AMERICA HEALTH CARE FOLLIES
With my finger tip, I could feel something on my back, but I couldn’t see it. Since I had been out in the garden, in an area of New England where Lyme Disease is an issue, I thought that might be a tick. I had no friends around, so went to the medical practice, (by appointment and walk-in as well,) where I have gone for years when in the United States. Through a wide glass wall, I could see that the office staff consisted of four administrative types, women busy typing, filing, reading computer screens. There was also a receptionist, two nurses and two young medical assistants (blood pressure takers), also women. I described my problem. “Can’t see what this thing is …. “While I waited, there were three other people in the waiting room, two of whom had appointments for flu or shingles shots. They were taken rather quickly, had their shots, and left. After twenty minutes or so, the other patient was taken. As for me, nothing happened. The nurses and medical assistants in the back office chatted and made entries on charts. After waiting an hour and a half I went to the desk and announced that I would leave. The receptionist, responding to my irritation, explained that I could only be seen by what she called a “provider.”
“Can’t a nurse look at it?” I asked. I am watching one of the nurses chatting in the background, leaning against a desk. The answer in the negative.
But by expressing irritation, I nudged the receptionist out of her chair. She talked to one of the young medical assistants, who, in about five minutes took me into an examination room. She looked and said, “yes, a tick.” I thought I ought then to get the Lyme Disease lowdown, so I waited. 30 minutes later, a proper “doctor,” an MD, the “provider,” appeared, looked at it, said “not a deer tick, nothing to worry about, ” and removed it with tweezers. Three minutes of interaction with the “provider.” Charge $150.
As I left the four administrative staffers, the two nurses, the two young medical assistants, and the receptionist were still chatting and teasing, but looking busy. There was no one in the waiting room.
Now I don’t pretend to understand all the aspects of this ludicrous scene, but I can take a guess: the insurance companies will not reimburse unless the medical issue is considered serious enough to require the attention of a doctor. So a condition that could have been taken care of quickly by a nurse – and surely a RN in this region is as familiar with the identification of ticks as is the doctor – requires the higher priced service. And it is necessary to charge $150 to pay the salaries of the administrative personnel who spend their time dealing with all the different insurance companies, the different forms, etc.
In France, a medical practice requires no administrative staff because there is a single payer for the basic coverage, and all filings are electronic, done by the doctor in the process of the treatment. The patient usually has a supplemental policy, but handles all that filing him or herself. The idea that it requires a medical degree to manipulate tweezers to remove an insect would be seen as downright silly. A walk-in visit to a French medecin general , for me who has no national health coverage, costs about 24 euros, $31.