Mr. Kafka, call your office

April 03, 1997|By Jeffrey M. Landaw

''Why was Jesus born in a manger?''

''Mary and Joseph had an HMO.''

-- American folk wisdom of the 1990s. ALL RIGHT, STEVE FORBES, Jack Kemp and the rest of you. You win. You can have your flat tax, if -- if -- you give people like me something for it. That something is a single-payer health-care system.

You say the flat tax will let us concentrate on doing productive work or spending time with our families instead of keeping records and figuring out ways to outwit the system. It sounds fine. But what the flat tax might give, the health-care bureaucracy takes away, with interest.

Between strep tests and amoxycillin prescriptions, what the flu season this mild winter brought on was a bonanza for paper-makers. We go through acrobatics every billing period trying to figure out what we owe each of our doctors, and what we and they (or their staff -- who remembers when a doctor's staff consisted of a nurse and a receptionist?) can persuade the walking dead at our medical plan to cover.

That's been bad enough. Now I'm carrying a package the size of a small textbook, full of information on the new health plans among which I have to choose in less than 30 days. Just hauling it gives me tennis elbow; trying to figure it out requires the combined talents of a stockbroker and a Talmudist.

You flat-taxers say, when you say anything about it, that the new world of managed and profit-driven health care will give us oodles of exciting new options while it keeps the costs from bankrupting us all.

I can believe the part about keeping costs down, but it looks from here as if the system will do it by making us pay more for less care, or making us fight the bean-counters every time we want to go to the doctor.

Once we're finished keeping records, dealing with the system's voice mail, copying our papers and writing letters, what's happened to the time, effort and emotional strain the flat tax was supposed to have saved?

Three people arrive at the gates of Heaven. ''Why should we let you in?'' asks the admitting angel.

''I spent my working life curing the poor and sick,'' says the first. ''Come in,'' says the angel.

''I invented a drug that saved millions of lives,'' says the second. ''Come in,'' says the angel.

''I saved hundreds of hospitals from bankruptcy by perfecting the HMO,'' says the third.

''Come in,'' says the angel after a long look at his computer, ''but you can only stay three days.''

--More American folk wisdom

We think -- we hope against hope -- we've figured out the system for next year. While our current medical plan keeps us on hold, we list all the doctors we've used or expect to use. Eight out of 10 are in the new plan we're expected to choose -- a serviceable grade -- but wait! Doctor No. 9's office says they may accept assignment (yes!), while No. 10, an arm of Johns Hopkins, no less, says the insurer sent them a letter saying the practice doesn't meet its parameters.

When we called the insurer, we learned that the parameters the practice doesn't meet are ''variable'' and based on ''circumstances.'' Did somebody leave a call for a Mr. Kafka?

You flat-taxers and entitlement reformers seem to accept all this as the price of progress. Which makes me think George Will got you right: ''Social Darwinists secure in cocoons of abstraction.'' I might not have been so kind myself.

Send in the bureaucrats

Moving to managed care might even increase bureaucracy instead of reducing it, as Congress and the states move to protect patients from the bean-counters. New York's Sen. Alfonse M. D'Amato already has taken a warning shot from the Washington Times for proposing some controls. Bills are moving through the Maryland General Assembly to provide appeals for patients, force disclosure of HMO operations in plain English and let doctors make decisions about hospital stays. And President Clinton announced a commission last week that would develop a ''bill of rights'' for patients.

In a recent episode of the TV series ''Chicago Hope,'' the blubbery, suspender-wearing head of an HMO (suspenders are as reliable a mark of villainy in contemporary melodramas as waxed mustaches were in those of a hundred years ago) ranted in a high-pitched voice that health benefits had spoiled the American people as he toyed with his collection of mounted butterflies. Wildly over the top, but I suspect the prejudices it expressed will find a lot of resonance in the country.

The choices a single-payer plan might take away from us all seem to be the ones we don't want or are losing anyway. If all we have to do is fill out one set of forms, and then show a card every time we go to a doctor or a druggist, maybe we can actually find better uses for our time than trying to dig up every piece of paper we've filled out since the top doctor TV shows were ''Ben Casey'' and ''Dr. Kildare.''

Wallace Stevens, the famously difficult poet, worked for an insurance company -- and come to think of it, so did Franz Kafka. Where do you suppose he got his ideas?

Jeffrey M. Landaw is a Sun makeup editor.

Pub Date: 4/03/97

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.