By on March 23, 2016

Blue Cross, Blue Shield, red tape.

JACKSON HOLE, WY – Last year, I hurt myself at one of my jobs. Or, more accurately, a chronic injury I got from working that job got bad enough that I decided to report it and get it looked at. There’s a system in place that’s theoretically designed to protect workers who are hurt on the job: the worker’s compensation program.

My employer sent me to the emergency room to get it screened. They referred me to an orthopedist who examined me and ordered an MRI, after which they told me I had medial epicondylitis. It’s a condition otherwise known as golfer’s elbow, but mine is definitely not from playing golf. It’s a pretty common injury for people who load luggage onto airplanes, as I do.

I had the initial worker’s comp claim approved and was referred for physical therapy. After racking up a few thousand dollars in bills, I was told that my claim was being denied because I couldn’t prove that the injury was a result of work.

I clearly think that it was, but I’m not going to try to argue that here. What I want to talk about is what’s happened since. My claim was denied by someone at the state level—not a doctor, nor someone who ever examined me or discussed the injury with me.

I was told I could appeal. I did. I was told I would be scheduled a hearing, but it wouldn’t be for five months. I was told I had the right to representation, so I applied for that. That’s a lengthy and time-consuming process. I’ve been sent documents regularly. These are documents that I have to read carefully or risk losing my appeal. They are long, technical and full of legal language. I’ll have to attend an appeal hearing somewhere, probably out of town. And after doing all of this, I’ll probably lose because the burden of proof is on me, and last time I checked, I’m not a medical expert.

I’ll probably just pay these bills and move on at this point. Luckily, I’m a single white male with a decent job and a relatively stable income, and while it’ll hurt, it’s not going to keep me from eating or paying the rent.

But think about how insanely stupid this whole process is. The state is going to spend more money fighting this claim than they would if they’d just pay it. And I’m going to forgo physical therapy, which I need to keep the injury from getting worse.

So why do they do it? Well, there’s a lawyer somewhere (two, actually) who will get paid. But maybe, and most importantly, our society gets to keep insisting that working class people jump through hoop after to hoop to get any kind of help.

We set up these complex systems so that no one ever gets something they didn’t work for. (Or rather, so that working class people don’t ever get things they didn’t work for. It goes without saying that this doesn’t apply to the wealthy.) And the costs imposed on people are real and much higher than people realize.

How is a person without a law degree or a medical degree, who is working three minimum wage jobs to support a family, going to find the time to go through this appeals process? How would they find an extra $3,000 to pay the bills if they lose? They aren’t. If they get treatment, they might end up with their credit ruined. More likely, they’ll realize this and just never report an injury in the first place. And never get treated.

The idea for this column came from a Facebook post from a friend, who wrote:

“I’ve been dealing with Blue Cross of WY for the last two weeks trying to get a prescription filled. It’s been perhaps the single most infuriating experience of my life. I’ve spent over 10 hours on the phone over [the past] two weeks and been given seven different numbers to have my doctor call with a pre-authorization. They are also demanding decade-old medical records that may not even exist. Could be worse, I wonder how many people are at home dying of cancer or AIDS right now without medication? We need single payer [health care]; put all the insurance companies out of business.”

What’s the point in all this? How much time do we waste on both ends of this conversation, multiplied by a hundred million people? How is any of this helping anyone get what they actually need, which is health care?

One of the most frustrating things about Obamacare is the sheer amount of time and complexity involved in both getting coverage and using it. It’s almost like the people who designed it assume that every American has free time to burn or is an expert in the complexities of the insurance business. It also makes the assumption that everyone has an accurate idea of what their future health problems will be, and that they are thrilled to spend their evenings browsing through a wide range of healthcare plans with no meaningful ability to choose between them. Time is money for working people, but you’ll never see that factored into the cost of these plans.

This isn’t because this is a government program, either. Private insurance is worse, and if you think government can’t be efficient, you should probably go apply for title and registration at the county treasurer’s office. (That’s a well-oiled machine right there.)

No, this is the result of an economic system that sees working people as disposable profit centers. The purpose of our working class health care system isn’t to deliver health care; it’s to extract as much money as possible from its customers who have nowhere else to go. One way of doing this is to keep piling up the transaction costs until people just give up.

It’s not just healthcare. The Home Affordable Modification Program promoted by the Obama Administration in 2009 was essentially designed to string homeowners along and extract a little more equity from them while getting banks off the hook for the fraudulent mortgages they sold to working class Americans. The complexity in these programs is not a bug, it’s a feature. The same could be said for the tax code. Those with the time, education, and professional assistance take advantage of these systems; those without just get taken advantage of.

Again, this is not because these are government programs. There is no reason things need to be so complex except that we choose them to be that way. Let’s choose better. PJH

About Pete Muldoon

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