søndag 24. juli 2011

In the wake of a Tragedy

Then it happens, 22 July 2011, in the tiny and peaceful country of Norway, the unthinkable but yet quite possible event of a terror attack. The lives of almost 100 people, most of them very young, are ruthlessly and meaninglessly stolen by a man who calls himself a Knight on a mission for his rightwing extremist beliefs. The country is mourning and the world condemn this violence.

The young people who survived the attacks on the Island have shared their stories of a horror hard to imagine. It proves these youngsters have bravely helped each other despite the terrifying death machine they were facing and saved several of their fellows lives. They also speak up for reacting to this terror with more openness, stronger connection between people and resistance to letting the fear manifest itself in our society. I'm proud and moved by the strength of these youngsters and I will support their appeal by doing my part of incorporating the attitude to my own life and relations.

All people, whatever cultural background or religious beliefs, have certain values in common; we all love and care about our close relations, we all seek belonging to build trust, harmony and safety for ourselves and our nearest. Anders Behring Breivik attacks these basic values in a time where the society consists of people from several different cultural backgrounds. He wants segregation, barriers and distance between people rather than cooperation, closeness and openness.

He will not succeed. Instead of responding with fear, individuals will reject his goals and respond by reaching out to all fellow citizens from all different cultural backgrounds and emphasize our common values. Our enemy will be defeated by building bridges instead of barriers, embrace the similarities instead of differences, move closer together by calling all people in our society "us" and the extremists within all cultures, all societies and even potentially within each one of us - as "them."

The source for growth for "them" is fear and the unknown. Perhaps we all at some point during the last days have felt the tight and uncomfortable grasp of the fear. "Them" have pinched us. Today, we all mourn the tragic and meaningless loss of our fellow citizens. In honor of the lost ones, each individual can fight for our common values and destroy "them" by moving closer together, holding each others hands, being there for each other, allowing openness, seeking understanding and respecting our differences. We are all human. We all belong. We need each other to live in peace.

torsdag 7. juli 2011

American Healthcare Interference

If you get sick in America and need medical attention, it becomes a matter of money. Therefore, people invest in health insurance so that when something happens, the least they need to worry about is finances - their insurance companies will take care of that.

Not quite. It seems reality is a bit of a mismatch with this idea.

I came upon an article in the New York Times that illustrates very well the nature of so called health insurance: Insured, but personally bankrupt. The article highlights how most people who become personally bankrupt after illness in USA, are people who actually have insurance. Unless you pay an insane amount of money every month, like $1.000,- (which is equivalent to 5425,- NOK with todays currency rate. Per month.) - you're basically left in the gutter if you should be so unfortunate as to need serious medical attention. If you're in a risk category, like - having a potential heart condition, your insurance will be so expensive that you might be better off without it. Then at least you're not up for surprises. A quick glance at the readers comments to this article shows very clearly how a lot of Americans feel about their health insurance system. Words like fraud, scam, inhumane reappear several times. 

I have gained an experience of my own with the health insurance while living here. Now that I'm pregnant I need to visit the healthcare provider on a regular basis. We are covered well through Helge's employment and financing health issues should't be a problem. So then it should be easy, right?

This is the country of freedom of choice - so choosing the right provider is the first step on the journey of being looked after. But I got to learn quickly that as a patient - you don't choose a provider, they choose you. They will "accept you" only if you have an insurance that they are dealing with. So choices are quickly limited to providers "in-network" with our insurance company, and the easiest way of finding a doctor will be from an address list of in-network providers - from our insurance company. 

Fair enough, limiting my choices might make it easier to find the right place. It would have been really helpful though if the insurance company also had some kind of information about the different doctors in their network to prevent me from going for a bad one. Like, feedback from other users, reputations they knew of - anything. But hey - they're an insurance company not a service provider. They guard the finances, not the people being treated so it is kind of a long shot to ask for. 

So I picked a bad provider. And before I could see any health assistant, I had to fill out a chunk of paperwork for the insurance company - with questions regarding my health history, my husbands health history, my family's health history and my husbands family's health history, questions about recent medications taken and a whole bunch of declarations to sign that stated everything the provider would withdraw responsibility from in case of things going wrong. The paperwork took me about 45 minutes to complete. Then I waited for about an hour more before I was called in. My first visit lasted for nearly 3 hours all together - nearly 2 hours in the waiting room, 5 minutes with the doctor and the rest of the time with a very unfriendly nurse. To be fair I can't really blame the insurance company for that.

