Monday, July 13, 2009

Why is health care a problem?

Every politician, of no matter what stripe, regularly attends the Church of Health Care is a Problem which Must Be Solved in our Society, as regularly as they all used to attend the local Presbyterian church. One must pay lip service to The Need for Americans to Have Health Care, or be declared unfeeling--one who does not care about the least among us--a man, or woman, who regularly gouges out the eyes of newborn puppies for fun.

I know nothing about the ins and outs of health care, but Mr Charm and I have recently consumed more health care than we would have chosen to. Why does it cost so much money?

Let me give some anecdotal evidence. Mr Charm, while in a rehab getting in-patient therapy, had to have an MRI. I thought I would drive him down the street, approximately one mile away, to a perfectly good MRI facility. The rehab would not agree to this. He had to go by ambulance to a hospital 20 miles away. And I had to pay $175 for the privilege.

On another occasion, we wanted him to be seen by a specialist. This time, since he had a referral, Medicare would pay. He got dressed and got into a wheelchair. Since it was a nice day, we went to the entrance of the building to wait. When the ambulance came, however, the attendants refused to transport him because he was sitting up in a wheelchair. They would not be reimbursed, according to the paramedic, unless he were transferred directly from his bed to a stretcher. So they went away, and another ambulance service was called, and Mr C got back in bed. In due course, Ambulance B arrived and transported him.

All this, according to the nursing staff in the rehab, was dictated by Medicare. They might have been right or wrong. The rules are so many and so contradictory that no-one knows. All I know for certain is that I could have helped into and out of my car and he would have been no worse off.

Another point: whenever I went to have a procedure done at Valley Hospital in New Jersey, I was made to sign a statement that I had been informed that I could have the procedure even if I could not afford to pay for it. I took this to mean that the State of New Jersey, or the federal government, or at least somebody other than I would pay for it if I couldn't. Otherwise, why have me sign the thing? Oh yes, I forgot: If you go to the emergency room, at least in New Jersey, they have to treat you.

To me, it looks like all bases are covered. Am I missing something here?

Oh and by the way, dental care is not covered. So if you get a toothache, you're on your own. Unless your jaw gets infected, and then you can go to the emergency room, but only if you are transported in an ambulance, in a stretcher, lying down.

But when the government takes this over....


Ckemtp said...

Ahhh Medicare rules governing ambulance transports. I long for the good old days when they'd pay for things. You know, things like necessary care for patient's who needed necessary care. These days, Medicare and Medicaid exist as complex labrynths of paperwork and regulations designed to prevent them having to pay out a dime for the patients they cover. On the rare occasions where an ambulance service *does* happen to get it right, the pittance that they pay is a small percentage of what the true cost of the service was and it is usually paid months later.

As far as non-emergency stretcher transport goes (and as a ten-year Paramedic with expertise in the field, take my word) I don't know the rules either...

I do know that patients who are ambulatory (can walk) and have the ability to sit in a wheelchair are denied reimbursement for non-emergency ambulance transport unless there is a life or health threatening reason that they must be attended to by an EMT (or paramedic) on a stretcher. Otherwise they are to go by a wheelchair van (which is much cheaper). However, Medicaid does not pay for medivans.

Just wrote a post concerning this

miriam said...

It's good to hear your side of the story. Thanks or stopping by, and thanks for what you do for our society.