Remember the so-called health-care crisis in this country? It might not be on the political agenda these days, and it isn't making headlines. But make no mistake, it's still with us. This national problem has more angles than a geometry exam, but let's take just one: HMOs -- health maintenance organizations. Somewhere between the low-grade annoyances of managed care and the structural crises experts see down the line -- not to mention the occasional horror stories -- lie tales like one that recently came to my attention.
A woman goes to a specialist for a routine checkup. Because there is a problem with the referral from her primary-care physician, she almost doesn't get in. Her busy schedule barely allows time for the appointment, much less a debate with an overworked receptionist over the fine points of actuarial management. She nearly says "Forget it."
But the problem is resolved, she has her checkup, and just as she's about to leave, the specialist opens her file and finds a test result from eight months before -- one that came back positive for a very serious, potentially life-threatening disease. The specialist says that his office had tried to reach her, without success.
True, the woman has moved recently, but her office number is in the file, she's listed in the telephone directory, and, perhaps most infuriating, her primary-care physician (whom we once would have referred to simply as "her doctor") is right across the hall. Maybe the office did try to find her; or maybe a support staff overwhelmed by insurance paperwork let her test results slip through the cracks.
With time now at a premium, the specialist schedules her an appointment with another specialist. Three days later, she arrives at the surgeon's office, eager to have a procedure she should have had eight months prior. The receptionist asks for her referral. Problem is, in the midst of worrying for her very life, she has forgotten to worry about this. Wasn't it taken care of when the first specialist scheduled her with the surgeon? Apparently not.
No problem, the receptionist says, she can just reschedule her surgery and get the referral in the meantime. Nothing doing, says the patient -- this treatment has waited too long already. So patient and receptionist embark on a series of confusing phone calls. First question is: Should the referral to the surgeon come from her primary-care physician or her specialist? Patient doesn't know, receptionist doesn't know.
Once they get that settled, turns out the referral requires a "diagnostic code." Until she sees the surgeon, she won't have a diagnosis; without a diagnosis, she doesn't get to see the surgeon. Catch-22, HMO style. Receptionist and patient finally fudge a diagnosis so the patient can get medical care that was urgent months ago.
This story has a happy ending, but how many similar cases do not? It's been stated before in this space that the United States has the best doctors in the world. Problem is, lots of Americans are having trouble getting in to see them.
What's more, managed care might be jeopardizing the quality of our future medical care, as tomorrow's best and brightest doctors learn that the benefits of practicing medicine might no longer outweigh the mounting hassles on their end.
Is America ready to deal with the HMO mess? Doubtful, with even such halfway measures as the so-called Patients' Bill of Rights stalled now for years and facing resistance from the current administration. Meanwhile, one keeps hearing the stories -- stressful, scary and in-between -- of those who experience our medical crisis up close.
Dan Rather works for CBS News.
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