Monday, August 29, 2005

Club Med-ical

After suffering many HMO hassles, I finally got arm surgery last Friday. It thus came ten days after the accident, even though every doctor I asked agreed that no more than five to seven days should elapse between fracture and surgery in such cases. I think it'll work out fine, nonetheless, as I have great confidence in my orthopedic surgeon, Dr. Karim Abdollahi, M.D. At a minimum, though, Blue Shield's incompetence and sloth cost me several days of needless pain.

My misadventure highlighted the contrast between the administrative and technical sides of medicine. The paper-pushers struck me as largely inept and uncaring. The problems started because Blue Shield had assigned me to the wrong primary care physician. (Blue Shield blamed my HMO's health care group, Monarch, which in turn blamed Blue Shield and/or the physician. I didn't bother figuring it out, as I blame them all.) Phone purgatory followed. I finally got a new primary care physician—but not leave to skip a superfluous visit so he could look at my x-rays and say, "Hmm. This is broken. You'll have to see an orthopedic surgeon."

In contrast, I found the doctors, nurses, and technicians efficient, kind, and even funny. I always enjoyed working with them. I use that phrase advisedly, for they never dismissed my comments and questions. I especially appreciated that Dr. Abdollahi and my anesthesiologist accepted my request for a nerve block. After researching the matter, I'd tentatively concluded that general anesthesia would not give me an optimal outcome. (See, e.g., this spot-on paper.) Though they initially favored general anesthesia, they heard me out, and agreed to use a nerve block. That—like all the many other high tech tricks used on me—worked like a charm.

Are healthcare bureaucrats just evil bastards, and healthcare providers brilliant saints? Probably not. At the least, I'm sure that some doctors and nurses deserve scorn, too. For the most part, though, I think my varied experiences reflect the incentive structures of HMOs. The people on the insurance side act as gatekeepers, intent on screening out customers who make undeserved claims (as well, perhaps, as some deserving claimants). When and if you fight or charm your way past those bouncers, however, you enjoy the ministration's of medicine's 24-hour party people: The doctors, nurses, and technicians eager to spend the insurance company's money on your care.

I won't defend this "Club Med-ical" as an ideal system. I will say, however, that I'm glad to have a choice between insurance plans and companies. Imagine if I'd had to fight my way past bureaucrats working for a federal healthcare monopoly! I rather doubt that I'd done quite so well or, supposing I'd managed to crash the party, that I'd have found getting in quite so worth my while.


Glen Whitman said...

When I hear people advocate a single payer system, I always ask them, "Do you like HMOs?" When they say no -- as they invariably do -- I reply, "Single payer: one big HMO."

Tom W. Bell said...

Right on, brother! And, as I observed to d after I began to get uppity with Blue Shield and threaten litigation, imagine if that inescapable HMO also ran the IRS, and exercised eminent domain powers, and had lots of guns.