A wrong number and purpose

Yesterday, I had a busy day at work.  I was running SQL for a claims analysis of Medicare beneficiaries who had died in the Carolinas.  After that I was reviewing a data dictionary for complex chronic care conditions in alternative payment models.  And to take a break from that, I sketched out a table to describe the impact of the exclusionary criteria from a paper that my collaborator and I are working on a revise and resubmit.  It was a productive day.

However the most important thing was a wrong number leading to an illuminating conversation.

 

 

This was worth a chuckle at first, and then I had to think more about it.

The young woman on the line was new to the area and new to insurance. She was trying to follow her new doctor’s orders and get a simple thing done. The system was working against her best efforts and then she decided to reach out for help.  I’m listed as working at the Health Policy Center and my name is early on in the directory.  She has an insurance policy, and this seemed like a good spot to start.

I could not help her, but I understood where she was coming from.  She was trying to navigate a confusing system to take care of a problem.  And the system was throwing up road blocks.  And when she reached out to a seemingly plausible source of help, I was of no immediate assistance.  I helped her find the member service number on the back of her insurance card and wished her well.

She did not care that I am working on an evaluation of a fascinating palliative care model.  She does not care that I have a nifty little paper that has a really cool identification strategy.  She just wanted to solve a health problem and let the nerds in the background work towards helping her solve actual need.  This was a good reminder of the vast space between my interests and the outcomes that most people care about — can I get to my doctor or my test and can I afford to pay for that needed care?

Setting up, evaluating, arguing and assessing about the structure of healthcare delivery is critical; it shapes the hallways that the woman on the phone has to walk and it creates the choices that she needs to make, but in a day to day experience, it does not matter too much for the patient who is just trying to figure out how to follow their doctor’s recommendations to take care of a problem.

 

 






25 replies
  1. 1
    Randomrando says:

    Shorter David: ‘Hey, I did the first real work I’ve done in years yesterday!’

    Well done Mr. Anderson.

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  2. 2
    Haroldo says:

    Thanks for this – a reminder that whatever we do, it has to meld with the greater purpose.

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  3. 3

    This is why we need single-payer. The system, even with Obamacare, is too complicated to navigate.

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  4. 4
    Just One More Canuck says:

    @Cheryl Rofer: Just after Christmas in 2016, my sister found out that her husband has cancer. Then at the end of September las year, she learned that her 21-year-old son also has cancer (for my fellow Canadians, the same type as Terry Fox). Her husband has a history of health issues that have made it difficult for him to work regularly, so she is the primary breadwinner. She has spent the last 18 months or so driving an hour and a half each way (in good traffic) from her small town to various hospitals here in Toronto, and then getting home quickly so she would miss as little work as possible (she works for a good company, has an understanding manager and a supportive union). If she had to deal with the rat’s maze that the US health care system seems to be on top of what has to be the most stressful time of her life, there’s no telling what would have happened to her. Fortunately, even with all the problems that our system has, she doesn’t have that additional weight added to her shoulders

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  5. 5
    daveNYC says:

    @Cheryl Rofer: A Swiss system where the baseline insurance policies that everyone gets are regulated to within an inch of their lives would work too, but I’m skeptical of our ability to create and maintain that level of regulation.

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  6. 6
    Ella in New Mexico says:

    @Cheryl Rofer: absolutely.
    I’m halfway through my family NP program at UNM this summer. Our program has a rural medicine and primary care focus-so let’s just say my patients are not rich. What I’m finding in my clinical settings this summer is that the burden placed on not only the patients but providers to sort out what each plan does and does not cover, figure out where a person can go for a given service, how to get prior authorizations for medications that are one plan’s formulary but not another, and the hours of visit documentation a provider has to spend so that your clinic gets reimbursed properly–OMG it’s horrible.

    I heard the other day NM was looking at going to a Medicaid buy-in program and it that did happen I’d be ecstatic. it’d be one less insurance headache for a huge chunk of our population.

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  7. 7
    satby says:

    @Cheryl Rofer: we need universal access to health care insurance. Whether single payer or tightly regulated kludge like the Swiss system matters less to me.
    I think the blowback from the job losses in the insurance industry plus the misgivings of the employer insured would doom a single payer plan.

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  8. 8
    WereBear says:

    @satby: I think the blowback from the job losses in the insurance industry plus the misgivings of the employer insured would doom a single payer plan.

    I have run across this, and it frankly astonishes me. For one thing, wouldn’t there be a need for jobs to help with this huge undertaking; transferring it from private corporations to civil service perhaps, but why wouldn’t skills transfer?

    And the employed/insured have no idea how precarious their situation is. It’s tough enough to handle when it’s a simple thing. They have no idea the Hoover Dam of crap that will fall on them if their illness is longer and more serious. By the time they do, they are someone the majority of the employed/insured don’t want to listen to any more.

    And David’s experience here just illuminates the difficulty anyone has getting any help in today’s corporate customer service.

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  9. 9

    The way we do health insurance is extremely wasteful of people’s time. I cynically suspect it’s set up so you can’t use it because then the insurance provider makes more money.

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  10. 10
    WereBear says:

    @Dorothy A. Winsor: How you doing? Glad to see you here.

    I believe it is outsourcing their employees work to the customers in all corporate endeavors: life-threatening or not, makes no matter.

