I'll tell you a story about my own health insurance to underscore why I think it's important for President Barack Obama, his policy makers and Congress find some common ground to fix it.
First off, I don't have the kind of health concerns that keep me and my family up at night. No cancer. No heart problems. No diabetes.
I'm an aging Baby Boomer who's in good health but with some medical issues that test the efficiency of this nation's health care system and test my patience.
Since my retirement, I've been on my wife's health plan. It's a so-so plan through her employer ... not as good as the coverage I had when I was working, but not as bad as having nothing.
The plan has a deductible of $500 and it requires a co-insurance of 20 percent up to a maximum of $3,000 per year. That means that my out-of-pocket expense can be $1,100 a year ... and that's on top of co-pays of $20 per visit and on top of cash out of pocket for any care that the insurance company just won't cover.
By giving its employees a so-so plan, the employer saves money. It's expensive to give employees a real good plan.
Again, it's better than having no insurance at all, but frustrating nevertheless: To have insurance, but to have insurance that requires a lot of cash on my part.
And a lot of effort on my part to manage.
I had a test done in a local hospital in December 2008, ordered by my primary care physician. The data from the test required the interpretation of a specialist. The specialist went through the data, then made a report to me and my doctor.
Everybody then made their submissions to the health insurance company -- the hospital, my primary doctor and the specialist. The health insurance covered the test, but I still started writing checks -- toward the $500 deductible, toward the 20 percent co-pay, etc.
Even though they covered the test, they rejected the specialist's bill.
So now I'm on the phone to the health insurance company: Why was this bill rejected when the procedure was covered? We need more information, I was told. What exactly do you need? Patient history and physical, I was told.
And then I'm on the phone to the specialist: Do you have the information that the insurance company needs? No, I'm told.
And then I'm on the phone to my doctor: The specialist doesn't have this information, do you have it?
Yes, the doctor has the information but won't fax it to the insurance company for me. I have to do it. We'll mail you the information, I'm told, then you can send it to the insurance company. I get the information five days later -- my patient history, my physical. I read it all. I love my doctor, but it's true -- they have lousy handwriting (though I shouldn't be one to talk).
And then I call the insurance company about where to mail the information: Make sure you send it to the attention of Medical Review, I'm told when given the address.
Ten days later, I'm still waiting to hear about the claim. Meanwhile, the bill from the specialist is past due. And I'm waiting, trying to be a patient patient. And I'm hoping he'll wait too, that he'll be a patient doctor and not put me into collection.
The point is that updating the nation's health care system, getting patient records online would help this situation. The military will be the first to get electronic health records, according to an announcement earlier this month.
It won't cure the out-of-pocket expenses that I think are too steep in lousy health plans like mine. But the ability of my insurance company to access my records online would have saved everyone the time, inefficiency and aggravation of having to chase them down.
The hope is that the efficiency drives down some costs.
As I said, this example isn't anything major. It's just symptomatic of a much bigger problem out there that the politicians have to fix once and for all.
