Saturday, 31 January 2004 09:00

If health insurance were like auto insurance

Written by Dick Strom

"Looking at your X-rays, your right hip is pretty shot… must be painful." I couldn't help noticing the way Dr. Jack looked at me sideways, sizing me up, a few gold crowns gleaming through a cryptic Rhett Butler sneer that, lacking only a cigar, would have pegged him a dead ringer for a used car salesman, not a surgeon. 

"It's hard to get more than a few minutes sleep at a time," I admitted, "And I'm not getting around like I used to…this hip is definitely slowing me down."

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"Well, even without the X-rays I'd have said you're a prime candidate for my hip replacement surgery, and I'm the man your insurer sent you to, so I guess we're stuck with each other, right?" Dr. Jack concealed the latter part of this comment somewhat under his breath.

"My family doctor suggested I have Dr. Sorenson do the surgery because of his reputation for thoroughness and lack of comebacks. But my insurer said Sorenson was running a drug lab out of his office, and stuffing baggies of dope in his patients during surgery… that they'd be carrying the stuff around until Sorenson sold the secret locations to some pusher, who'd someday cut him open for the dope he didn't know he was carrying. Two surgeries for the price of one," I nervously laughed. "Anyway, my insurer insisted I get a second opinion, from you."

Special promotion!

"You're in luck because we just happen to be running a special promotion on hip replacements this very week… three for the price of two, non-transferable of course, and prepaid deductible… long as we knock 'em out at the same time. Now, how's that for a bargain?" Dr. Jack prodded.

"But I only need the right one replaced now," I protested, "And maybe have the other done in a year or so. Besides, isn't it a lot more difficult doing both hips at the same time, I mean, how would I get around and all?"

"You're not a sissy, are you? We can whip 'em both out at the same time a lot faster than individually. We just knock you out a little longer, and from any mistakes we make on your right hip we'll be able to make up time on the left one. Like they say, 'practice makes perfect.'"

"Uh…," I hedged, "But if you performed this surgery what options do I have concerning the replacement parts... what materials are the stem and socket made of?"

"Figured you'd go there!" Dr. Jack mumbled to himself, rolling his eyes. "Well, lets see, there's the titanium ball and stem version that's been used for years, but that's terribly expensive and, to be quite frank, terribly antiquated, outmoded. This is the 21st Century, man…the new age, and we've been experimenting with several new prosthetics that recently came on the market.

Insurers are giving 'em rave reviews. They're the 'cat's meow' in bone replacements - they're cost-competitive, don't set off the buzzers in airports, and are even helping bring down the cost of those old-fashioned titanium joints. Good ol' Yankee ingenuity… free enterprise marketing, and all that rot - don't 'ya just love this country? Where else, but in America!"

He continued, "Those fancy-dancy titanium joint makers thought they had the corner on the market, but we showed 'em. Insurers have unclogged the strangle-hold the titanium boys had on our beloved free enterprise system, and in the process givin' you choices…. CHOICES… do ya hear me?" Dr. Jack flashed his creepy smile at the mirror.

Like, kind and quality

"Your first choice is one the recycling groupies can sink their teeth into. We can replace your worn out parts with 'previously owned parts.'" My stomach began a syncopated convulsing as my mind panned in on a ghastly scene of green, molding, shriveled up corpses, eyes sunken, jellied. Dr. Jack immediately started pumping up the positives of using "recycled"… obviously there was money to be made using previously-owned parts.

"These are true Like Kind and Quality, Original Equipment parts - we call 'em LKQs - and they're a real bargain 'cause my insurer-buddies have worked out a deal with another business down the street. The way they're looking at it, in open casket funerals no one ever opens the lower half of the casket, so no one's the wiser if the poor stiff is missing a few LKQs, - it's not like he's going to get up and walk out of there, ya know." His mind wandering for a moment, he blurted out before he could catch himself, "Man, can't ya just see that… a stiff crawling out of his casket and floundering around on the ground trying to stand up!" But he quickly snapped back into reality and, leaning into my face, almost at a whisper, confided, "We get tons of good, serviceable LKQs before a stiff's remains are cremated, but I didn't tell ya that."

Putting some space between us, he continued, "And as long as we use recycled, and do both sides at the same time I don't see why you shouldn't be standing up fairly straight… you might be somewhat taller than you were before, but hey, the gals I run around with love taller men. And if the recycled parts are different lengths side to side, we can lengthen or shorten 'em to match. Of course, insurers won't pay for alterations, or for cleaning up LKQs… or, for that matter, for the materials used in alterations. But not to worry, we'll make it up somewhere in the operation so you don't have any out of pocket expenses. We're real creative at making up for all the 'not included' and 'cost of doing business' items insurers refuse to pay for."


Other options

I hesitantly ventured, "And the optional procedure you mentioned?"

"Oh, that." Dr. Jack glanced into his mirror again, practicing his smile. "Yes, you certainly do have options when you deal with us." I sensed the salesman in him beginning another pitch. "Ya know how all those Asians are known for the advanced scientific healing potions they conjure up with bats ears and frog warts, and the like? Well, insurers have worked out a venture deal with some South Korean manufacturers to flood the U.S. market with identical copies of that ridiculously expensive titanium joint your family doctor wanted you to have." He leaned in close again, "Lets face it, if your doctor was any good, he'd be a surgeon like me, not some yokel getting his kicks by thumping people's knees. Trust me, I know what I'm saying when I tell you these Taiwanese babies are the wave of the future. They're way ahead of their time, insurers have certified them through their Certified Anatomical Prosthetics Association (CAPA), and they're a fraction of the cost.

