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A story about our broken health care system.

broken-net

We have a broken health care system. People can’t get the help they need, and the broken parts don’t communicate with each other – as witness this story.

A woman, married and with a child, got pregnant. Her family’s income was about the median for her county, which made her eligible for Medicaid as a result of her pregnancy. Unfortunately, she miscarried. There followed several months of unexplained abdominal pains. Doctors and specialists were unable to diagnose them. They told her if she was in pain, go to the ER, which she did about a dozen times over six months. The ER, of course, treated the pain but did no diagnostics. They told her to go back to her primary care doctor for diagnosis. But neither the primary care doctor nor the specialists were able to identify a cause for her pain.

Then one day, a PA in the ER flagged her as a possible drug seeker because of her frequent visits. As a result, Medicaid put her on restriction, which means that only her primary care doctor can prescribe for her, and she can’t see any other doctor without a referral, and she can only get her prescriptions filled at one pharmacy (Walmart).

Here’s the fun part: her doctor told her to get a flu shot. Medicaid covers flu shots. However, Walmart doesn’t offer them, and since she is restricted to one pharmacy, she was unable to get one that was covered by her insurance.

Then there’s even more fun: she got pregnant again. She’s allowed to see an OB/GYN, because her primary care doctor referred her. But the OB is not allowed to prescribe for her, nor refer her to any other specialists. For that, she has to go back to her primary care doctor. The average wait time for an appointment is ten days. Ten days, when a woman is pregnant, can make the difference between a healthy baby and a miscarriage.

Her nine-year-old son was also eligible for Medicaid, until the family bought a $2,000 car. Medicaid determined that the car was actually worth $4,000, which put the family over the $3,500 limit for personal assets. That disqualified the son from Medicaid. There is no appeal over the value of a vehicle – they use a table that overrules both actual and market price.

I think Medicaid is a great program. But our system is so flawed that it doesn’t work for many people.

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