Health reform complexity, contradiction: a case study
Business schools follow the case method.
Social scientists make use of case studies.
Law schools have their students read casebooks.
And medical professionals treat and report cases.
Kathryn Alexander’s case has ties to all those disciplines. Alexander, of Boulder, is an adjunct professor of organizational leadership in the School of Management at Regis University. Although she is now covered by Medicare, she once was part of Colorado’s uninsured population. She’s presented her case in bankruptcy court to free herself from overwhelming medical bills. And she is a survivor of cancer and numerous other ailments.
Alexander’s business and management background gives her a different perspective in critiquing the American medical system as she has seen it in action during more than a decade as a patient.
That background occasionally makes itself known in her choice of words. Who else but a management scholar would speak of the “industrial model of medicine” or would use “not a normal procedure” to describe a late-night fall in the bathroom?
She’s a student of W. Edwards Deming’s management techniques for maintaining industrial quality control, to the extent that she tracks her own medical test results on a spreadsheet. “I was sort of looking for trends,” she says.
Alexander’s health problems began in her 40s when she had to have a hip replaced. Since then, she has suffered a liver tumor, another hip replacement, a third operation to replace her first artificial hip and an operation to remove a ovarian cyst, which led to peritonitis and a hernia operation. She racked up hundreds of thousands of dollars in medical bills and had to file for bankruptcy to protect her home.
She still suffers from chronic hepatitis C infection, which she said she believes she may have had, undiagnosed, for decades. Her own research tells her hep C may have been a factor in her early hip problems and her liver tumor.
Today, Alexander qualifies for Medicare. But even that system has drawbacks. She says that this year, Medicare stopped paying for the test that lets her track how well alternative treatments are controlling her liver problems.
Among Alexander’s other critiques of the American medical system:
- HIPAA, the law that protects patients’ medical privacy, means that she can no longer get names of previous patients from prospective medical providers in order to ask the patients how good their experience with that provider was. “In ’91, when I interviewed doctors, one of the things I asked them was, could I talk to some of their patients? At that time, they would give me the names and numbers of some of their patients, and I could call them. Fast-forward — when I had my other hip done, you can’t get that information anymore, because of HIPAA. So you have no way of finding out whether the doctor you’re talking to is good or not.”
- Many alternative medical techniques are not recognized by physicians and not covered by insurance. Alexander credits Life Vessel treatments and diet supplements with helping control her liver cancer — at a lower cost than chemotherapy — during the 18 months between diagnosis and surgery. “It’s not like it’s an either/or situation, and I wish that the medical profession would get that. They could certainly improve their capacity to help improve people’s health if they’re in partnership with the alternative folks, who look at the body in a different way, and get new, different, information. Because I did not have insurance, I was not forced into, or felt that somehow I had to go (with chemotherapy) because they would quote-unquote pay for it, because I had to pay for it anyway. So I had freedom of choice, and I think that that was actually a good thing for me.”
These are only some of the quandaries facing proponents and opponents as they debate health care reform in the U.S. It is not just a question of regulating large insurance or drug companies. Or setting standards for medical providers. Or figuring out how to pay for it all.
Ultimately, they also must take into account the unique and sometimes contradictory cases of 300 million individual Americans, each with his or her own story and idiosyncrasies.
Of which Kathryn Alexander’s case is just one.