Bureaucracy

Ezra makes a critical point:

Paperwork gets lost. HR Departments are busy. People are between jobs for a few months, or they pressed submit but not “save.” So they go uninsured for a few months. Or maybe more. Maybe they don’t notice for a year. That’s fine if they don’t get hit by a car. It’s not fine if they do get hit by a car. The problem with slipping through the cracks is that you don’t know how you’ll land.

But it’s the inevitable product of a fractured system where there’s no default insurance status, or continuity between jobs and conditions. If you’re born in Canada, you’re simply covered from birth until death. Here? You’re on your parents’ insurance, or maybe S-CHIP. Then maybe you get insurance through your college. Then you’re uninsured for a bit. Your first job doesn’t offer benefits. Your second job does, but it only lasts a year. So you have to reenroll with a different insurer in your third job, and change your primary care provider. You move. You go to grad school. And so it goes.

In the process of the wife changing jobs and our… er… lifestyle change, we have had to make several shifts between programs and insurers. These are matter of course for anyone dealing with employer based insurance, although the simultaneous job change and arrival of babies complicates factors. I have spent untold hours on the phone with employers and insurance companies, in offices talking to bureaucrats, and at the table poring over the marginal differences in various plans. We have had to make adjustments to our health care expectations because of this bureaucratic awkwardness, in that some appointments get canceled and some medications either don’t get purchased or get purchased on a delayed basis. We’ve had to deal with the terrified look that comes onto the face of the receptionist at the doctor’s office when you say “We don’t have an insurance card yet, but seriously, we ARE insured.”

None of this seems to get counted when people talk about wait times, but believe it or not, the 16 hours you spent on the phone trying to organize your health care is 16 hours that you don’t get back. Moreover, the experience has made me even more unreceptive to warnings about the bureaucratization of health care; I’ve dealt with so many bureaucrats from so many different organizations that giving all of their jobs to one single government bureaucrat tasked with determining how useful my life is would seem like sweet relief…