Friday, July 17, 2015

Would Government-Run Be Any Better?

Before I begin, let me state categorically that the answer to my title question is an emphatic no.  But that doesn't mean that my health provider experience this morning isn't as silly as it could be.

Since returning from Europe I've had coughing bouts that are violent enough to make me dizzy and weak afterward.  This morning I finally broke down and called an advice nurse, who after a series of questions and answers instructed me to see a doctor today.

So I called my primary care physician.  It's apparently been two years since I've been in to see my doctor, and in that time my doctor moved and I have a new doctor.  But I can't be seen today because I "haven't established care with my doctor".  So I have to pay twice my co-payment and go to an urgent care facility.

I know the nurse didn't create the policy, but how stupid is that policy?  She said I should go to urgent care today, and she could make a follow-up appointment for me next week to "establish care" with my doctor.  I asked what the point of that would be, if the urgent care facility can take care of my issues?  She said it would be "follow-up".

The reason I couldn't be seen today was that the doctors were busy and "none of the doctors know [me]".  What the heck does that have to do with anything?  None of the urgent care doctors know me, either, but they'll be able to see me, and on a walk-in basis.

I should have just asked for the earliest possible appointment with a doctor so I can "establish care".  In fact, I think I'll go call them back and do just that.

It's crazy to me to think that I'm being penalized because I've been healthy for over two years!  What is this, Catch 22?  I can't see my doctor until I see my doctor!

Before all the socialized medicine fanatics point and cry out "See?  See?" I'll point out that I can be seen by an MD today, and at a cost less than that of a dinner for two.  So no, confiscatory tax rates to pay for socialized medicine are not a good trade-off in my book, and there would be no guarantee under a government-run program that I'd be able to see anyone today.

But while the market is better than government at providing services, let's not fetishize the market and pretend that it's ideal.  Been in "sardine class" on an airliner lately?  No, the market doesn't always provide perfect service, but it does incentivize people to do so.  Government absolutely does not.

Update:  OK, so I called back and asked for the earliest appointment with my doctor.  Smart move!  My doctor's first available appointment is August 20th.   But when I spoke to the nurse before, she said to go to urgent care today and to make a follow-up appointment next week to "establish care".  The nurse I just spoke to was incredulous that I wouldn't want the August 20th appointment; I have to "establish care" sometime, right?  I told her that I anticipate being healthy by August 20th and see no need to make a medically-unnecessary appointment with a doctor just so that I might be able to see a doctor more easily in the future, if need be.  She didn't seem to understand my reasoning.

There must be some reason for such an absurd policy, but I certainly can't figure out what it is.

August 20th.  That sounds like an answer I'd get from Britain's NHS or Canada's health care system!

Update #2, 7/20/15: Let's read about the cost of Canada's wait times:
One measure of the privately borne cost of wait times is the value of time that is lost while waiting for treatment. Valuing only hours lost during the average work week, the estimated cost of waiting for care in Canada for patients who were in the queue in 2014 was $1.2 billion. This works out to an average of about $1,289 for each of the estimated 937,345 Canadians waiting for treatment in 2014.

This is a conservative estimate that places no intrinsic value on the time individuals spend waiting in a reduced capacity outside of the work week. Valuing all hours of the week, including evenings and weekends but excluding eight hours of sleep per night, would increase the estimated cost of waiting to almost $3.7 billion, or about $3,929 per person.

This estimate only counts costs that are borne by the individual waiting for treatment. The costs of care provided by family members (the time spent caring for the individual waiting for treatment) and their lost productivity due to difficulty or mental anguish are not valued in this estimate. Moreover, non-monetary medical costs, such as increased risk of mortality or adverse events that result directly from long delays for treatment, are not included in this estimate.
Private Cost of Public Queues 2015 - Infographic


Jean said...

You actually should go, and I'll tell you why because I just did this.

