Lint-Trap 2/17/01: Managed Health Care
Managed Health Care
I went to see Diana today, and she is looking better. She's sleeping, and that makes a lot of difference. And she is working on her plan to turn her life around when she is discharged (probably Monday).
When I came in, she was deep in conversation with one of the nurses, and they were discussing doctors she could go to who were on her medical plan.
This didn't strike me until I got home. Here is someone who will be in charge of her mood and medication for at least the next six months. She doesn't know any of these people. Their sole qualification to be her biochemical God is that they are cheap enough to accept her insurance.
The more I think about this, the madder I get. And sadder.
It is so much like how she has lived parts of her life. "I'm not worth the best, or even the good." "I don't have much money, but I get really great buys at the thrift shop." She spent an appalling amount of money on various tutors for her boys--as much as 1/3 of her income. But little or nothing on her.
My first wife hated insurance companies. I think if she were to come back to life today in this era of managed care, she would instantly die of apoplexy. The doctor used to be an ally in trying to do the right thing for the patient. Now he or she is a "delivery system", and much of his energy, and the energy of the patient, goes to trying to strike a compromise between the insurance company and the needs of the patient.
I guess a lot of the time it works OK. And I suppose that these doctors who accept payment from these plans are probably OK. The question is--is OK good enough? For me, or for Diana?
I have friends who, when they need an operation, call in the favors of a lifetime to be able to be seen by the head of the department of a major teaching hospital, for example. They think nothing of flying to the other coast for an option from someone they believe to be the world expert in their condition.
And I have other friends to slouch down to Kaiser when they have a problem, and are treated by the first person who stumbles across them in rotation.
I've watched Diana do the dance trying to get medication for her boys that is acceptable to her insurance company.
This is a degrading way to have to behave. For someone coming off depression, it's like a ticket for a relapse. So I'm writing Diana a letter, saying much of the above. And offering to pay for the person who is best for her, whether or not it's covered by her insurance.
We'll see what happens. Stay tuned.
Thank you for reading.