"And, if by some off-the-wall chance one of these Platinum Pluz units should fail prematurely, remember it's fully guaranteed to be as good or better then that outmoded titanium version. If this baby falls apart early, just remember your titanium one would have failed even earlier. You've got my word on that! That's why we're running our 'three-fer' deal right now - if one of these babies blows out on you, we'll just slice you open again and slap in another unit. Bet your fancy-dancy titanium unit doesn't come with a guarantee like that!"

"But how can Koreans make these replacement joints so much cheaper?" I asked, confessing that I wasn't particularly crazy about the thought of having an operation in the first place, let alone the possibility of a re-do. I didn't think I was asking too much.

Free enterprise alive and well

"Well," Dr. Jack continued, "Like I was saying, it's all in the manufacturing process. Labor's very reasonably priced over there and, well, we're doing our best to raise their standard of living. We should feel privileged using these cost-conscious knockoffs, knowing that you're making a difference in this old world by giving these foreigners a chance to better themselves, have a steady job for the first time in their lives, pay taxes, and all. Give 'em a taste of that good ol' American free enterprise spirit," he nearly shouted, at a frenzied pitch, as stars emanated from his toothy grin, and stripes rolled in the breezy, distant reflective look in his eyes.

I had to wonder, as Dr. Jack laid heavy emphasis on the 'we', which joint option he would have opted for if it were his leg on the chopping block.

His head undulating like an Ichiro Suzuki bobble-head doll, searching the recesses of his mind for the place where he'd left off from what his insurer-partners had programmed him to say. "Lets see," he mumbled to himself, "They're cheaper because of the high-tech manufacturing process they use over there, and because their labor's dirt…uhhh… their technicians' labor rate is much more in line with reality, and uhhh…" Dr. Jack was definitely struggling, his mind deeply mired in a 'senior moment' even though the only two diplomas on his wall, one from the Insurance Criterion for Anatomical Repairers (ICAR) Institute, the other from Anatomical Structure Excellence (ASE), proved he was barely through with peach-fuzz-and-pimples.

I prompted him, "Does the material they're made from affect their low cost?"

"That's it! That's it!" He sparked to life again. "It's that new high grade metal they're making 'em from - this stuff is so high-tech that it actually glows in the dark… talk about a trip, man!" I was beginning to think he'd spent too much time on "trips" - and wondering if we were both talking about the same type of "joints."

"Glows in the dark?" I asked. "What kind of metal glows in the dark?"

"Couldn't say for sure," Dr. Jack replied. "But they told me it's recycled top quality stuff from power plants… something like that. I was curious about where it came from too, and why it glowed, but they said they'd fill me in on all the details some day, though at the moment they were in a big rush to promote their program to other surgeons. Anyway, it's gotta be some awesome metal for the nuclear industry to have used it!"

Upgrades - pay for it yourself

"There's one other minor detail I should mention that'll help you decide which joint option you'd rather have" Dr. Jack continued. "Since all my surgeon colleagues have agreed to push the use of the "recycled" and Taiwan options, they're now considered the standard of excellence, and this is all insurers will pay for. What I'm saying is that if you want titanium you'll have to pay the difference yourself. I've found ways to cut a lot of corners in this procedure, but there's no way I can slice enough out of this job to cover the cost of that expensive unit… unless I don't sew you back up afterward." He was joking… I'm sure he was just joking.

Dr. Jack moved on to the very last detail. "Usually we have to put you out during this operation, and to do that we use one of these harmless looking little plastic masks." As he dangled one menacingly close to my face, my mind momentarily diverted to those flight attendants droning on and on about what to do in case of an emergency.

You are getting very sleepy...

The mask. Dr. Jack now dangled before me looked suspiciously like the ones that magically pop out of some compartment above you when your plane is about to crash, giving you a good shot of oxygen so you don't pass out and miss any of the action. "Only our mask feeds you anesthetic to make you get sleepy and forget the pain your body is going through. Here, try this one on just for fit," Dr. Jack said as he slipped it over my nose and mouth. "This'll give you an idea how painless the operation will be." Out of the corner of my eye, I notice Snookie, his nurse, fidgeting with the top of a nearby tank.

It must have been the mental drain of trying to comprehend all the nuances of the options Dr. Jack laid out before me, but all I wanted to do just then was sleep. From somewhere far, far away I heard a faint cackle, followed by an ever-retreating voice, "Quick, Snookie, turn up the gas just a little… not too much, though… insurers haven't paid for anesthetics for years. While I slice and dice him, you grab a couple of those universal "glowey" units from the fridge. We should have this sap wrapped up in half an hour flat, and when he recovers we'll tell 'im we installed those fancy titanium units he wanted… and saved him 20%! I always feel better about using those Platinum Pluz units anyway… everyone knows platinum's better than titanium."

But by that time all I wanted was sleep.

Postscript: O.K., so the above story is a little far fetched… at least far fetched for the medical industry. But I did have my right hip replaced by Dr. Sorenson (who doesn't run a drug lab), and will have the left one done at some future date. I was walking on my new hip fairly normal, and without aid, a few weeks after the operation, and sleeping and getting around pain-free for the first time in years. I'd recommend this operation, performed by a competent orthopedic surgeon, to anyone else who has been hobbling around in pain, putting off the inevitable.

A word of encouragement: My hospital roommate following surgery, an avid ice hockey player in his early 60s, flew to Seattle from Alaska to have his hip replaced at this hospital on the recommendations of several northern friends, one of whom had both hip joints replaced at the same time, and was back to running 26-mile marathons within the year. Modern medicine has come a long way and I encourage you to benefit from it, if you've been putting off a needed operation.

Dick Strom, Modern Collision Rebuild, 9270 Miller Road, NE, Bain-bridge Island, WA 98110; (206) 842-8056; email: moderncol@aol.com.