ROGER SIMON COLUMN
JULY 21, 2003
WASHINGTON - - Like most people in America, I have health insurance.
And while I am
sympathetic to plans to provide health insurance to everyone in this country,
millions of people like me face a different kind of problem:
The health care system
we have currently does not operate in a rational way.
Here is a true-life
example, one I bet most of you have experienced yourself.
You find a doctor you
like and trust - - one whom your insurance company has approved, of course - -
and you are prepared to follow his or her medical advice.
Recently, my doctor
prescribed a drug for me for a common ailment. He did this after examining me
and talking to me. He then called upon his years of training and expertise to
prescribe exactly the right drug.
So I take his
prescription to my pharmacy and hand it in.
After a wait, the
pharmacist says to me, “Your insurance company won’t pay for this.”
Why not? I ask.
The pharmacist shrugs.
“It’s on their list,” he says.
Their list of what? I
“Their list of drugs
they won’t pay for,” the pharmacist says.
Why the insurance
company won’t pay for the drug is something mere mortals - - you and me - -
cannot find out.
They won’t pay because
they won’t pay.
I call my doctor and
tell him the insurance company won’t pay for it.
“I was afraid of that,”
Is the drug no good? I
“Oh, no,” he says.
“It’s very good and it’s what you need. But the insurance companies don’t like
to pay for it.”
The drug is neither
exotic nor experimental; the insurance companies just don’t want to pay.
My doctor mentions
another drug and I check it with the pharmacist who checks it on his computer.
His computer, by the way, is not showing him information on the drug.
It is showing him what
the insurance company will and won’t pay for, which is the most important
decision in medicine today.
“They will make a
partial payment,” the pharmacist says. “And your doctor has to call them.”
Why does my doctor have
to call them? I ask.
“Because the insurance
company says so,” the pharmacist says.
I tell my doctor he has
to call the insurance company. My doctor is a hard-working, busy guy, but he
will do it. “It usually takes about 10-15 minutes on the phone,” my doctor
Which is not a real lot
of time, unless you have to do it for five or six patients a day.
My doctor calls me back
and tells me he has called the insurance company and the company has agreed to
make a partial payment on the drug. The insurance company almost always agrees,
he tells me.
Why, then, does the
insurance company make the doctor call? Because the insurance company knows
that most doctors don’t want to waste their time calling, which means they will
prescribe some other (cheaper) drug instead.
In other words, some insurance
toad somewhere, who does not have any training in medicine and has never
examined me, determines what kind of drugs I can take.
I pay for my health
insurance. I also make co-payments on all drugs, doctor visits and treatments.
But the insurance company
does not view this as my money. The insurance company views everyone as an
enemy: It operates as if every patient, every physician, every healthcare
provider is trying to cheat them out of their money.
Undoubtedly some do
cheat them, but this has become an excuse for treating everyone as an
But I am an optimist.
And I look forward to a day in America when doctors make medical decisions and
not faceless bureaucrats who neither know nor care about us.
And if some
presidential candidate could come up with a plan to do that, he or she might
really be onto something.
Posted by roger
simon at July 18, 2003 03:04 PM