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Sunday, July 23, 2006

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.

35 Comments:

At 7/23/2006 12:56 PM, Blogger David Schantz said...

The idea of the government getting involved in my medical care frightens me. I do agree that something needs to be fixed, but where do you start?

God Bless America, God Save The Republic.

 
At 7/23/2006 8:48 PM, Anonymous And Another Thing said...

During my time in Ireland I of course had to avail of health care. I had a private physician; private insurance, etc., just like here. However, I also paid taxes out the wazoo (like here) and the biggest difference was that no one lived in fear of losing their homes and retirement with a serious illness.

It was a mixture of private/public and worked quite well. Nothing is perfect, and the healtcare situtation here leaves a lot to be desired.

The powers-that-be know an improvement could be made, but there is a lot of money being made right now so there is no incentive to change what is.

Government in and of itself doesn't frighten me. It's who the government holds allegience to that scares me. Right now it is to use its power to enrich the rich, health of citizens be damned.

 
At 7/24/2006 1:51 AM, Blogger Stephanie said...

David,

Where do we start is a good question and one I'm not readily prepared to answer. I think somebody needs to look into why medical care is so expensive here and is not nearly as expensive elsewhere (and the quality certainly isn't it). We're told that it's because of medical lawsuits, but I doubt that's the whole of it. If medical staff weren't always in a rush, that in itself would make mistakes less frequent, which would make insurance prices go down.

My guess is medical care, either through the bureaucracy of the providers, or through the bureaucracy of the insurers, is top-heavy and thus the price goes up. I also think that less attention is spent on care that prevents or diagnosises and treats conditions early, when less needs to be done and the overall care is cheaper.

But, those are only steps to reduce the cost of insurance. There is an experiment going on, I believe in Mass., which will require businesses to provide insurance for all employees, or pay extra taxes for the state to do it. I don't know if I like the sound of that, but if the experiment works...

 
At 7/24/2006 1:56 AM, Blogger Stephanie said...

And Another Thing,

A mixture of private/public sounds like the only way to really solve the problem. I know of no other viable solution. But, still, it depends on how it is arranged as to how well it works.

No system will be perfect. I know that. However, a system that relies on non-medically trained people to make medical decisions is something that worries me. And in America, at least, that happens whether you have state-funded medical assistance or are insured by private HMOs. I'm not saying service providers should be able to do anything they want, and have it funded. But a well-reasoned explanation of why, the benefits, and what current/future problem it solved shouldn't be able to be denied by somebody who is not medically trained.

Having worked in an HMO, I know the process of approving and denying services is pretty arbitrary and is often determined first by data entry clerks, and only if something is flagged is it considered by somebody who might understand the medical jargon.

 
At 7/24/2006 5:11 AM, Anonymous Anonymous said...

I would start by cutting off state and federal funding and letting people take care of their own kids.

Especially people who keep having kids that they need government assistance to take care of.

walking around wanting other people to pay your way is certainly not conservative leaning in my book.

 
At 7/24/2006 7:38 AM, Blogger historymike said...

I think that the federal government should take the Medicaid/Medicare monies and simply allow the unisured to get health care through private insurers.

Some states have begun to experiment with this, and it is much less expensive than a massive bureacracy with state-run insurance schemes.

This way you get the public commonwealth angle working through the more efficient private sector insurance industry.

And, while I agree with the sentiment that people should be responsible, we don't live in such a world, anonymous.

Personally, I don't want to live in a country in which children can be tossed aside just because they had idiot parents.

 
At 7/25/2006 5:48 PM, Blogger Stephanie said...

Anonymous,

I re-read my post and do not see anywhere where I suggested my position is conservative leaning. In fact, I say frequently that when it comes to economics I take the traditional liberal position, and take the traditional conservative position when it comes to social issues. But even that is a gross generalization of my politics.

As for me, personally, I don't want others to pay my way. I'm working hard to get out from under the system. But, then again, that would be something you would know had you bothered to get to know me before passing off your judgement, and you didn't even bother to leave your name let alone have a clue.

 
At 7/25/2006 6:09 PM, Blogger Stephanie said...

Historymike,

"I think that the federal government should take the Medicaid/Medicare monies and simply allow the unisured to get health care through private insurers."

Wisconsin does something like that with it's Badgercare program (which Doyle has recently announced his intention to make available to all Wisconsin children). You have a few HMOs to choose from, depending on your area. And while it may limit the bureaucracy to a certain extent, it doesn't eliminate it altogether. There's still a lot of medical bureaucracy in Wisconsin. Which is what I often have to deal with.

The benefit of not being in the HMOs (due to receiving the SSI insurance) is that the boys can go to almost any doctor irregardless of their affiliation, which means I do not have to keep going back to the same doctor who initially told us to institutionalize Willy. But, instead, we have to deal with the public bureaucracy instead of the private system.

 
At 7/25/2006 6:10 PM, Blogger Stephanie said...

As I said, I don't know of any good solutions, but I'm familiar with a whole lot of snarly problems.

 
At 7/26/2006 9:55 AM, Blogger reverse_vampyr said...

It makes me sad when ANY American pushes for socialism. I would think that people could see how it's a failed system. But then again, I would also think that common sense is something everyone has. And I'd be wrong on both counts.

I'm sorry you have to deal with the government bureaucracy. I wouldn't wish that on my enemies.

Hey, wait a tic. There's an idea! We take the Islamic terrorists we've got in Guantanamo and put them on government healthcare, then send 'em to the DMV....

 
At 7/26/2006 5:24 PM, Blogger Praguetwin said...

When I ran nubers on this, the English spent a smaller percentage of a much smaller budget on admnistration. The American's spend about 10%, which is high.

 
At 7/26/2006 11:17 PM, Blogger Stephanie said...

R_V,

LOL! Yeah, but I'm pretty sure that'd fall under "cruel and unusual punishment."

 
At 7/26/2006 11:18 PM, Blogger Stephanie said...

PT,

While I've never run numbers on it, I would sure believe it. Just comparing how much office space we have to some of the pictures of buildings I've seen elsewhere is impressive.

 
At 8/04/2006 2:01 AM, Blogger Caduceus said...

You're situation sounds rough. Here are some words for thought.

http://houseofcaduceus.blogspot.com/

 
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