and I get logarithmically more angry.
This morning, in preparation for open-heart surgery to repair or replace a valve, I was required to have a dental checkup. So, off I go to the University of Minnesota Physicians Dental Clinic. I try to avoid going more than once a year or so because it’s like trying to do business with the Keystone Kops. Last year, the question was whether or not to pull a tooth. The answer changed depending on the dentist and, apparently, the day. “That tooth’s got to come out.” “No, it just needs a deep cleaning.” I walked away from the Kops’ ping-pong match, still have the tooth; it’s no worse this year than last, and doesn’t hurt at all.
I was told to request the dental appointment for pre-open-heart surgery and that it was urgent. You’d think that “urgent” means pretty much the same thing to everyone in the healthcare field. Today I learned that’s not at all the case.
The dental assistant took x-rays and the dental resident did an exam. But the cleaning and a peek by the endodontist would have to wait a week. Just like last year, two visits for what should have easily been done in one. Who’s on first; what’s on second, but they made me sign an acknowledgment that they expect their co-pay up front.
After a quick lunch at home it was off to the cardiologist’s office for what I was told was to be a meeting about my coronary angiogram in two days. Turns out they want to draw blood for labs. But I’m a very difficult stick and needle-phobic (even after 11 years of dialysis with 14-gauge needles) and of course, it was no go. If they had bothered to communicate with the dialysis center, extra blood could have been drawn yesterday—prior to my dialysis treatment—for the cardiologist’s office. But no, because then they couldn’t have billed for it. Then it’s off to an exam room for yet another electrocardiogram—the third in about a month and the second in less than a week. Of course, all three providers get to bill separately for the procedure.
All of that, believe it or not, is tolerable. Or at least nearly so. Here’s what’s not.
Each provider wants insurance information, medicine allergies, and current medications. And they each want it separately. I carry it around on my iPhone, but each time a medical assistant enters the data there’s possibility of error. Each provider claims this information can’t be centralized and shared because of the Health Insurance Portability and Accountability Act (HIPPA) privacy rules. Fine. So, store the information centrally, in an open format, encrypted with public key cryptography, and allow the individual patient to unlock the information for each provider. Or, in the alternative, waive your co-payment, give me secure, authenticated remote access to your system, and let me enter my information myself. Something, anything other than multiple redundant error-prone systems.
Make no mistake: I have immense respect for the healthcare practitioners that provide my care. The American healthcare system works like clockwork in the event of a crisis. It’s amazing how all the parts mesh perfectly under pressure. But when the crisis has passed and the pressure is off, the wheels fall off.
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