Eyes Above The Waves

Every so often I hear Americans who believe that their health-care system is the best on the grounds that certain treatments available in the USA are not available, or less common, in other countries. I also hear some New Zealanders saying the same thing. It enrages me. For example, an American friend once said, without arrogance, "my relative lived in New Zealand and got cancer and of course had to come back to the USA for treatment, because, you know, socialized medicine". It wasn't a put-down, it was just a simple statement of what was obvious to her.

In fact, I believe that the US health system is very poorly designed and implemented. Whatever advantages it has are mostly due to the fact that more money goes into it than in any other country (in most cases, very much more). And who accounts for the time and frustration invested by the health consumer? Here's what's been happening to us:

We've been getting bills from our paediatrician (actually their outsourced billing service) for services that should have been covered by our insurance company (Aetna) --- regular checkups and immunisations. Aetna's online accounts show that the billing people submitted charges twice for the same services; they show that Aetna paid once and refused to pay the other. So we called our paediatrician's clinic a few times --- took a while to get someone, timezone issues, and no-one wants to call us back (maybe they don't know we have phones here). They told us we have to talk to billing. Call billing a few times, get a machine, leave messages, not returned. Forget about it for a while. More bills. Tempted to ignore them, but don't want to provoke international diplomatic crisis. Call billing again, get a human being, who says that Aetna never paid them, Aetna had sent them a form saying they didn't know who the charges are for (despite the fact that they paid bills for the same kids, same place, many times before), so billing just resubmitted the charges again hoping they'd go through. Billing promises to sort it out with Aetna, now that we've provided "more information" (that they already knew).

Conclusion:

• Someone is lying about whether Aetna paid out.
  
• Billing is incompetent. (Why keep sending us a bill while you know there's a problem between billing and Aetna? Why do I have to call before you try to resolve it?)
  
• Everyone has lousy customer service.
  
• Whoever idolizes a system which requires us to wrangle three parties who blame each other while we try to avoid the debt collectors should be thrown in a river.
  
• The most compelling feature of this system is that the insurance companies and billing agencies can reap free money when the customer pays out due to ignorance or exhaustion.
  

This is not an isolated case. This kind of thing only happened once to us in the ~4 years that we consumed US health services (OK there were a couple of other billing mistakes that created surprise charges for us, but they were easily sorted out), but it's happened to several people I know, some of them more than once.

Here's how the system here has worked for the regular checkups and immunisations we've had so far. We go to the nearest clinic (either the Plunket nurse's clinic or one with a doctor). The first time at the doctor's clinic, we filled out a form identifying it as our local clinic. The staff take our names and addresses. We pay a copay ($10 or so). That's it. No bills, no insurance companies, no billing agency, no hassle.

So maybe the USA gets great outcomes from vast amounts of money. Good for them. But if you want to emulate them, I suggest emulating their expenditures before emulating their structures.

BTW, you can get private health insurance here if you want it.