By RICHARD SHAW, ECP publisher
Last year a friend of mine had knee surgery and decided rather than to recuperate at her home where there were numerous stairs to get in and out, upon our invitation, would stay at our house while recovering.
Now this woman is a professional with a very good job in a large government agency. She has two choices for health care, one being Select Care (a branch of Intermountain Health Care) and the other being Blue Cross/Blue Shield. She had selected the Select Care for a number of reasons, partially based on the fact it was somewhat less expensive and provides for a number of coverages that the other does not.
She spent a number of days in an IHC hospital after the surgery and then went to a rehab hospital in Sandy approved by the plan. So far, so good. The care was good, and despite the pain of having a joint replaced, she was in good spirits when she left.
She then came to our place and that is when she learned that Select Care was just that, very select. Other than an option for physical therapy in Carbon County, they did not allow her much leeway for other health concerns she had while here. Basically they told her that all her options were along the Wasatch Front.
With some finagling, and help from local health care people, she was able to obtain some other services eventually, but a sick, recovering patient shouldn't have to do that.
It's a national problem. Large health care organizations, which own hospitals now are using their wholly owned insurance companies to funnel patients into their facilities and theirs only, unless it is an absolute emergency.
The problem with health insurance nowadays is that doctors and medical professionals are not getting the chance to make the decisions for their patients, but instead some six week wonder claim specialist is deciding what is best for patients, as well as where they can get the services.
It's a travesty against the health profession when doctors in a facility think a patient should stay longer that a plan "limits" allow and they have to send patients home early. Then the patients must find a way to make it on their own.
Now most insurance people will tell you that they have to control costs, and I certainly understand that. But what I don't like is an insurance company that has a direct link to the profits of its parent organization, which is a health care chain.
While doctors make a lot of money, most of us wouldn't want their profession in terms of responsibility, liability or the hours. For the most part they are knights in shining armor in this debate, despite the fact that like every group they have people working in their profession that are far from perfect.
Nurses have probably the toughest job in the world. They have to smile while people in pain and under the influence of drugs take out their frustrations on them and then they must clean up the messes that result from a patients stay. In my experience with hospital stays they are certainly angels on this earth.
Most other hospital personnel from social workers to physical therapists to housekeeping all add to a good stay, and a productive one. Most do their job for patients as if they were taking care of their own families.
But unfortunately, nowadays, health insurance companies are like the collector in a black outfit banging on the door in an old time melodrama. They take and take, increase rates and decrease covered services, and when it is time for the payer of premiums to collect a bit from the payee, they cut corners everywhere they can and make it miserable.
It all adds up to a good case for some kind of national health insurance that covers everyone universally, with doctors and health professionals making definitive decisions on patients care.
That's better than some 19 year old claims clerk who is barely out of high school making those choices.