A Battle

Yesterday I saw first hand what a quagmire our health care system has become. This year during election while politicians debated health care reform I chafed believing this issue was primarily relevant to the uninsured in the same way that I believe the immigration debate is the primary concern of those who are here in our country illegally. Jess and I pay a considerable portion of our income towards health care and this year due to JAC we were able to put our coverage to the test. Unfortunately the results have been very disappointing. Yesterday Aetna - our insurance provider send me an explanation of bills it would be paying. As I read down the list marvelling at how expensive it is to have a kid I noticed a charge for almost three thousand dollars that Aetna was refusing to pay. I thought this was odd and the bill was not itemized so I was unsure what the charge was for. I called Aetna and after a long wait they explained that it was a charge for the delivery room they were refusing to pay. When I inquired why they explained there was a pre-arranged agreement with the hospital that they could only charge a certain amount for delivery room and the hospital had exceeded this amount resulting in Aetna refusing to pay even a portion of the bill. They also added that since the hospital had over charged I was now responsible for the entire bill for the delivery room and they would be paying nothing. When I asked how much the hospital was supposed to charge they could not give me an answer.

This whole incident has left me a bit sick to my stomach and I have started doing some research on the subject. In the past I felt the faults in our health care system were by the uninsured and now I believe it is about a complete lack of efficiency and predatory insurance companies. With the population aging this has come to a head and sparked great debate. One of the most interesting debates concerns Comparative Effectiveness Research (CER). The research simply studies a variety of treatments to determine which were most effective and recommends doctors use these treatments. For instance a 2006 study found that new schizophrenia drugs were no more effective than older ones but much more expensive. This research is spurred on by widespread disparity in the current system. For example rates of coronary bi-pass are five times higher in McAllen Texas than Pueblo Colorado. Do more patients have heart trouble in Texas or do more doctors simply recommend bi-pass as a solution.? The president allotted 1 billion to these studies in the stimulus package and naysayers are already up in arms. There is a fear that these studies are only a first step to the government dictating who gets what care. Would the government deny your 95 year old grandma a knee replacement simply because the operation is too costly to perform on a patient who will likely only live a few more years? I am unsure what the correct answer is to reforming our health care but today I feel like a victim of the process. I am angry and want something better.