what is wrong with america's health care system?

ok, i am officially p*ssed off at the american health care system, and here's why: you get penalized for being proactive. let's face it: in america, you have to literally be *dying* for certain kinds of tests or screening to be authorized and paid for by the insurance companies. you can't just waltz into the doctor's office and say that you want a blood test or an mri just to make sure everything is ok with you. you have to have a "medical" reason for it, otherwise, you have to pay out of pocket for the tests.

the u.s. is one of (if not the) only industrialized nation that does not provide universal health care to its citizens. i mean, even cuba, which is neither industrialized nor even democratic, provides subsidized universal health care to its citizens. why we in america can't have the same benefits afforded to our citizens beats me. even if you are one of the lucky few to be privately insured, there is no guarantee that the insurance companies will pay for your medical expenses, it all depends on how the medical provider "codes" your visit.

an example: my friend pili felt ill on christmas eve last year, so she went to the emergency room. after an examination, the emergency room doctors determined that she'd just had what they deemed a "mild" heart attack (gasp!). it turns out pili had coronary artery disease, with three arteries blocked at 99%, 95% and 85% respectively, and another blocked at 40%. she was scheduled for surgery to place heart stints in her three most clogged arteries, and when she inquired about the fourth, she was told that it was not sufficiently blocked and that she had to wait until it was blocked at least 80% so that they could operate on her. when she pressed on for further information, asking what would happen if she wanted all four of them to be stinted so she didn't have to go through surgery again in the future, they said that it would not be covered by insurance if it was not medically necessary..."not medically necessary"?!?! pili had just had a heart attack for pete's sake!! so now, not only is she worried sick that her artery may get worse, but is now under heavy medication precisely to prevent that, which keeps engrossing the arcs of big pharmaceuticals and the insurance companies, while diminishing her quality of life.

another beauty: i called my insurance company a few days ago to ask about my annual well woman visit as my doctor had advised that, in their experience, only one visit was allowed every 365 calendar days. i was put on hold for what seemed like hours and when the customer service rep finally got back on she said that it was ok to go sooner than 365 days as my insurance company would pay for two "routine" visits per calendar year...screeeech...two routine visits? i asked. what do you mean by "routine" visits? she said that routine visits were basically "preventive" care visits that you make to a general practitioner or family doctor when you do not have a "medical reason" for going (translation: when nothing's hurting).

obviously this explanation didn't sit very well with me and, as a good auditor, i continued to inquire:

me: what happens if you want to have a third "routine" visit?
insurance rep: you have to pay out of pocket for it.
me: so you are telling me that i am penalized for being proactive and wanting to get a checkup even if nothing is essentially wrong with me?
rep: yes, basically.
me: what happens if there is, say, family history of cancer or other hereditary diseases and i want to get tests performed more often or at an earlier age than the "medically recommended" age?
rep: unless you can prove that you have a first degree relative that had the disease, it will not be covered by insurance .
me: what happens if i go to the doctor and say that something is hurting just to get a particular kind of test, will insurance cover that?
rep: well, depends on how the doctor codes your visit, if they code it as a medical reason, then yes, it will be covered.

i later googled "medical billing codes" and found out that these codes are what insurance companies use to determine whether they will cover whatever procedure you are having done. obviously "being proactive" is not one of the codes that is covered...