Abusing Health Care

What you don’t know does hurt you

by John Knight, editor

This is bad: a fever, cough, stuffy nose, and sore throat—you’ve got swine flu. Okay, so you haven’t exactly confirmed it with a doctor yet, but you’re sure of it. It is a pandemic, after all, sweeping through college campuses with no vaccine yet available. Two students have already died. In fact, you’ve heard so much about the virus, it’s just about impossible that it could be anything else. Never mind that the common cold, strep throat, and a sinus infection all have similar symptoms—you’ve got swine flu.

So you should go to Boettcher, right? You’ve never been to Boettcher, but you’ve heard all about the place: misdiagnoses, irrelevant assumptions about pregnancy, and hasty treatment. It’s not even a hospital anyway, just a bunch of nurses. But this is bad—this thing is killing people! You’ve even heard that statistically, swine flu will kill off at least one CC student this year—what if it’s you?

You hurry over to the health center, sure that they’ll just give you Vicodin and send you away to die, alone and sniffling in your room. But at least you won’t feel the pain. Plus, your parents told you that you’ve got the school’s health insurance, so it won’t cost you any money because that’s what insurance does—it covers you, and why shouldn’t it? This is your life we’re talking about!

When you finally get to Boettcher, you have no patience for the lines (another student beat you to the window), the paperwork (a sign-in sheet), or that stupid mask. “FIX ME!” you scream. “I want everything you’ve got! Fix me, NOW!”

 

If you are familiar with any of these sentiments, you probably don’t know enough about what’s going on. Yes, the nation’s health care system is in shambles and the statistics (45 million uninsured) and stories (costs so high people have to choose between groceries and medication) have certainly painted a grim picture. It’s not difficult to understand why we need national health reform, but too many people do not realize how they have directly contributed to the present state of affairs. It is easy to make assumptions about your health given the current scares, easy to use Boettcher as a scapegoat, and easier still to demand every medication and treatment available because it’s free (your insurance will cover it), but it all comes at a much higher cost than you may think.

Dr. Judith Reynolds, the Medical Director of Boettcher and one of the health center’s physicians, has a favorite saying she feels epitomizes health care: “If you take antibiotics you will be better in seven days. If you don’t take antibiotics you will be better in a week.” She thinks that the prevailing problem for adequate and affordable health care is not the high insurance premiums or the 45 million uninsured Americans (though these are certainly problematic), but the general ignorance regarding how the system works. Given the incredible complexity of the patient-hospital-insurance triangle, most people have neither the time nor the patience to learn what the relationships are. Instead, they trust—or at least resign themselves to—their insurance policies and hospitals, using both as an excuse not to think about their health care. The prevailing mind-set is this: If you’ve got health insurance, then it’s taken care of—you go get treated whenever you need it and insurance pays for it.

Ignorance is bliss, but America is slowly realizing that whoever came up with that maxim was definitely only in it for the short term. In the wake of the financial crisis, it has become clear that resigning oneself to an economic system without proper standards of transparency is a dangerous move. As it turns out, health care is no different. “Insurance is insurance,” says Reynolds. “It’s a business.” And it’s a business that makes billions on its customers’ misfortunes. In 2008, UnitedHealth Group (CC’s student insurance provider), the largest and most profitable health company in the US, reported a net income of $2.9 billion, $300 million more than Boeing and only $50 million less than Google. The company’s current CEO, Stephen Hemsley, reports an annual salary of $1.3 million and a compensation package of $3.2 million. Anthony Welters, the Executive Vice President, pulls in $5.6 million annually. The insurance companies are certainly not paying your medical bills for free, but you’re getting away with thousands of dollars in medical treatment, so where do the profits come from?

Health care, in its innovative and technical state, is incredibly expensive; but Americans are still encouraged to use as much as they can. The prevailing mind-set is not only that more care means better care, but physicians will generally play it safe and overestimate treatments and prescriptions rather than fall short. With their jobs on the line, there is no reason for doctors to opt out of administering possibly revealing tests or prescribing drugs that may help, especially when the insurance company will pay for it. But here’s the catch: each time an insurance company pays for anything (tests, equipment, medication), that expense is then factored into the company’s premium rate for the following year. This means that, in a roundabout way, you will still have to pay for your flu treatment; it’s just that the payment will take the form of your health care premium next year.

In the last decade, the cumulative cost of premiums in the country increased 119 percent. Although the student health insurance at CC is only $1,700, some families pay as much as $13,000 for their plans. Of course there are a lot of factors that determine premium costs, such as age and medical history, but even in 2003, almost one-fifth of American families spent more than 10 percent of their disposable income on health care. The combination of incessant patient demands for more care and the lack of financial incentive not to deliver it results in skyrocketing costs throughout the entire system. “It’s that American sense of ‘I want everything done for me,’” says Reynolds. “We’re a nation that has been spoiled.”

