Expected Surprises
It was 1981. I was about to graduate from a top law school, with honors. I had worked as nursing administrator at a major urban hospital before going to law school, learning a tremendous amount about the challenges of delivering patient care. It inspired a passion in me to improve the system while also opening a door to a job as a law clerk for one of the largest firms in the Nation specializing in health law.
The time seemed right to attack something that had been bothering me about the health care system- my health insurance coverage. Not the coverage, per se, as I was young with little need for coverage other than an occasional broken bone and peace of mind for some unlikely calamity. No, what was bothering me was the actual policy, the long and jargon-filled document sent to me whenever I paid my annual premium.
I had skimmed through it before- and couldn’t understand it. Now, with my years of knowledge and experience, I thought it time to unravel the mystery of this document. Surely this would provide me some answers to the craziness of the health care system I’d confronted as an administrator and at the law firm. Maybe it would even offer some rationality to what seemed like a very disorderly system.
One quiet afternoon at work, I took out my contract from my book bag, gathered my pencils and rulers that I used to review legal documents for clients, and began to pour through the document.
Minutes ticked off the clock as I toiled away. Then an hour, heading towards two. I put down the contract and contemplated what I had learned. I had to face the reality of my research- I didn’t have the foggiest idea what the contract said or meant.
I felt a bit like an idiot. My mind shifted to discerning why this was so. Not wanting it to be my mental defects, I dug for a better explanation. Two thoughts came to me- it was either the most complicated system known to mankind that could produce such a document, or the authors were intentionally using it to hide something.
I also contemplated it in the bigger picture. If I couldn’t understand this contract, with my background and recent experiences, who could? Not many, it seemed. No, this wasn’t a health care system easily explained to – or understood by- most Americans.
Forty years later, I now know this is the case. I’ve had experience after experience in my professional life, and a few personally, that reinforce my conclusions from 1981. That it is both an obtuse system and intentionally complicated by those in control of it.
I guess that would be fine if it was working well. Few think it is, despite the clinical miracles that occur every day. And while there are mysteries of clinical care and other matters that will always remain technically beyond the grasp of many of us, the relationship of these matters to our personal state of being and wellness cry out for greater individual knowledge and involvement.
We know it has an attraction, as many have pledged their belief in related concepts, or at least for marketing purposes. Many a health care system or provider brags of their “transparency”. Or their “patient centeredness”. Some claim that it is the defining difference between them and their competitors.
Maybe so. My experience has found some who really believe this, and a lot who mostly like the possibility that the brand might curry favor from the public, while leaving them still in the dark.
The gap of understanding about the health system to people has real consequences. A good contemporary example is surprise billing, where a patient discovers after their care that they owe all sorts of money because of the consequences of some largely unknown part of their health insurance contract or practices.
The discovery usually comes in the form of a bill, or worse, a bill collector, unleashed by the health care provider. Sometimes for tens of thousands of dollars. Let’s be clear- it might be a surprise, but it is not entirely an unexpected one.
Another contemporary issue is hospital pricing. Laws have been passed to help consumers to shop based on price- for various services and tests. Good luck trying to navigate what is out there as tools for this, though many of us find that the spread in prices is a large one across the system if we can get the information. It doesn’t necessarily help us with our choices, though.
Maybe solutions to these and other problems will finally lead the way toward helping the average person and buyer understand the system and what it means to them. But it sure seems like there is a long way left to go to get to this reality.
The Washington Health Foundation has explored this territory before. Back in 2010, we formed a Center for People’s Health, and used this to explore innovations to truly build health care around people. We based much of our approach on Donald Norman’s work on user friendly consumer design in his groundbreaking book “The Design of Everyday Things.” We even held a symposium on redesigning patient care around the person.
Our most important innovation was the design and production of a series of “Health Home Tools”. We still have over twenty of these tools free to anyone who wants to download and use them. They can be found on our new website at washhealthfoundation.org, under the Tools and Resources section. They cover a variety of topics, such as “Managing Your Hospital Stay”, or “Rx for Your Physician Visit” a guide to taking control of their physician office visit. Some of our tools are available in Spanish.
Perhaps we will get to develop more of these tools as we figure out our next steps as a Foundation and change agent. Or perhaps we will act more in policy circles. But for sure, the notion of building a health care system around the people it serves will remain a core tenet of our work. This blog rekindles our intent to do so.
All I ask in return, personally, is that I don’t have to try and read a health care coverage contract again.