July 1st, 2009
02:13 PM ET

Will reform stop people from working the system?

By Caleb Hellerman
CNN Medical Senior Producer

Tuesday afternoon, I was hanging out in Harlem, working on a story we’ll be running later this month. A few blocks away, the barricades were up and police were directing traffic around the Michael Jackson tribute at the Apollo Theater.

Donald Childs, a bicycle repairman, was holding court on the north side of Marcus Garvey Park. Looks like Jackson was working the system, he told me, finding doctors all too willing to give him whatever he asked: “Yes-man health care.”

People in poor neighborhoods work the system, too, Childs said. “You go to a clinic and wait for hours to be see anyone. Poor people, people around here, just expect that. It’s the norm. [But] they know what to do if you really need a doctor. You go to the emergency room and you tell ‘em it’s asthma, or a heart problem."

“My wife has pancreatic cancer,” Childs confided. “But when she goes to the emergency room, and she needs to be seen right away, she tells them it’s her heart.” It was painful to hear, but sad to say, not surprising. I’ve talked to a lot of people who struggle to find decent care for cancer.

A few yards away, I heard more about gaming the system. “There’s a dentist’s office at ____; they’re paying homeless people $10 for their Medicaid number,” Heidi Flores was saying. “There’s another one pays $15.” [With a Medicaid number, a doctor or dentist can file claims for reimbursement – in this case, presumably, for nonexistent services.] Her friend, George Cabassa, chimed in. “There’s another one where they give you a cleaning but they tell Medicaid they did everything and the kitchen sink.” He told me to check it out, handed me a phone number and strolled off.

No surprise here, the health care system we have is maddeningly complex. It’s full of rules, full of odd financial arrangements and full of loopholes.

Monday evening, I found myself relaxing in the office of the Rev. Dr. Joe Bush at Walker Memorial Church in the South Bronx, listening as he argued that we need something simpler: a government-run health system like the ones in Canada or Western Europe. The air conditioning felt good with the sidewalk still sweltering outside, but the pastor was getting agitated.

“The first thing they ask when you step up to the counter: ‘Where’s your card?’ It’s all about the almighty dollar.”

I asked about his own health coverage and learned something new: According to Bush, insurance companies consider pastoral work to be a high-risk profession – high-stress, with associated health problems. To cover himself and his wife, Bush pays $27,000 a year for a policy with a $2,000 deductible.

When I asked what he thinks of the argument that a “public option,” or government-run insurance plan, might drive private companies out of business, his answer came as no surprise: “That would be a wonderful thing,” he said, a smile lighting up his face. “It would be the best thing that could happen to America.”

That might be a dramatic point of view, but riding home on the plane I found myself wondering if a government-run system would make a cancer patient lie about a heart condition, just to get a doctor to take her condition seriously.

Did you ever lie or shade the truth, talking to a doctor, hospital or health insurer?

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