Monday, January 03, 2011

Health Care Reform Explained

One of the great legislative triumphs (and I use the word advisedly) of the recent past was President Obama's overhaul of the nation's health care system. It was a resounding success, offering something for everyone: Republicans love it because it gives them something on which to focus their hatred of the administration, Democrats hate it because it doesn't provide free health care for everyone, insurance companies love it because it forces everyone to buy insurance, lawyers love it because it offers exciting new vistas for lucrative litigation, pharmaceutical companies love it because they can sell more drugs, lobbyists love it because it gives them endless opportunities to make money lobbying both for and against, and Real People trying to get well are baffled by the whole thing.

If you, Dear Reader, are one of those folks being intellectually whipsawed by "experts" on both sides of the argument, and have to decide whether to eat, pay your mortgage, or buy the health care you need, here are a few frequently-asked questions and answers that will help you make sense of the whole thing:

What does HMO stand for?

This is actually a variation of the phrase, "Hey, Moe!" Its roots go back to a concept pioneered by Doctor Moe Howard, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes. Modern practice replaces the physical finger poke with hi-tech equivalents such as voice mail and referral slips, but the result remains the same.

Do all diagnostic procedures require pre-certification?

No. Only those you need.

I just joined a new HMO. Can I choose the doctor I want?

Of course! Your insurer will provide you with a book listing all the doctors who were participating in the plan at the time the information was gathered. These doctors basically fall into two categories: those who are no longer accepting new patients, and those who will see you but are no longer part of the plan. Fortunately, the new law requires the remaining doctor who is still in the plan and accepting new patients to have an office no more than a half day's drive from the nearest town named for a Nobel Prize-winning Czech agronomist.

What is a "pre-existing condition?"

A grammatically elegant obfuscation used by insurance companies to designate things they don't want to pay for.

Can I get coverage for my pre-existing conditions?

Certainly, as long as they don't require any treatment.

What happens if I want to try alternative forms of medicine?

You'll need to find alternative forms of payment.

My prescription drug plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomach ache. What should I do?

Poke yourself in the eye.

I have an 80/20 plan with a $200 deductible and a $2,000 yearly cap. My insurer reimbursed the doctor for my out-patient surgery, but I'd already paid my bill. What should I do?

You have two choices: ask your doctor to sign the reimbursement check over to you, or wait until death from old age intervenes while you wait for the doctor to deposit the check, wait for it to clear, write you a new check (less processing fees), and deliver it by the slowest possible method.

What should I do if I get sick while traveling?

Try sitting in a different part of the bus.

No, I mean what if I'm away from home and I get sick?

You really shouldn't do that, because you'll have a hard time seeing your primary care physician. It's best to wait until you return, and then get sick.

I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his office?

It's difficult to say, but considering that all you're risking is the $550 co-pay, there's no harm in letting him take a shot at it.

What accounts for the largest portion of health care costs?

It's a tie between doctors trying to recoup their investment losses and lawyers buying television air time to advertise their ability to sue on your behalf for diseases you never heard of.

Will health care be any different in the next decade?

No, but if you call right now, you might get an appointment by then.

I hope this helps. In the meantime, get ready for the non-anesthetized colonoscopy you're about to get from the new Congress. Good luck with all that.

Have a good day. Don't get sick.

More thoughts tomorrow.



The Mistress of the Dark said...

Yup...sad but all of it is true :(

Raquel's World said...

This is funny, it took me a minute to realize it was humorous. I'm slow like that sometimes.

KathyA said...

LOL! Amazing! I think you have this printed as a leaflet and we drive around and leave it in doctor's offices all over the area!!

Mike said...

I'm poking myself in the eye now. IT'S WORKING!!!!! Now all uhend ksfhkufiod ksdf ekn f