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Sunday, March 4, 2012

The Travails of People with Health Insurance Are Not Trivial!

Austin Carroll at The Incidental Economist has posted what is at least the third installment of his saga to keep getting medication for a chronic condition. This is an excellent reminder that American health care does not just let down the 49.9 million uninsured, but fails those who have health insurance, too.

By way of background, it is important to note that Carroll is not just an expert on health care policy and IT, he is also a physician. He is, of course, insured by his employer, Indiana University. And it is there that this installment of his story begins:
Indiana University, in its infinite wisdom, changed the health care plans for the gazillionth time on January 1. This means that the laboratory I used to have to go to (which is NOT an IU [Indiana University - KT] lab – crazy) is no longer covered. So I needed to search for a new lab that would qualify as in-network. Of course, that meant that the standing order I had at the old lab needed to be reissued. So I had to call my doctor and wait for them to get me a new prescription for my labs. That took a few tries, because they couldn’t understand why I needed a new prescription. But, eventually, I got it.
 End of story? Hardly. His insurance had tripled in price, he had to get a new pharmacy, he had to navigate a labyrinthine website to request a new prescription from his doctor, only to find that the links were broken!

For those keeping score at home, none of the expense of working one's way through the bureaucracy of health insurance is counted as an expense when you see data on how much the United States spends on health care.

Is this an isolated story? Ask the approximately 6 million people who had to change pharmacies in January because Express Scripts and Walgreens couldn't reach agreement on reimbursement rates. My father, a military retiree on Tricare, was one of them. I was another one. I complained to the benefits people at University of Missouri-St. Louis that this would be horribly inconvenient to people like me who need to fill prescriptions in multiple parts of the country and benefit from Walgreens' nationwide reach. Of course this was in vain. Express Scripts is headquartered literally on my campus. The building next to mine is now Express Scripts Hall. The University of Missouri will never get rid of Express Scripts as its prescription benefits manager.

Having health insurance in America doesn't guarantee you access to health care (you have seen "Sicko," haven't you?), it doesn't deliver low costs, and it certainly throws up new kinds of bureaucratic roadblocks on a daily basis. As Carroll says, there is no way we have the best health care system in the world. Even Reason magazine editor-in-chief Matt Welch is convinced in practice, if not in theory (h/t to commenter Steve on Carroll's post).

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