This attitude is especially prevalent among college students, says Reynolds. “When they come to us, it’s the first time they’ve accessed heath care outside of their family doctor with one of their parents in tow. So their world view of good medicine or what medicine is like is sort of skewed.”

This sense of entitlement reaches beyond how much care Americans tend to believe should be available but also grounds the belief that it should be free if they have insurance. “People have to get out of the mind-set that insurance will pay 100 percent,” says Janet Teel, the Office Manager at Boettcher. “Insurance is designed to offset your costs and make your health more affordable, not pay 100 percent.” The people who provide care, advance medical technology, and administer hospitals should be paid, and paid well. Furthermore, leaving some financial responsibility to the patient is incentive not to abuse the health care system, but Americans should also not fear bankruptcy when they enter a hospital. Health insurance, like hospitals and clinics, has a place in this system, a much needed resource the country can’t afford to do without. The problem is that we don’t know how to use it responsibly.

 

About 15 percent of CC’s student body enrolls in the school’s insurance plan. For those students, medical treatment costs are extremely low as long as they go to a preferred provider (a clinic or hospital that is a member of United’s policy). Inside this network, deductibles (the amount the patient must pay out-of-pocket before the insurance company will pay a dime) are a low $150 and copays (the processing fee that is charged per visit to the clinic or hospital, paid by the patient) are usually $25. Since Boettcher is the primary provider for United’s student plan but not for most family plans, the majority of the care and treatment at Boettcher for students with the school’s plan is 80-100 percent covered, whereas a family plan might only cover 60 percent of the charges. Sure, Boettcher has a reputation high costs and inadequate care, but maybe that rep is simply a result of warped expectations.

“We’re an easy target,” says Reynolds, well aware of the Boettcher stereotypes that circulate campus. “It’s like the food service—you never can be good enough.” Reynolds says there are a variety of factors that determine the development of an illness, and it is often hard to know from the beginning what is wrong. Reynolds has been working at Boettcher for thirty years and has seen repeated instances in which students refuse antibiotics because they would rather drink alcohol or forgo sleep recommendations only to complain that Boettcher doesn’t provide good care. “It’s hard when you have that very narrow view of what good medicine is all about to get a sense of what’s best for you,” she says of students without much health care experience.

Glynna Kerr, a CC senior who has only had positive experiences at the facility, says, “I have a lot of experience with health care and I know what to ask for. Most students just don’t know.” But given the fact that students often don’t know much about health care, some believe Boettcher should be more of a guiding hand. Boettcher staff say the routine question posed to women about possible pregnancy is an effort at this guidance. “I don’t think it is an outrageous question to ask,” says Kerr. “Boettcher sees a lot of drunken college students so it makes sense that this is one of their routine questions. Plus, it’s an important possibility to consider.”

But misdiagnoses do happen. Noah Gostout, another CC senior, went to Boettcher the first week of the block with massively swollen throat glands. He said the Boettcher staff was so worried he had swine flu that it took them over half an hour to finally give him a throat culture (standard procedure for swollen glands) which quickly determined he only had strep—a test he had suggested. Nonetheless, Boettcher is a nationally accredited health service provider, a claim that few private practices can make. “Medicine is not an exact science,” says Reynolds. “It is always a puzzle and diseases evolve. It’s very difficult to give patients the exact diagnosis and fix they often demand.”

As Colorado College came under pressure last year to trim down its budget, the school extended its voluntary retirement program to Boettcher staff. Half the nursing staff accepted this offer, and consequently Boettcher is no longer a twenty-four hour facility. While the health center hopes to change this soon, the school has put considerable pressure on the facility to become self-sufficient—a difficult requirement for a center that works tirelessly to keep costs down for students but has no other source of revenue. Currently, CC pays the salaries of the full-time Boettcher employees, a cost entirely subsumed by the school since no part of student tuition is explicitly designated to cover Boettcher costs. The health center proposed a $250 increase per student last year to make Boettcher self-sufficient, but the proposal was denied by the tuition committee who refused to burden students with any “unnecessary expenses.” Many Boettcher staff members hope that a national reform would consolidate the billing process, a step they feel would save Boettcher thousands of dollars. But, given the complicated system already in place, staff members are hesitant to wish for too much.

“I’m not sure how much national health reform will change the standard,” says Reynolds. “It’s a step in the right direction, but there is still a lot that will need to happen.” Meanwhile, Boettcher has committed itself to providing CC students with the best care they can, and UnitedHealth Group has, well, committed itself to being a business. You, someplace in the middle, are most likely committed to both your health and your savings. So the next time you make that trek to Boettcher with insurance card in hand, however reluctant you may be, consider what it is you actually need, and don’t let your prejudices, assumptions, and ignorance milk you for more than you’re worth—you’ll still have to pay for it. ~

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