July 12, 2011

A little too much care

There is, obviously, great debate going on in the United States about health care and health insurance. And it's interesting to me that different countries handle it in different ways.

It used to be something most of us never thought about. You worked for a good company and you got good health insurance. It wasn't complicated. And as time has passed, now if you get health insurance at all -- you're grateful, no matter how meager the benefits.

When I left a part-time job at the NY Times, I was eligible for COBRA. The monthly payments were $1,400. I think I paid $50 a month to get it while I was employed. Once I was out of work, it was roughly half my monthly pay. The value of my job was entirely the cost of the insurance.

I got a new job that had lesser health insurance, and I was just happy to have it. While I was under that coverage, I actually had to use the insurance, something that hadn't really happened when I was younger. My co-pays over the years have ranged from $10 to $35 per visit, and other things are extra. My hospital stay, I had to pay a $500/day co-pay -- in advance.

Before that, in France, there was nationalized health care. I didn't use it that often, but the entire bill was rarely ever more than 40 euros. In fact you could call a service that made house calls, and it only cost 40 euros.  (And here is a good assessment of European health care, in my experience). 
Largely, however, the French have a very non-interventionist attitude toward treatment, but they do love their medications.

Here, we have a perfect example of insurance abuse -- the worst of American problems and a lot of the bad bits about France.

My insurance was excellent when we got here. It covered almost everything, and was valid anywhere in the world. Paul had a late-night emergency room visit shortly after we arrived and there was no wait and no charges. The insurance was downgraded last year and everyone is complaining about the newly initiated co-pay which is a whopping $6.80. And that includes treatments.

Last week I got sick. There was tonsilitis raging through my office, along with a few more itises. Almost everyone was sick, and those who weren't were on their way. When it was my turn, I went to the doctor, prepared to pay my $6.80 and get my antibiotics. At 46, I have had had sinusitis, tonsilitis, bronchitis -- all enough times to know what I have and what I need.

But here, the doctor can't let you go without ordering tests. I've had blood taken three times in less than two years. And this time was no different. The doctor ordered a CT scan. For a sinus infection. I was sort of baffled (and this is why healthcare is out of control!!)

In the US, the doctor would have said yup, you have an infection. Take these antibiotics and drink lots of fluids. End of story. Even if the doctor wanted to prescribe a CT scan for a sinus infection, there is no way the insurance company would approve it, and the co-pay would be hideously expensive.

In France, they would have ushered you out the door before you finished explaining your symptoms, prescription in hand.

So the CT scan. Apparently it showed a blockage, which seems rather obvious since I had acute sinusitis. The insisted I go see an ENT. There aren't really any family doctors here, so they do a booming business in specialists. I can honestly say I've never seen one before. (And after today's experience, I'm not likely to again).

The doctor said yes, the CT did indicate a blockage, but it looked like congestion. (Duh). I'm not sure the referring doctor clued him in about anything. So the ENT decided to take a look for himself. First thing he did was numb my tongue and throat and poke at my tonsils. "You have chronic tonsilitis, he said. Lots of scarring." Um, thanks ... kind of knew that, and I'm for my sinuses.

He looked into my ears next. Didn't like the look of that and flushed my head with a power house. Loved that, too.

But the best part was when he numbed my nose, and stuck a six-inch tube up it (both sides) to take a look around. No problems with the sinuses. (Surprise -- I was sick a week ago and on anthrax-level antibiotics, I'd be stuned if I still had an issue). He said there was some slight swelling, it seemed worse on the right side and decided there was slight deviation. Then he proclaimed I had chronic rhinitis. This is exactly what my pediatrician told my mom when I was 6.

So far, I learned nothing new, and had six inches worth of tubes stuck up my nostrils.

The problems that still remained -- post-nasal drip and laryngitis. He had no real explanation or solution for that. He did, however, stick that $#%#%% hose up my nose again to see if maybe it was my larynx. Did you even know that you could see a larynx by looking up someone's nose? My sense of anatomy is crucially off, apparently.

So, 40 minutes, some discomfort and $6.80 later, he gave me a prescription for actifed.

The national health insurance company is going to go bankrupt at this rate. I know the American system doesn't work, and I know this one doesn't work, either. Maybe France is the middle ground.

Do y