| Johnny AveragePerson is 63 years old and in | | | | Phone: If you are calling about finding a doctor, |
| relatively good health. His wife passed away six | | | | press 1. If you are calling about a claim, press 2. If |
| years ago. He has a daughter living in Florida and a | | | | you are calling about a lost or damaged card, |
| son who lives in New Jersey. Johnny lives in | | | | press 3, If you are calling about our new super |
| Brooklyn, New York and works at a bank, | | | | saver insurance plan, please press 4... |
| commuting into Manhattan each day. | | | | Johnny: Oh what the hell!.... Presses 2 |
| Today is a pleasant spring day in May; Johnny has | | | | Phone: Please enter you medical ID number, |
| just gotten off the morning train and walks into | | | | followed by the pound sign. |
| the corner deli to get a doughnut and a cup of | | | | Johnny: Shoot, where did I put that claim form... |
| coffee. Let's listen in! | | | | Here it is. Presses: |
| Johnny: Let me get a chocolate doughnut and a | | | | 02A9207C1-9965429B....waits....nothing |
| regular cup of coffee with half and half. | | | | happens...oh...presses # |
| Female Clerk: Can I see your medical ID card? | | | | Phone: Thank you. Please wait while we retrieve |
| Johnny: Here you go (Digs in his wallet and hands | | | | your records....OK, I've got your records here. |
| her the card) | | | | What would you like to do? Press 1 if you would |
| Female Clerk: Sir, I just scanned your card and it | | | | like to find a doctor, Press 2 if you are calling |
| says that your cholesterol is high. | | | | about a claim... |
| Johnny: I know, I just saw the doctor yesterday. | | | | Johnny: I just did this!! |
| He said it was a bit high but that it wasn't | | | | Phone: I'm sorry, I did not understand you. Press |
| anything to be concerned about. | | | | 1 if you would like to find a doctor, Press 2 if you |
| Female Clerk: It's above the limit to sell you a | | | | are calling about a claim... |
| doughnut. | | | | Finally after about 45 minutes, Johnny gets |
| Johnny: That's ridiculous! I always get a doughnut | | | | someone on the phone |
| in the morning. | | | | Medical Rep: Good afternoon, this is Emir, how can |
| Female Clerk: I'm sorry (Hands Johnny back his | | | | I help you today? |
| medical ID card). | | | | Johnny: OK, I fell about two weeks ago. I hurt my |
| Johnny: Look, the doctor said my cholesterol | | | | ankle and they said it was a sprain but it's been |
| wasn't even high enough to warrant giving me | | | | two weeks and it still really hurts. I haven't been |
| Crestor. He said he would prescribe Crestor but | | | | able to get any pain killers and I can't get an |
| he could only prescribe it if my cholesterol was | | | | appointment with the doctor because my card |
| higher! | | | | was damaged and I haven't gotten any money |
| Female Clerk: Would you like a bran muffin? | | | | back either and I've got bills to pay. |
| Johnny: No! I want a chocolate doughnut! | | | | Emir: I think I can help you with that sir. May I |
| Female Clerk: I'm sorry. Look, there are other | | | | have your medical ID number? |
| people in line. I can't sell you a doughnut. | | | | Johnny: 02A9207C19965429B |
| Johnny: So my cholesterol is too low to get | | | | Emir: OK, I see your record. You sprained your |
| Crestor and too high to buy a doughnut. | | | | ankle. |
| Female Clerk: (Getting annoyed) Sir, I don't make | | | | Johnny: I think it's worse than a sprain. This is |
| the rules. Now if you'll excuse me... | | | | killing me! |
| Johnny is so irritated when he walks out of the | | | | Emir: Well, the x-rays were negative. I see that |
| store that he trips on the door jam and falls | | | | you're 63 years old. Would you like to set up a |
| awkwardly. He hurts his ankle and can't get up. | | | | counseling session? |
| The clerk, with an annoyed look on her face, calls | | | | Johnny: Counseling???? What the f#@% do I |
| an ambulance which arrives an hour and a half | | | | need counseling for? |
| later. They scoop Johnny up and take him to the | | | | Emir: We would have to schedule an MRI to see if |
| hospital. At the hospital, they take x-rays. The | | | | there is any damage but that is very expensive |
| doctor walks into the room holding a chart and | | | | and anyone over 60 is recommended to take |
| smiles at Johnny. | | | | counseling before we put them on the MRI |
| Doctor: He puesto toda la informacion en su carta | | | | waiting list. |
