Health-care bureaucracy: Rage against the machine

RIO RANCHO, N.M. — On a recent doctor visit, I conversationally mentioned that I had just joined a local health advocacy board.

Cheryl Everett

I asked my doctor for his suggestions on how to improve access and quality of medical care in New Mexico.

His answer stunned me: “Single payer.”

Physicians, at least in the U.S., have historically shunned the idea of a government-run national health insurance program. But a profit-driven private insurance industry with multi-million-dollar CEOs and a cruel system of health-care restrictions seems to have pushed many physicians past a tipping point.

My physician told me how he had recently ordered an MRI to help diagnose a patient and indicate treatment options most likely to succeed. The patient’s insurer denied coverage for the MRI, leaving patient and physician in limbo.

No coverage, no service — except for the very wealthiest of patients who can afford to “self-pay.” Insurance companies frown on self-payment, as they do on doctors who accept “self-payment” for uninsured services.

Doctors who protest coverage denials for services to their patients are also frowned upon, sometimes leading to their removal from an insurer’s provider panel. Insurers can put doctors who are too patient-friendly out of business.

It’s a system that puts profit ahead of patient outcomes and denies physicians the satisfaction of providing the best possible care according to their own medical judgment.

All of this got very personal for me recently when my own medical insurer’s “claim investigator” contacted me about reimbursement for spinal stenosis treatment. Simply put, the investigator’s mission was to re-direct my medical claim to another insurer — any other insurer — than his client, my medical-care insurer.

My conversation with the investigator went like this:

ME, trying to be pre-emptive: “My condition was not caused by an injury on the job or in an auto accident.”

In those cases, my general medical insurer is off the hook and can pass the claim along to workers compensation or auto insurance, respectively. I had to repeat this three times.

INVESTIGATOR, taking a darker turn: “I see you’ve had several of these treatments recently.”

A veiled threat to deny me future coverage? I responded that the procedures were medically necessary to safely (without opioids) relieve debilitating pain.

INVESTIGATOR, relentlessly: “And you haven’t consulted an attorney or considered a lawsuit?”

ME: “That’s none of your business. ”

But I wonder in retrospect if I’ve cast suspicion on my medical provider and on my own future medical claims.No patient or physician should have to live with this. We have a broken system, and it won’t heal itself.

Meanwhile, all of us — patients and physicians alike, and our elected representatives — need to vigorously challenge health insurers who deny legitimate medical claims or prospectively eliminate a physician/patient’s preferred course of treatment.

Our health-care system is a remorseless machine that sooner or later touches all of us. Mindful of a 1990s rock group mantra, we all need to “rage against The Machine.”

(Cheryl Everett is a Rio Rancho resident and former city councilor.)

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