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Sunday, August 31, 2008

Broken Arm, Fractured Healthcare System



Last month, my son Zac and his girlfriend Erin left their jobs in New Orleans and moved to Santa Barbara. They found an apartment and then joined Alex (Zac's twin brother), for the annual group camping trip he organizes to Bass Lake, in the Sierras. On the second to last day, Zac calls to tell me he thinks he just broke his arm while wakeboarding. He'd returned to the campsite and was awaiting all the others who were going to continue wakeboarding for a few hours.

It reminded me of the night - when they were about 13 - that I got a call from Zac from the skateboard park in Palo Alto. He reported to me that Alex had taken a big fall, hit his head, and had trouble remembering much of anything. Zac asked if I could come get Alex and after a brief pause, asked if he could stay out later skateboarding.

There was one big difference from this medical emergency from all the previous ones he and Alex have accumulated. This was the first time there was no insurance coverage. It's Murphy's Law that this would occur during the interlude between Zac's job with Habitat for Humanity and whatever he will find in Santa Barbara. He intended to keep his coverage through "COBRA" - a law that allows people to continue their medical insurance policies for up to 36 months after leaving a job, but the COBRA forms had never arrived.

The next day, when he got back to Santa Barbara and went to an emergency room, they stabilized his broken arm with a splint and sling, but told him he needed to see an orthopedic specialist to determine if it required a cast or surgery. That's when he started his crash course on the failings of the US healthcare system.

1. The orthopedic specialist cannot see him without an insurance policy or cash up front.
2. Zac does not qualify for Medi-Cal. Having no income or significant savings no longer counts if you're not a senior, disabled, or a child.
3. The plan he was on in New Orleans was an HMO and the Orthopedic Specialist referred by the emergency docs does not take HMO patients.
4. The COBRA administrators couldn't figure out what plan he is eligible to sign up for in California. He had Blue Shield in New Orleans but "Blue Shield of Louisiana" is considered a different company than "Blue Shield of California."
5. There is no non-profit agency that gives advice to uninsured people who are trying to navigate the fractured U.S. healthcare system.

Finally we found a clinic that operates on a sliding scale basis. Zac will see an orthopedic specialist this Thursday - about 12 days after the accident. If he needs surgery, then we'll pay a Blue Shield doctor up front and get retroactive coverage from the Cobra plan when it kicks in. The COBRA plan is expensive though because (after repeated calls somebody came up with the information) his only option is to continue with Blue Shield of Louisiana and pay "out-of-network" costs. If he doesn't need surgery, then he will probably wait to get a job that offers medical benefits.

Hopefully, we'll see universal healthcare and a single-payer system before long. At least that promise gets a lot of traction in the Democratic campaign speeches. But dismantling the highly profitable web of insurance companies, pharmaceuticals, and doctor pay scales, may be as unlikely as dismantling the firmly entrenched "defense industry." It's probably as unlikely as me being able to order Zac and Alex never to wakeboard, skateboard, or any other kind of board, anymore.

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