I went to this provider a couple of times, but after they lost my urine sample, asked me sensitive medical questions in front of other patients, made me pay extra for having blood drawn (which is kind of standard procedure during pregnancy) and generally treating me like a parcel on a factory belt - I thought I'd better find a different doctor. 

So I did. I picked another one from the list and this time I did some research on the internet as well to check possible online user reviews. I called to book an appointment and the first thing they asked me was "What kind of insurance do you have, m'am." 

This reply seems to be a standard procedure when you call a new provider but it strikes me every time what a financial engine the whole healthcare system is. The providers are not even concerned about your reason for calling before they know how you'll pay for it. 

I told them "Europeiske - or Euro-center." 
"We don't accept international insurance" was the brief reply. 
"But you're on their list of in-network providers" I argued. 
"But we don't accept international insurance" She said again. 
"I got your phone number from my insurance company, and they're not international!" I said.
 She got annoyed and repeated "well that doesn't mean anything - I believe it is international and we do not accept that insurance! Sorry. Have a nice day."

And so started a long string of phone calls between me, our insurance company and the doctors office which ended with our insurance clerk booking an appointment for me. 

The new healthcare provider was - after finally being able to get an appointment with them - far better than the previous one. They could also offer me a choice between seeing a regular doctor, like in the other place - or a midwife with 30 years of experience and very good documentations. I was open to meeting the midwife and check out the natural birth thing and I've continued seeing the midwife regularly. She's great and things have been going well so far. 

Then on my last appointment I was faced with another insurance issue: At the counter, when signing in for my appointment, the assistant told me that my insurance company had refused to pay the charges up till now because they've discovered I'm seeing the midwife and not the doctor. They will not cover midwife assistance, only doctor. So in order to see the midwife that day I had to pay out of pocket right there and then or else we had to swop the care plan and continue the follow up with the nurse and the doctor instead. 

"Is this real?" I thought. My insurance company wants to decide how I'll give birth to my baby and who is entitled to do the regular prenatal check ups on me? They could't care less wether I'm seeing a good or a bad provider, wether I feel well looked after or terrified - but they do want to decide wether I give birth in a safe birth center (with a doctor back-up), or in a hospital, and wether a midwife or a doctor is assisting me.  

"... so how much money are we talking, exactly?" I replied. She said they'd allow me to pay half of the sum to make it easier for me - "that would be $1997,-."

I tried to do the maths to grasp the amount she was asking for but I was too focused on concealing my anger and avoiding breaking out in tears. I decided to refuse being dictated by a totally f... up insurance regime so I pulled out my Norwegian Visa card and drew the 11.000,- NOK from my account. Then she let me through to my prenatal appointment with the midwife. 

The receipt is on it's way to the insurance company and hopefully with a lot of pressure from my husbands employer - they will reimburse it. After all, as expats for DNV we are supposed to be well covered. Still don't know what will happen with the rest of my prenatal care, though. Would be really nice if my own preferences was prioritized. This is the country of freedom of choice, isn't it? 

Thank God I'm not having complications. With all this hassle for a regular check up, I don't even want to think about what insurance joy we might face if I need any care out of the ordinary. Thing is - you really need to be mentally fit for fight to put up with all the negotiations, questions, paperwork, disappointments, reclaim rejections, arguing, phone calls and emails required to get the coverage you're supposed to have. And who are really up for that when they got serious health issues to worry about ...? Be sure the health insurance companies are well aware of that.   

There are several actors in the healthcare industry that contribute to making general healthcare appear inaccessible and problematic. Although the actions and interference by the insurance companies can cause a fair amount of frustration, they are not running the show alone. Medical companies, lawyers, greedy doctors, front ends in the doctors offices and politicians all play their parts. Bottom line is - the health industry is a race about money, leaving the actual patients - who should have been the centre of attention, as nothing but peasants on a large chessboard where profit is at stake. I feel sorry for Americans, and I feel kind of grateful for being Norwegian. In Norway, healthcare might not be perfect, but it is free, covered by the government through taxes. I know that for a lot of Americans this sounds like boundaries of socialism and lack of individual freedom. But at as far as I know - nobody feels like peasants on a chessboard in a game to large to grasp.