Waiting for Care, Not Management

By |2018-01-02T15:09:12+00:00December 1st, 2017|
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Tim GilmerAs I write this, I’m waiting … waiting for an insurance pre-authorization for an MRI. During a cystoscopy a few days ago, my urologist discovered a mass in my urethra that is potentially malignant. On the other hand, it might be a benign, chronic abscess. Whatever it is, I want it out of me, but the insurance company is taking its sweet time to consider whether an MRI, followed by surgery, is “cost-effective.”

The insurance company doesn’t actually do the considering. They contract with another company, American Imaging Management, which will tell them if they should approve the MRI or not. This is the American way of doing what is referred to as “health care,“ a system where doctors must be subservient to the almighty dollar. Cost is primary; care secondary. As I wait to hear if I have cancer or not, the management model, which takes much longer to run its twisted course than a doctor’s order, makes me very anxious.

I think back to my lifelong friend, Loon, who got trapped in the management model when he was told he had metastatic mel¬anoma, a deadly cancer. He died in 2010 after a year-long battle, but I still hear his voice on the phone, saying, “I’m lying here in the hospital fighting for my life, waiting … waiting for my cancer treatment, but no doctors or nurses or technicians are here to do anything because it’s the weekend, and next Monday is a holiday. So I have to wait three extra days because no one is working.” Three days is a long time to wait when your life hangs in the balance.

While I wait, the management company, AIM, is deciding whether I need an MRI followed by surgery based on what is called “best practices.” Best practices is another misleading health care term. If you are like me, a 72-year old paraplegic with a neurogenic bladder who has had to self-catheterize five times per day every day for the last 30 years in order to pee, there is no information on “best practices” for your demographic — because no such group is recognized. Doing the math, if there were such a group, each person in the group would have self-cathed about 54,750 times. You think AIM’s cost managers have a lot of stats based on best practices for that group?

Just who are these managers and why do we have them? To me, the main reason we have health care managers is that legislators who want to pay less taxes have decided that health care cost management is the way they can get those taxes back in their pockets. Most, but not all of them, share a political worldview based on conserving wealth — mostly theirs. To them, health care for all Americans is blasphemy. You may remember that they tried to ram a “health care” bill through Congress in record time earlier this year. Now they are doing it again but calling it a “tax cut.”

Personally, I would call it a health care cut — not a tax cut — and I’m quite certain it’s based on worst practices.