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Tuesday, February 22, 2011 

'Unfettered Free Market' Health Care Is A Financial Horror Show

The following article is written by Naomi Lakritz and appeared in the Calgary Herald February 22, 2011:

Barely had Ted Morton announced he would run for the Alberta Tory leadership, than speculation began about the stance he might take on health care.

The Friends of Medicare worry he might resurrect his position from the last leadership race, which was that -as per former premier Ralph Klein's late, unlamented Third Way -Albertans should be able to buy private insurance to pay for private services.

Another aspiring Alberta premier, Wildrose Alliance Leader Danielle Smith, says her party will abide by the Canada Health Act, but she has praised the virtues of private health-care delivery.

After experiencing private health insurance first-hand recently, my question is: Why would anybody subject themselves to such a financial horror show?

My husband, Mark, a health-care professional in Texas, suddenly fell seriously ill in December and was hospitalized for five days.

He has basic health insurance from his employer, but he pays an extra $60 out of his own pocket each month to bring his deductible down. The deductible this year is $900. His insurance company tells him he will have to fork out a maximum of $5,000 himself each year before they will step in and pick up the cost.

So here come some of the bills for his fiveday hospital stay. He has to pay $100 for the emergency room bill and $246 of the $828 for two CT scans.

A doctor assigned by the hospital to see him on rounds sent in his bill for five daily two-minute visits, which totalled $722. The insurance company decided the doctor would only be allowed to bill $312 for those five visits, not $722, and it only covered $250 of that, leaving Mark to pay $62.

"Doctors can bill whatever they want," Mark says, "but the insurance company decides how much the final charge will be."

Not all the bills for that hospital stay have come in yet, but new ones have since been racked up, including a third CT scan.

Mark underwent major surgery last month to fix the problem that caused his illness. He was hospitalized for a week. The bill from the surgeon totals $7,225 for the 2 1 /2 operation. hour The insurance company has informed Mark he will have to pay $1,125 of that out of his own pocket.

Still to come are the anesthesiologist's bill -Mark has to pay 25 per cent of that -and, among others, a bill from the pathologist who examined the diseased tissue that was removed.

His policy covered the lab bill for all the blood and other tests because he is a healthcare worker, but he would otherwise have had to cover 25 per cent. Then, there's the medication.

"A bill for medications in your IV and other drugs they give you in the hospital could easily run into the hundreds," Mark says.

Home again, and in debilitating post-operative pain, Mark received a letter from his insurance company.

"They wanted proof that I needed the surgery before they could approve it, even though it was already done," Mark says. Without the surgery, his illness could have been fatal.

However, the insurance company insisted that he provide them with the doctor's notes, the results of various exams and other detailed information from his file within 40 days of the date their letter was written or they wouldn't cover any of his hospital bills.

He advised them it was his job to lie on the table and have surgery, and it was his job to recover from surgery, but it was not his job as a patient, who was in pain and unable even to leave the house, to obtain, photocopy and mail information from the doctor's files on behalf of the insurance company. They never returned his call.

"Dealing with this process is extremely stressful," Mark says.

There's nothing good about any of this. This kind of financial hit is what ideologues -lost in their free-market dreams -have, in previous messages, proposed for Albertans under the guise of "choice." Choice should offer you something good. I suspect any politician who advocates inflicting this nightmare on Albertans has the best interests of insurance companies, not of Albertans, at heart.

Mark's message to Albertans: "Stick with the single-payer system."

- Lakritz is a columnist for the Calgary Herald.

Regina Leader-Post

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