Health Care Minus the Stress

ROUGEMONT -- Imagine a health care plan that would allow you to go to any doctor in the country. Imagine it would pay for any specialist care as long as you got a referral from a GP, including psychiatric treatment. For the regular doctor's visit you'd pay $2, for specialists, nothing. Hospitalization would be free. Any treatment deemed appropriate by your specialist would be covered, from toenail surgery to the most advanced cancer treatments.

Imagine this system also had a network of specialized baby care centers with highly qualified nurses who would visit your home, provide advice, administer all the necessary immunizations and do regular checkups at the centers.

For all this you would pay a flat 1.5 percent of your income.

That's the plan I had, back in the 1980s, when I lived in Australia. It has changed a little since then (I believe the levy has gone up to 1.8 percent) but it remains intact. Not a month goes by that I don't miss it.

I was missing it in particular last week after my latest run-in with my latest health care plan. Folks who want to change the way health care is delivered in this country usually focus on the big disasters: life-saving coverage denied, people bankrupted by medical bills, lives lost. That's appropriate.

But what often gets lost is the constant stress caused by smaller problems. Like last week.

My plan covers, among other things, an annual physical for each child. One of my kids wanted to try out for the soccer team. She needed a physical to do this. Great, I thought. I'll just get that physical done. I made the appointment, she went in and had the exam and a week later I got a piece of paper from United Healthcare saying I owed $65 and that the exam wasn't covered. I called the customer service number and was informed that the plan covers routine physicals, not, the lady explained, school physicals.

What's the difference? No idea. I guess my daughter must have let it slip that she was trying out for the soccer team, leading the doc to list it as a school physical. As far as I was concerned, it was just a physical, period.

So now here I am, 60-odd bucks out of pocket, no recourse.

The thing is, this is not unusual, as I'm sure most of you know. I'd say that, over the course of a year, at least a third of the medical treatments my family needs are denied the first time around. Either the insurance company has changed its computer system (this led to six months' worth of hassles last year) or the hospital has filed the wrong form (as happened when one of my kids needed attention in the emergency room) or -- sometimes there's just no reason.

I've gotten threatening letters from specialists who haven't been paid for procedures that were supposed to be covered (and eventually, after nine months of hassling, were in fact paid for by the insurer). But worst of all, I've had to spend hours on the phone with different company bureaucrats, fighting for what I and my employer have already paid for.

Most weeks my laundry doesn't even get folded. So I don't have any extra time to spend on hold while trying to pry the benefits I'm entitled to out of a faceless Customer Service operative.

That's just my time. Then there's also the person at every doctor's office who now works full-time just dealing with insurers, and the benefits person at my work who does the same. All this in the interests (supposedly) of cutting costs. It's madness.

Why do we put up with it?

Why are we the only country in the civilized world to have such a lunatic system? Why do the world's most educated consumers allow themselves to be so humiliatingly, and sometimes dangerously, fleeced when it comes to the most important service they buy?

Because the insurance companies and their supporters -- and many doctors -- have managed to raise the specter of Socialized Medicine every time anyone comes up with a sane alternative.

I point you to the Australian example. It's not perfect. But no one gets denied treatment they really need, no matter how poor they are, no matter whether they're self-employed or not, no matter how old they are.

Yes, if you need surgery, you may end up sharing a hospital room and you may not be able to choose your surgeon. However, if you want that privilege, you can buy top-up insurance that will allow you to stay in a fancy private hospital and have the doc of your choice for less than $2,000 a year.

You're thinking that such generosity must be expensive -- just leaving it up to the doctor and the patient to determine what treatment is needed. Maybe you're also thinking the care isn't as good as it is here. Think again. Australian medicine is first-rate. (Many of the in-vitro techniques now used here, for example, were pioneered in Australia.) And that country spends a smaller percentage of its Gross Domestic Product on medical expenditures than we do.

It's clear why this is. The whole cost-cutting exercise here, combined with the proliferation of competing systems, has spawned an army of bureaucrats at insurance companies, doctors offices and workplaces, and those folks have to be paid. Every time someone checks out whether you need an MRI, it probably costs as much for their time as it would to have the procedure in the first place. Or close.

I vote for Socialized Medicine. And I still can't understand exactly why I'm in the minority.