| medica. Lleve la carta a una farmacia y ellos la | | | | Johnny: I'm really in pain here. |
| prepararn la receta. | | | | Emir: OK sir I can do that for you. I have to tell |
| Johnny: I'm sorry I don't speak Spanish | | | | you though, that for people your age, I can't |
| Doctor: Enfermera!! | | | | guarantee an MRI for anytime within this month |
| Nurse: The doctor is putting all the information on | | | | or next. There might be an opening in July. |
| your medical ID card. Take the card to the | | | | However if you take the counseling session, you |
| pharmacist and have this prescription for painkillers | | | | might be able to get in there earlier. |
| filled. He is listing this as a severe sprain so you | | | | Johnny: I'll take the counseling session, if that's the |
| should be good to go back to work in two weeks. | | | | only thing I can do. |
| It's all down in your card so you shouldn't have | | | | Emir: Very well. I can do that for you sir. Can you |
| any problem with work compensation for lost | | | | make it on Tuesday the 14th? |
| time. | | | | A meeting for counseling is set up. Johnny's ankle |
| Johnny hobbles out of the hospital on crutches | | | | has gotten very bad. He comes into the meeting |
| with a soft cast on his foot. He heads to the | | | | sweating, not feeling well at all. He meets with a |
| nearest pharmacy. | | | | counselor by the name of Mica. |
| Johnny: Hi, I want to have a prescription filled. | | | | Mica: Mr. Averageperson, I'm very pleased to |
| Pharmacist: Well, let's just see what we've got | | | | meet you! Please have a seat! |
| here. May I have your medical ID card please? | | | | Johnny: Thank you. Listen I'm really not feeling |
| Johnny hands over his card... | | | | well. I don't need counseling. I need to see a |
| Pharmacist: Let's just put it in the scanner.... | | | | doctor. |
| Johnny: Is there a problem? | | | | Mica: Mr. Averageperson, I think I can arrange to |
| Pharmacist: The scanner doesn't seem to want to | | | | get you pills that will make you feel better. |
| read your card. Did you put your card next to a | | | | Johnny: That would be great. |
| magnet or some electronic device? | | | | Mica: I'm going to be very frank with you Mr. |
| Johnny: No | | | | Averageperson. Looking at you I can see that |
| Pharmacist: Well, I'm afraid you're going to have | | | | you are not well. The government just has so |
| to fill out this form to get a new medical ID card. | | | | much money to spend on care and there are |
| You have to send the card and the form to this | | | | people who have a better chance of living longer, |
| address, along with a $75 fee and you should | | | | healthier lives than you do. |
| have your new ID card in about 2 weeks. | | | | Johnny: I just hurt my ankle. This can be healed. |
| Johnny: What about my pain killers. I'm in pain | | | | Mica: But at what cost Mr. Averageperson, at |
| here! | | | | what cost? |
| Pharmacist: I can give you Advil, that's it. I'm really | | | | Johnny: I'm not an old man! |
| sorry. | | | | Johnny disappeared soon after that. A couple of |
| Johnny leaves the pharmacy and hobbles home. | | | | people in the Health Administration Department |
| About two weeks go by. Johnny has not received | | | | were reviewing some files and came upon that of |
| his new card yet. He has not gotten paid anything | | | | Johnny Averageperson. |
| from work or workman's comp, or anything to | | | | Person 1: We really didn't handle this case well. |
| cover his medical expenses. Worst of all, the pain | | | | This person should have gotten earlier treatment. |
| in his ankle has gotten worse, not better. He can't | | | | Person 2: Perhaps, but we must have saved, |
| wait anymore and calls a number to get some | | | | what, $50,000 all told? Maybe $100,000? Isn't it |
| help... | | | | our job to save money? I think we've handled |
| Johnny dials the phone: | | | | this case extremely well! |
| 1-8-8-8-U-S-A-H-E-A-L-T-H-C-A-R-E | | | | In a small town in Arizona, a person by the name |
| Phone: Welcome to the United States Health Care | | | | of Jonathan goes into his mailbox and pulls out an |
| System. Para informacioan en espanol, marque | | | | envelope from the government. It contains a |
| ocho | | | | check made out to Jonathan Averageperson for |
| Phone: If you would like to participate in a brief | | | | $106,000. Itemized for an MRI, x-rays, lost |
| survey, please press 7 now. | | | | wages, medication and other incidental expenses. |