ObamaCare and me: a cautionary tale

May 22, 2014

President Obama promised to “fundamentally transform” America. Mission accomplished, sir.

Unfortunately, transformation is a qualitatively neutral word. Knives can transform a Rembrandt into rags the way fire transforms a house to ashes.

That’s about what ObamaCare has done to my healthcare.

As a freelancer, for most of 30 years I bought health insurance directly from providers on individual policies, and it worked perfectly well. Pretty much every doctor I ever visited or wanted to visit was on whatever plan I happened to be covered by at the time. This came in particularly helpful late last year, when I had a bad bicycle accident that required (a) a trip in an ambulance, and (b) surgery on my left leg.

While recovering, I learned that my wife’s and my policy would be canceled as not being ACA compliant. Apparently it didn’t have pediatric dental or maternity coverage. Since we’re both past the age of both and had no dependents at home, this seemed ridiculous but not terrible after we were informed that we could go right back to Anthem Blue Cross and buy an ACA-approved policy.

Our new policy was far more expensive than the previous one, but it had the advantage of—well, it didn’t have an advantage. In fact, it came with the disadvantage of having to deal with Anthem at a time when everyone else was trying to, too. Sparing you all the details, I’ll just say that our saga that began on November 25—and has included more than 40 calls, three letters, four faxes, four communications with the CEO’s office, and at least 70 hours either speaking with someone or on hold—has yet to conclude.

Anthem still can’t get our billing right because the bureaucracy prevents any single employee from looking at both enrollment records and billing records. This company that used to have acceptable customer service now makes USPS look like Nordstrom.

No wonder. There’s no need anymore for accountability. With customers locked in, healthcare in the individual market is a monopoly that has zero consequences for atrocious wait times, utter incompetence, and poor performance.

Still, that’s the least of the problems ObamaCare has caused me. Worse is that, in February, after an MRI taken because of persistent excruciating pain in the injured leg, my surgeon concluded that I needed three, possibly four, maybe five surgeries in the next 12-18 months, all performed sequentially with periods in-between for healing.

“Great,” I said, “let’s do it. I’d like to walk normally again.”

“Okay,” he said, “let’s schedule them.”

“Not so fast,” said the woman who runs his office. “We’re not on the exchange”—Covered California.

“Neither am I,” I said. “I bought my policy directly from Anthem.”

“Doesn’t matter,” she explained. “All individual policies were pushed onto the exchange.”

A phone call that afternoon to Anthem’s executive offices confirmed this. I pointed out that when I’d signed up and asked about the exchange, I was told that this policy had nothing to do with it because we weren’t getting a subsidy. In response, the woman adopted the deadly voice of a civil servant and noted that all individual policies had been moved to the exchange. Period.

“Why?” I asked, “because enrollment figures were low?”

“Will there be anything else?” she asked.

“Yes,” I said, “a new orthopedic surgeon.” I love this guy. He’s been our orthopod for a dozen years, since miraculously repairing my wife’s arms after her biking accident turned one elbow into pixie dust.

The Anthem lady referred me to the website’s list of providers, where I learned that I’d lost not just my surgeon, but every doctor I’ve seen for 30 years, from dermatologist to internist.

It was no surprise to read in the LA Times that up to 80 percent of specialists aren’t participating in the exchange, thanks to the low reimbursement rates. Frankly, I don’t blame the doctors for saying no. And just as frankly, I wouldn’t want to be treated by a doctor who’s desperate enough to look through the sofa cushions for small change.

How about paying the out-of-network rate? Nope. In essence, there is no more out-of-network rate. According to the woman in the Anthem executive offices, policy holders must be out of pocket $5,000 before being reimbursed at 60 percent.

But even that pittance is misleading. The five grand is on what Anthem and Anthem alone determines to be reasonable and customary, so in practice it’s probably ten or fifteen grand—even more.

To put a bow on it, my wife and I now pay almost $2,000 a month for theoretically excellent coverage (hooray for pediatric dental and maternity), except for the fact that we can’t use it anywhere.

If I were younger I’d cancel the policy and tell them to stuff it. But at a certain age making an FU statement like that is unwise. True, I won’t be getting on a bicycle again soon, maybe ever (and the same may apply to walking, especially with this metal plate still in there). But accidents do happen. And if one does, I want to be able to pretend that I’m actually covered.

I was born during Eisenhower’s time in the White House, which means I’ve lived under 11 presidents—a fourth of those who’ve ever held the office—and without doubt the president who has impacted me most directly is Obama. You might even say he’s fundamentally transformed my life.

Hey, see those strips of canvas with paint on them? I promise, they’re a Rembrandt.

{ 1 comment… read it below or add one }

LukeHandCool May 22, 2014 at 10:52 am

Feel-good story of the day!

I think that soon we’ll all feel like forgotten, neglected veterans of the war on American medicine. Japan has nationalized health insurance, and after the experience of my wife’s emergency surgery and two-week stay in the hospital there, my takeaway was, as advanced as the country is technologically, I would never want to have surgery there.

She had some eight or 10 root canals done by the age of 18, all of which have had to be redone here in the U.S. As our Japanese American dentist wondered aloud, “They are so advanced with their technology. I can’t understand why their dentistry is so terrible. I have so many young Japanese patients who are students at Santa Monica College and the dental work they received in Japan is terrible.”

When my wife was being treated by the dentist we had when we first moved back to America in 1996, his procedures were being observed by a visiting Japanese dentist at UCLA. My wife asked him why dentistry was so bad in Japan and he told her it was because of the low reimbursement rates from the nationalized health insurance plan. Often dentists would perform a root canal when a filling was all that was needed because the reimbursement was higher for root canals.

Of course, these systems being what they are and doing what they do—innovation and improvements have been stifled and techniques and procedures are often years and decades behind.

One specialist my wife had to see, a Filipina of Chinese ethnicity, told my wife, “I’ve had to redo every root canal of every sushi chef on Sawtelle. Japanese dentistry is terrible.”


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