Fatherhood I: The Health Care Bit

Friday will be the girl’s first birthday, and in honor of one year as a parent I thought that I would toss together a few things I wrote on the topic (some from way back) and try to make a series of it.  The first installment has to do with health care; the wife’s pregnancy was the first time that I had to deal at length with America’s health care bureaucracy. We also had to deal with the fact that my wife changed jobs shortly before the birth of the girl’s, meaning that we needed to shift between health care providers. This post is more about health care than fatherhood per se, but the experience of having kids brought me to a series of revelations about our health care system.

So, last June I was a more or less happy human being with health care supplied by the University of Kentucky.  We knew that my wife would soon leave her job, and we knew that pregnancy often involves a variety of health complications, so I decided to change from the cheap-but-adequate plan to the expensive-but-a-good-idea-if-you-might-get-sick plan.  I discovered in the process of making this change that, because of a computer error, I’d actually been uninsured for about a year.  Fortunately, I failed to get sick.  In any case, I filled out the form and added Davida to the plan.  When the little dependents arrived, I added them to the plan.  Shortly after the LIFE CHANGING EVENT, we moved to Baltimore for the wife’s new job.  The insurance plan offered by the University of Maryland was marginally better than the long distance plan offered by UK, so we switched the wife and kids to UM, while I stayed at UK.  This required numerous additional forms.  In January, we moved back to Ohio, and switched back to the UK plan, incurring reams of additional paperwork.  Finally, in May we arrived at the “Open Enrollment” period at UK, in which I was able to change from the super-expensive plan back to the reasonably-priced plan.

Now, all of this sounds reasonably easy and straightforward; however, anyone who’s ever actually dealt with the multiple bureaucracies that make up the US health care system understand that the story could never be so simple.  Every change involved negotiation with at least two, and often three, bureaucracies.  The first interactions with UK were difficult, but went very well once someone at UK HR took an interest in our case and effectively became an advocate.  This person (who deserves nothing but our eternal thanks) really went the extra-mile, giving out her office phone number so that we could have pharmacists call her in order to find out how much our prescriptions should cost.  Had we not been so fortunate in finding someone interested in helping us out, we might have been in real trouble.

We had lots of other interactions with these bureaucracies, and not all of them went as smoothly as the UK…

Trying to get ahold of your insurance company means negotiating a bewildering maze of phone trees and webpages.  I use Humana, but I don’t have any reason to believe that any other insurers are any different.  The key point to remember is that your insurance company DOES NOT want to talk to you.  Maintaining a call center is expensive, and the company will undertake whatever means it can in order to force you onto an automated system or, barring that, attrite you into submission.  Moreover, the question you have, if answered properly, might cost the company money.  This is bad, and the insurance company is going to do its darndest to make it difficult for you to get the information you need.  On a couple of occasions I was forced to repeatedly enter my policy ID# in order to move on to the next phone tree, all with the carrot of a “patient care representative” dangling in front of me.  At one step, the system insisted that I verbalize my ID#, birth date, and zip code. No matter how clearly I said any of these, I was then forced to punch them into my phone keypad.  I was told at one point to represent any letters in my ID# with the star key.  I was then dragged through the agonizingly slow process through which the automated system tried to figure out exactly what letter a star represented (“Press 1 for G.  Press 2 for H.  Press 3 for I”).  At another stage in the phone tree, the automated voice refused to accept any number I pressed before it was done speaking.  If I made the error of pressing a number before the sentence was finished (and the robot, for some reason, favored long, pregnant pauses), then the system would stop for about 15 seconds before telling me that it didn’t understand what I was trying to say.  It would then repeat its entire spiel.  When you finally reach “waiting for the next patient care representative” stage, you are invariably treated to ridiculously terribly music punctuated by a voice patiently explaining how useful the website or the automated system would be, with the implication that you’re a moronic ingrate for needing an actual operator.  On one occasion, I made it through the phone tree only to be told that the call center was closed.

Perhaps my favorite roadblock was on the (otherwise useless) Humana website.  Shortly after creating your account, the website insists that you read a series of statements about the confidentiality of your health care, and that you click “I agree” at the bottom of each statement.  If you don’t scroll down and read the entire statement, it refuses to let you move on.  Ingeniously, one of the statements didn’t show any scroll bars on the page.  It simply didn’t allow you to move forward.  Clicking on “I agree” only makes you more angry, with the eventual (I assume) purpose that you will hit your keyboard so hard that your computer will break, thus saving the insurance company any additional difficulty.

None of this is accidental.  The point is to irritate and confuse the customer so much that he or she eventually hangs up.  It works, too.  We would all like to think that we have the wherewithal to fight through the system, but often we don’t.  We run short of phone minutes, or we get another call, or we have to do any one of the myriad things that amount to normal, everyday life, and we end up hanging up.  This is what the insurance company calls “a win.”

So, all of that was pretty frustrating.  Living through the experience made the health care debate (“People in Europe have to wait!  In the emergency room!  For service!”) some combination of surreal and absurd.  Of course, nothing about the health care bill that we actually passed does anything to solve any of this.  I can say, however, that if I ever had the choice, I would absolutely leap at the prospect of a public option program; the state bureaucracies were invariably easier to deal with than the private ones.  I suppose if there was real competition with a public option the private programs might get better, but I can’t say for sure.

I should also note that I appreciate how fortunate we were to actually have jobs, and for those jobs to have decent enough health care programs.  I cannot imagine having done all of this without the level of security that even…. complicate coverage provides.  We got the drugs we needed, were able to take the girls to the doctor when we needed to, had Elisha’s helmet (mostly) paid for, and so forth.  Taking the girls to the doctor was never a difficult choice for us, as it is for some.  When we were concerned about Miriam’s weezing and barfing, we were able to take her to the emergency room without worrying too much about paying for it.  All of that was (and is) nice, but it doesn’t require the infuriatingly complicated system that we currently have.  I don’t think that we properly factor the complication, aggravation, and genuine irritation of that program into the costs of the system that we currently have, in part because it’s so hard for Americans to properly imagine a different system.