    The pattern of ME figuring out what has gone wrong, ME figuring out how to fix it, and ME demanding it be fixed — all the while battling my way through layers of voicemail, people whose jobs are structured to not let them fix it, and not even knowing who can — with lots of dropped calls and outright hangups, even though I keep my tone even and my words civil.

    Apparently the effort I expend to stay polite shows in my voice, because I get told “I have never been spoken to like that!” even so… I guess I should look for cartoon voice work, because it’s not the words I say, it is how I say them :)

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  11. 11
    Old Scold says:

    )rHealth care coverage should be as salient to the average Joe as traffic control or utility regulation. We shouldn’t have been spending 50+ years arguing about the right thing to do. Set up a sensible system of universal coverage, make it as reliable as plugging your iPad(R) into an outlet out-of-town, have a mechanism for adjudicating the inevitable glitches, and leave the fancy modeling of system efficiency and price setting improvements to the policy wonks. I say this as a wonk myself.

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  12. 12

    @WereBear: I’m good. I tire more easily but then I lie down for a while. I’m still picking adhesive off my skin in weird places I find only in the shower.

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  13. 13
    O. Felix Culpa says:

    @Cheryl Rofer: I agree. America makes so many major life issues unnecessarily complicated (and expensive) for people, often when they’re under stress and least capable of dealing with them.

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  14. 14
    Doug R says:

    You see, that’s the problem with going from Mayhew to Anderson, you’ll have to answer the phone once in a while.
    I heard the phone company around here actually had a fake entry at the end, something like Zzyyrk to act as a trap to cut down on crank calls to their “last” customer.

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  15. 15
    California Stars says:

    Well, thank you for the work you do, both there and here.

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  16. 16

    When I said “single payer,” I intended to cover pretty much any program in which people get health care when they need it. I’m not averse to or advocating any particular arrangement, just saying that most advanced countries have found much, much simpler ways to do this.

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  17. 17
    The Moar You Know says:

    We expect the same people who took Donald Trump at face value to be able to navigate today’s health insurance systems. This is patently ridiculous. Hell, I can’t do it. My mother, who spend four decades working with insurers as a provider, in between stints working for an actual insurer, can do it…barely. If you pulled the same kind of shit on people that insurers routinely do as an individual, you’d go to jail for abuse or assault.

    The system as it stand is designed to default to denying people health care from the start and that needs to change. ACA didn’t and couldn’t address that. But the next step in healthcare reform needs to. And it will have to involve the phasing out and elimination of for-profit insurers, as they have proven again and again that they won’t change how they treat their customers.

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  18. 18
    J R in WV says:

    @Old Scold:

    “have a mechanism for adjudicating the inevitable glitches,”

    There should never be a reason for adjudicating anything in health care. If a doctor legitimately diagnoses a problem and prescribes treatment then insurance should pay for it. The end.

    Dave, I’m partly using this as a way to test commenting and editing comments, but thanks for your health care resource here on B-J, it’s wonderful to have such expertise for such a complex issue!

    And testing edit – it works!!! Hurray!!!

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  19. 19
    joel hanes says:

    People don’t need health insurance at all.

    They need health care.

    David, I love you, man, but you’re working for vampires.

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  20. 20
    Juice Box says:

    I had a minor problem with a medication refill, mostly due to my own desire to pay the minimum amount, and spent a ridiculous amount of time on it this week. It was stupidly frustrating.

    I also take a generic drug now and then for asthma flairs. The prices are $15 copay for 30 days, $45 copay for 90 days by mail, $45 for 90 days from Canada, or $25 cash price for 90 days at the local pharmacy. That does not make a whole lot of sense.

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  21. 21
    StringOnAStick says:

    @joel hanes: David works for a university now (Duke), assessing policy. He doesn’t work for an insurance company anymore.

    As for health insurance, I think most people who like the current system haven’t had a whole lot of contact with it. Yet.

    I had a friend who ruptured her spleen in a bicycle accident and required emergency surgery twice to deal with the results. Her health insurance company tried to deny paying for anything because “she lied on her application”. The “lie” was that she had forgotten to mention that she was taking birth control pills when she applied, and for that they denied care from an accident that nearly killed her. She sued, and won but it is shit like this why people who have had to deal with a difficult life event HATE this system.

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  22. 22
    YetAnotherJay formerly (Jay S) says:

    @J R in WV: @Cheryl Rofer: A better generic term is universal healthcare. It seems to get fewer people tangled in the weeds of a particular implementation.

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  23. 23
    Older says:

    I am so very glad to have kept my FEHB coverage when I retired. That stands for Federal Employees’ Health Benefits. And it’s a program that could have very easily been extended to cover everyone. As could several other federal programs, including Tri-Care (FEHB for the armed forces) Medicaid and Medicare, Which I also have, because I’m required to.

    Back in the days when I was employed, one of the things I did was, I was a statistician. I occupied some of my spare time working out the details of extending FEHB to everyone. believe me, it would have worked, and it would have been so very much easier to understand than Obamacare. I’m pleased with Obamacare in the sense that I approve of any “universal” plan, and in the sens that it’s “better than nothing”.

    But it could have been better.

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  24. 24
    Older says:

    It’s that word “socialist” that dooms better plans. Our largely ignorant electorate does not understand how many of the benefits of modern life in the US are socialist in nature.

    ReplyReply
  25. 25
    Arclite says:

    I was running SQL for a claims analysis of Medicare beneficiaries who had died in the Carolinas.

    Inner left joins?

    ReplyReply

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