Monday, July 17, 2017

What we ought to expect from health insurance

Almost all health care stories these days seem to be about either how millions of people are about to have access to care ripped away from them by the GOPer Senate or how the U.S. medical system is inaccessible, impersonal and balky. I had a happy medical experience today that seems to me to exemplify what we ought to be able to expect from medical providers.

People who read here probably have noticed that I've just spent 10 days on Martha's Vineyard island off Massachusetts. Cape Cod and environs are having what may be the worst tick season ever. The little buggers are not only ugly, their bites also spread Lyme and several other nasty infections. And much to my horror, I discovered Saturday night that I'd brought a deer tick home on the plane with me, embedded in my armpit.

Emergency time!

If I'd still been on the island, I knew what I would do: pull out the tick carefully, rush to the walk-in clinic, explain, and pick up a dose of the antibiotic doxycycline. That's the standard protocol and docs hand out the drug daily to a parade of visitors. If those who have been bitten get treatment within 72 hours, most avoid tick disease.

But now I'm in northern California where I have my health insurance through Kaiser Permanente. Would this system recognize the prophylactic protocol which is standard in Massachusetts? Would they give me a dose of an antibiotic on the basis of my claim to have pulled out a tick? About a decade ago, I went to Kaiser in somewhat similar circumstances and the docs didn't act as if my having a bite and nasty rash was worth attending to. Tick bites just weren't part of their world in those days.

But today, my experience could not have been more smooth and efficient. I called the advice line at 6:30am on a Sunday morning and explained about the tick and that I wanted an antibiotic. I was passed to the outpatient clinic for an appointment within a few hours. The doctor on duty listened and agreed that I should be treated ASAP. He didn't know the dosage because the need for tick prophylaxis doesn't walk in every day, but did some quick research and returned with a prescription. This was filled in the same building within 15 minutes. Less than an hour after walking in, I'd taken my drugs and -- I hope -- killed off any Lyme in my body.

This is how a medical system is supposed to work. Kaiser is an HMO, a self-contained medical facility whose doctors and ancillary staff work on salary with in-house computerized medical records, labs, and pharmacies. Instead of getting paid for doing ever more things to those of us in their system, Kaiser gets paid for keeping us healthy. They make their money when their insureds don't get or stay sick. That is, their incentives are aligned with mine as the patient. Sure, the system is big and sometimes requires a little persistence to get the process of being seen started (not today though!) but mostly Kaiser works.

Why can't all the health care system work like this? Docs, especially specialists, might not make quite the same enormous salaries, but most everyone else would be happier. This is what being insured ought to mean. Medicine can't cure everything, but the experience of being a patient shouldn't add to the misery of being ill. This can be done and we should demand it.


Hattie said...

Hear, hear. Glad your medical need could be so promptly met. I am so grateful for the cancer care I'm getting through Kaiser.

Sandra de Helen said...

Did you pull out the tick before going to Kaiser? Did you take the tick with you? How did you deal with the tick?

janinsanfran said...

We did immediately pull out the tick when I found it, because shortening the time embedded is vital to avoiding disease. Fortunately, Kaiser had provided an exceptionally good pair of tweezers during a previous episode. That time, we carefully preserved the tick and nobody wanted it, so this time we flushed. Deer ticks are tiny; the size of the head of a pin. This time, the doc would have taken it if we'd kept it; he asked. :-)

Anonymous said...

Your experience with Kaiser in Northern California is different from my son-in-law's in San Mateo. He too got ticks embedded in his skin, 3 to be exact, while working in the coastal redwoods out near Pescadero. The Kaiser doc took blood and tested it to see if the Lyme disease was there. It wasn't, so no meds.Perhaps the different protocols are because of the different places where the ticks were picked up.

George Waite said...

Wow-vacations on Martha's Vinyard!
Could you be more of a parody of a privileged White woman?

joared said...

Glad you rec'd tick care you did. Recall encountering them in the Midwest in my youth -- they were fairly good size. Then in south when wild blackberry picking all morning, came home to discover the strange feeling I experienced under my blue jeans were hundreds of tiny seed ticks moving up my leg into nowhere land. Always was able to get rid of them with concoctions, or if embedded could force release various ways I can't recall now, but seems kerosene was used on latter. No Lyme we knew of then.

There definitely can be some good care being provided by Kaiser in the area here as know of some HMO patients who were very pleased they changed to Kaiser. Kaiser quality can vary from my experience providing health care services, as some treatment decisions reflect a group "one size fits all" approach which may not always be most appropriate as some might agree. This also has the potential to be a concern if a one payor system adopted in U.S. & see even sometimes with Medicare. Problematic in a local area here, also, is the requirement to be transported to Kaiser hospital when a closer one 10 or 15 mins away might be better. Even going for regular outpatient treatments, Dr. visits, or person feeling sick can find the necessary driving distance to there less than welcome -- a deterrent to some people who have said they might consider changing to Kaiser.

ellen kirkendall said...

My brother uses Kaiser in Denver, which I found to be serviceable, if not especially individual. It reminded me somewhat of the clinics I used as a military spouse. I imagine that as a one size fits all service for all kinds of common issues and problems it would work very well. Maybe less satisfying for unusual conditions or needs. Still, most people need pretty ordinary care most of the time.

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