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Gary Horton: They got between me and my doctor

Full Speed to Port!

Posted: February 16, 2010 8:20 p.m.
Updated: February 17, 2010 4:55 a.m.
 
Here are some numbers for this column. Remember them, because we’re going to use them.

Early 50s. Thirteen thousand dollars a year. Seven years. Three-hundred-fifty-dollar MRI.

Every day we hear more noise and static about health care reform. The rightful are frightful of death panels and government bureaucrats “getting between them and their doctor.” Lefties feel the pain of 50 million Americans (and growing every day) who have no health insurance and are just frightful.

With news of Anthem Blue Cross raising rates in California up to 39 percent, it’s amazing we’re all not lined up outside the emergency room, red and blue alike, united in common heart attacks for the breathtaking acceleration of health insurance costs.

If rising rates like these don’t scare both the working man and employer alike, I don’t know what will get our nation off our dysfunctional dime.

We, the patients, watch in medically induced haze while our health care system bleeds us dry. Health care is nearing 18 percent of America’s GDP. That’s a huge tax on our income and productivity, and, left further unchecked, will leave us for dead in a globally competitive world.

At our company, Anthem Blue Cross attempted raising our group rates 14 percent this year, so we switched everyone to Health Net.

That one only went up 6 percent this year — but with higher deductibles and lesser benefits.

I have a Chamber of Commerce friend who’s got COBRA coverage that’s strangling him and his wife. But with a pre-existing condition, they can’t switch, and they’re eking it out until they hit the magic age for Medicare. Imagine it, a business-centered Republican grasping for the national health care for salvation.

I’ve got another friend who’s an elected official in the Santa Clarita Valley. This person has coverage with their agency, but the spouse does not — again due to a pre-existing condition. The spouse’s single rate increased from $360 to $500 this year. They just had a baby, too, and the bundle of joy added $600 to their monthly bill.

My friend said: “One hundred more in monthly insurance costs and we’ll have to bail out.” They’ll buy a catastrophic plan and otherwise pay out of pocket. This, in a family of two professionals.

So this is what we’re coming to. A nation of health care under-insured and beggars — buying time until we’re old enough for Medicare or cutting our coverage until there’s nearly no coverage at all.

It’s pathetic, and we mock ourselves in front of the universal-coverage industrialized world.

Let’s get back to those numbers from the top of the column: I’m in my early 50s and am in good health. For seven years I’ve had an off-and-on again pinched hip. I pay $13,000 per year for our PPO insurance. And my doctor requested a $350 MRI from Health Net.

Their answer: “Nope.” Not until you go through stupid hoops. First, you’ve got to get a standard X-ray that won’t show anything.

First, you’ve got to take steroids and Vicodin. First, you’ve got to wait eight weeks. Then, maybe you get the $350 MRI.

My doctor thinks it’s pretty funny our insurance company wants to treat the disease before they’ve properly diagnosed the problem.

I think my insurance company thinks if I take enough of their Vicodin I’ll forget about the MRI.

Last week I got the letter from Health Net’s department of denials, officially informing me they got between my doctor and me. The letter had a photocopied signature from a doctor I don’t know denying my doctor’s MRI request.

My bet is, behind the photocopied signature there’s some kid in a cubicle earning $10 per hour to turn down claims.

So, just like Republicans warned, someone got between my doctor and me. Only it wasn’t the government, it was my own insurance company. Republicans fear government health care bureaucrats, but right here, right now, $10-an-hour cubicle dwellers tell our doctors how to practice medicine.

And if it’s not the ten-buck kid “getting between” — it will be insurance rates themselves. Not affording health insurance is the biggest “get between you and your doctor” of all. Thirty-percent-rate increases will keep us far, far separated from the doctor’s office.

So you still don’t think America needs health care reform, and fast? You still don’t think health insurance companies need competition and regulation?

Wait until it’s your turn with the ten-buck-an-hour claims denier, or wait until you get the 30 percent rate increase. If you’re not with Democrats on this yet, you’ll be joining us soon.

Gary Horton lives in Valencia. His column reflects his own views and not necessarily those of The Signal. “Full Speed to Port!” appears Wednesdays in The Signal.

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