Medical Care and Bureaucracy

There are two things I know:

1) With a nation as wealthy and prosperous as the United States is supposed to be, all citizens of this nation should have access to affordable health care.

2) I would prefer the government have as little to do with providing that health care as possible.

Bureaucracy is supposed to be efficient, or so my husband tells me. Where he got that, I don't know, but as far as I can tell it only works that way in the text books. Thankfully, as far as I know, I will not be reading such a text book during my scholastic pursuits, because I'm pretty sure I would be a disruption to the class -- having real-world experience, and little self-control when being "taught" bald-faced lies.

Anyway, as many of my readers are aware, I have three children with special needs, and I have a tendency to highlight what that means on this blog. And it means a lot of different things.

One of the things that having children with special needs (paired with being poor) means in America, and especially in Wisconsin, is that we all have health insurance. As long as the boys have SSI, they will be insured. Which is good news, because medical care for children with special needs is expensive stuff. However, the problem with this is that the medical assistance we receive is determined through a very bureaucratic process.

Simply put, this is not a good thing.

My youngest child, who was approved for SSI despite his ambiguous diagnosis, does not talk. Well, that's not entirely true. He can say "baby," "bye," and "daddy" clearly. He can also count to ten, but you won't know it until you notice the very fixed pattern to it: "un" "poo" "pee" "por" "pi" "pih" "denen" "ay" "na" "tih." There's a smattering of other "words" that come and go. Sometimes we can discern meaning from them and other times we cannot. This has all happened within the last month or two, before that his sounds were limited to high-pitched happy noises and high-pitched un-happy noises. Sometimes even those two were indistinguishable from each other.

Ben received both speech and occupational therapy through the school system. But, it's summer and I elected not to send the boys to summer school, because, frankly, it's a rather traumatic experience for them to be in school, but have it be nothing like school, and have a different schedule on top of it. Melt-down city? No thank you.

Now, typically, they should still receive speech and occupational therapy through a private service provider. As the laws are written, they are entitled to that. Which is why the bureaucrats have to find very specific, miniscule, ridiculous flaws in the requests in order to refuse these services. Which they do over and over again. And not just to my children.

Now, I'm not going to get into the complex politics of all this. Suffice it to say, under Tommy Thompson's watch these services were covered; under Jim Doyle's watch they are not; and yet the laws governing these services have not changed. For those who don't already know, the D and the R are reversed from what you might expect. Basically, Thompson's the Republican and also the more "social medicine" progressive of the two. Oh, Doyle talks about it, but he doesn't fund it, because he's got too many of his own vote-buying pet projects in the works.

I digress: The problem with socialized medicine is that bureaucracy is like communism. While it may look good on paper, the reality of it is so close to evil that all it takes is removing the good intentions to push it over the edge. And even with the good intentions intact it doesn't actually work.

Part of how socialized medicine works, at least in this country, is by pressuring those medical professionals who wish to accept patients who receive such services to agree to being paid a rate that doesn't actually pay for their expenses. This creates two common situations. First, those practioners who are charitable enough (and they're few and far between) to specialize in medical care for the poor (meaning they accept only patients who have medical assistance and/or no medical coverage at all and are familiar with the red-tape involved in the bureaucratic process) need grants merely to keep their doors open. So they rely on bureaucracy in an exponential fashion. Second, both those who specialize in providing medical care for the poor, and those who are willing to accept medical assistance but also have other patients, have to compensate for the non-expense meeting payments by expediting their services.

In the business world, expediency is considered a good thing. In medical services expediency drastically reduces the quality of medical services. I don't say this to disparage the medical service providers. Most of them are exceptional people who are willingly taking a dramatic reduction in pay, compared to what they could receive in a private practice, and providing their services the best they can, because they care. However, the truth of the matter is expediency is detrimental to quality health care services.

Another difficulty is that the service providers are often not given the power to make decisions appropriate for their patients. The bureaucrats do that, and I guarantee they do NOT care, because they haven't the faintest idea who the people in question are, which is the way the government prefers it. In the world of the bureaucrats were all ambiguous name-less, face-less, humanity-less numerical codes. When a service is denied the person/people who make that decision never even see the person. Therefore, it is the clinician who has the awful job of looking their patient in the eye and saying the service was denied, often with no way to explain why. Having been denied numerous times, I can tell you it hurts them as much as it hurts me.

For example, I received the service denial for Ben's speech therapy and it was, as usual, written in legalese. Something was approved, but something else was denied. The service itself was not cited, just a code. So, I took the document to the service provider for an explanation. The therapist who had written the request was not there, but her boss was, so I took it to Sue.

I could see it in her eyes before she told me. Patiently, as if she'd done it many times before (as she had), she explained what the denial meant. The evaluation was approved, meaning the examination and testing that had already been performed in order to write up the request in the first place had been funded, but all other services had been denied. She then told me that most requests, irregardless of the merit, were being denied all across the state. A few were being approved, just to demonstrate that the state is acting in good faith; which, of course, it is not.

At the moment, blame is unimportant. That's not the point of this piece. The point is that when people advocate for socialized medicine in this country, it makes me shudder. Literally. Physically. Shudder. Because the truth is, when it comes to funding and actually providing the services promised, Wisconsin is a good state, even with Doyle at the helm. Many states do not even provide what Wisconsin does. Wisconsin is a leader in providing medical assistance to the poor in this nation. And that should give everyone who advocates for socialized medicine a moment of pause, because these same bureaucracies that control the medical assistance programs across the nation will be the same bureaucracies that control socialized medicine should it become a reality for us.

Which means weeks or months of waiting for non-life threatening services to be approved. It means service denials that make absolutely no sense in the real-world, because the decisions are made outside of the real world. It means that waiting a half-hour or longer for your five to ten minutes with the doctor will be the norm for everyone. It means that medical conditions will go undiagnosed for months or years, because your doctor simply does not have the time or resources to find out what is going wrong in your body...that is until your life is obviously threatened. It means that everyone will need to learn how to navigate the wonderful world of bureaucratic mayhem in order to get the medical services that they have been promised, but will probably never fully receive.

And yes, I've been told that all this can be fixed. I've also been told that all this will be fixed, and has been fixed, and doesn't really happen and a whole lot of other distortions that simply do not coincide with reality. The reality of bureaucracy is messy, expensive and inefficient. And entrusting your medical care to bureaucrats is not a good thing to advocate. And yet, I am grateful for the services we receive, and I completely understand why those who have no access to medical care would be willing to jump on this bandwagon. But, folks, really, there has to be a better way.

Socialism, no matter how fettered it may be, is not the solution to poorly fettered capitalism. A happy-medium must be reached; one that provides quality medical care, as well as affordable medical care, to all American citizens. While bureaucratic-controlled medical care may be better than no medical care, there should be a better solution. This is America, the land of opportunity and innovation. And, frankly, with our history, we should be smarter than this.