Wednesday, May 4, 2011

How Health Care Works

With all the talk about health care in this country, it would be helpful to get an understanding of how health care actually works from a qualified expert.  In the absence of such an expert, however, this will have to do.

When a person (hereinafter known as a patient) has some kind of problem, such as a pain in the whatsit, he or she goes to the doctor (hereinafter doctor.)  More precisely, the patient goes to the doctor's office, a large sterile environment decorated with early 20th century magazines.  Here the patient has the opportunity to pay an exorbitant fee (hereinafter co-pay) and take a seat.  After waiting the requisite 59 minutes (longer if there's a paid parking lot), the patient is escorted into another sterile room, called the examining room.  The patient is asked to undress and then wait another 59 minutes in his or her underwear (hereinafter skivvies.)

Eventually, the doctor enters the examining room and performs a thorough physical examination, sometimes lasting up to 90 seconds.  The doctor jots down some indecipherable notes, and dispatches the patient back to the front desk to a) pay another fee, b) schedule another appointment, and/or c) get instructions for using some prescribed drugs or equipment such as a framistat.

The doctor has had extensive training for this.  He or she has been through at least 4 years of medical school following college, and has also undergone 3 or more years of residency, during which he or she has been required to work long and erratic hours, treat actual patients, and have a series of torrid but ultimately unsatisfying affairs with other residents, interns and people with medical sounding titles.  (This is all vividly documented on Gray's Anatomy.)

Despite these apparently ample qualifications, however, the doctor's judgement is ultimately subject to review by the health insurance company (hereinafter bloodsuckers.)  The insurance company designates a medical claims specialist to review the case.  The specialist underwent rigorous college training majoring in Basque Literature, which enables him or her to divine all the pertinent facts about the patient's condition from a few three-letter codes on a claim form.  Based on this detailed analysis, the specialist can determine a) that the condition could be treated with a whoosiejigger instead of a framistat, and the whoosiejigger is 1/10 the cost, b) that the patient has not yet met the annual deductible of $16 million, so the whoosiejigger will be paid out of pocket, and c) that the patient's premiums should increase due to the cost of processing the claim.

2 comments:

jonwilson said...

This a rather intriguing article. You wrote this for people who've never been to the hospital, I suppose?

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Peter Davis said...

Thanks, Jon.

Healthcare keeps changing in the U.S., as brilliant innovators find ever newer and more ingenious ways to charge for basic services. So this overview should help even experienced patients.