I have been very very healthy for the past, oh, 6 years or so. So I didn't go see my doctor. It turns out there's a CA law (a silly one, clearly) that they have to drop you if they don't see you for 3 years. So I was dropped, and I only recently got around to re-establishing myself as a patient--I did that appointment and all. It's all CA law stuff. So now I have a doctor again and I can go see him anytime. For the past couple of years, since I got dropped, I've gone to the prompt care clinic once or twice for booster shots, but it would have been cheaper and less waiting time if I'd had my doctor. So I think it's worth doing even though it's a hassle.

I'm pretty sure if you don't go within the next year, you'll get dropped and have to get established all over again--and maybe the doc you want won't be taking patients by then. You have an in now, so I'd do it.

Darren said...

A law, huh? I can only imagine why California feels the need to inject itself into who's a patient and who's not--especially when my insurance premium gets paid every month.

MikeAT said...

California....veto proof Democratic majority. Need I say more.

Ellen K said...

I can seldom get to my doctor on the day of my problem I have issues with recurring allergies that crop up when specific pollen is in the air. Going three weeks later doesn't help. So I go to CVS or some other in network urgent care place where they make me pay over $150 for a fifteen minute consultation and give me the same antibiotics and antihistamine and steroid spray they have given me for ten years. My GP griped at me because I have had my age 50 colonoscopy. That was because while the procedure itself is covered, any medical issue they find is not. I can't afford the $1200 copay I would be stuck with thanks to the doubling of my deductible with the advent of Obamacare. Never mind all the other tests my doctor wants. I can't afford a bone scan. The scary part is like most teachers my insurance runs from Sept to Sept. As we get closer to the end of the summer it will be less likely I can get to the doctor since every other teacher is trying to do that for their own family. What is more, the meetings we usually have in May to reveal the new higher cost of insurance were deferred until the first week of classes. The board-very unexpectedly-passed a 2% raise across the board. What do you want to bet that signals a 5% increase in premiums for teachers?

Auntie Ann said...

It all would have been even easier, if California allowed real retail clinics. In other states, you could walk into a Walgreens or CVS or Costco and get seen by a Nurse Practitioner or a Physician's Assistant, pay cash and be on your way. In CA you can probably get vaccines and your blood pressure tested at your drug store, but in other states you can get treated for (this is Walgreens' list):

Allergies (seasonal)
Bladder and urinary tract infections
nausea & vomiting
Ear ache & ear infections
Ear wax removal
Headaches & migraines
Joint pain
Minor back pain
Mononucleosis (Mono)
Pink eye and styes
Sinus infections
Sore throat & strep throat
STD Evaluation & Testing
Swimmer's ear
Upper respiratory infections
Minor Injuries
Burns (minor)
Corneal (eye) abrasions
Minor cut & wound closure with skin adhesive
Splinter removal
Sprains & strains
Skin Conditions
Head lice
Mouth & cold sores
Poison ivy
poison oak & poison sumac
Skin infections & irritations
Skin tag removal
Tick/insect bites & stings

Darren said...

Walmart tried years ago to install such clinics. No go.

Ellen K said...

@AuntiAnn Texas has allowed clinics at CVS, Walmart and Walgreens for a few years. There are pros and cons. The positive parts are that it's nearby, it's cheaper than urgent care and for small things you can usually get the appropriate care. The drawbacks are that even with online reservation, you always wait. If you have a virus or cold, so does everyone else. Waiting areas are usually minimal, although our new one at Walgreens has actual seating and such. I've had good care and bad care at these types of clinics. One time they sent me to another clinic for follow up which was unnecessary and I disputed the charges. Let's face it, our medical care has become somewhat of a guessing game. I swear half the time the doctor wants me to diagnose myself. The other half of the time they're so plugged in to their computers that I can't get them to listen to me. As my generation ages, this is going to be a bigger problem. This has become such an issue that Johns Hopkins makes medical school students take Art History to learn how to look at someone and make an assessment rather than relying on a screen.