Tuesday, September 29, 2009

Risky business

Health care reform is a huge debate in the U.S. right now. As Canadians who spent the last few years in France, Amynah and I are still grappling our way through the American system – learning the differences between HMOs and PPOs, and the complexities of private health insurance.

So far, our only direct experience with the medical system was last week, when we had our first appointment with Amynah’s new obstetrician. The contrast with France was astounding.

We had visited several different doctors in France – our GP, a specialist when I broke my arm, and the “gynecologue” to monitor Amynah’s pregnancy. In each case, the doctors in question had exactly zero staff. They took their own appointments, did their own paperwork, answered their own phones. And they were, without exception, very good at what they did.

When we showed up in our new doctor’s office it was a bit of a shock. There were three people behind the reception desk and a nurse’s aide we had to get through before seeing the doctor, who was accompanied by an intern and who handed us off to a nurse for the ultrasound.

This, in itself, was not too surprising – it’s a hospital-based practice, and not shockingly overstaffed when compared to a Canadian practice. Still, our insurance is paying for it all.

What did shock me was the feeling that we had walked onto a car lot. It’s a for-profit health system, operating in a legal system that allows for massive lawsuits. Which means that it is in the doctor’s interest to “sell” you on tests that will a) earn the practice money and b) further cover people’s butts if things go wrong.

In this case, the tests we were being sold were for inherited disorders. According to the papers we were given, the American Geneticists Association recommends that everyone be tested for these illnesses – impeccable family histories notwithstanding - at a cost of roughly $800 each.

The documents we were given threw up some scary numbers for the diseases “One in 150 women is a carrier” for Fragile X (which, incidentally, is far higher figure than I’ve seen online, leaving me to feel even more manipulated) was one number that was particularly emphasized. That the actual incidence of the disease was only one in 4,000 was barely mentioned at all. Amynah and I declined the tests, at which point we were forced to rethink our decision by having to sign a ominously-worded waiver absolving the doctors of liability for our choice.

All of which seemed designed to push prospective parents – nervous and overwhelmed as they are – to shell out money for tests that they probably do not need. Meaning the technicians, labs, doctors and pharma-companies are - 3,999 out of 4,000 – wasting their time with tests that needn’t be done, however profitable they might be. While those resources are being consumed, the parents-to-be are sitting on pins and needles and out of pocket to the tune of $2,400, money which might have gone to their child’s college fund.


Jul said...

In Germany I've had various doctors push tests (screenings for things I am not at risk of) which weren't covered by my (public) insurance, claiming that the so-and-so doctors' association recommends everyone get it every xxx months. Luckily I've never had to sign anything when I politely decline.

Shannon said...

We felt a bit pushed too, at Max's 2 year checkup, to give him "optional" vaccines. And some "required" US ones that Canada doesn't require. We declined. We'll see what preschool requires when the time comes.

David Beeson said...

The other side of the coin of your experience is what happens in Britain: you really have to fight with a GP to get a blood test authorised (it's like getting a blood test out of stone). In this country GPs make no money from blood tests. Not that these two facts are related: doctors choose their profession out of a sense of vocation, not a sense of business.