In the waiting room of the hospital sits a gatekeeper. To this gatekeeper comes a man from the country who is in pain and seeks to gain entry to the hospital.
“Anyone may enter the hospital,” the gatekeeper tells the man. “All you need do is enter through the emergency door.” She gestures toward a wide, swinging door at the far end of the waiting room.
The man approaches the emergency door, then turns back. “How much will it cost to enter through this door?” he asks. The gatekeeper says that there is no way of knowing the cost before the man enters. She encourages him to enter for the sake of his health. “We can settle the cost afterward,” she smiles. “We are not barbarians, after all.”
The man returns to the gatekeeper’s desk and asks her if there is another way to enter the hospital. “I paid for health insurance,” the man from the country says. “I paid my premiums.” He offers his insurance card. The gatekeeper looks at the card and gestures toward a second door at the far end of the room. “Those with insurance may enter through the door for the insured. But first you must complete several forms.” The gatekeeper hands the man a small stack of papers. He returns to his seat. It seems to him that he has filled out these forms many times before. He signs each form, and hands the forms to the gatekeeper.
“Will the hospital accept my insurance?” he asks. The gatekeeper stares at him. “That is between you and your insurer,” the gatekeeper says. “I cannot offer guarantees.” “But I found this hospital through my insurer,” the man says. The gatekeeper encourages the man to enter the hospital. “We can discuss payment later,” she says. “After all, you have already signed the forms.” The man from the country wonders what he has signed. “If you found the hospital through your insurer,” the gatekeeper continues, “then you should have nothing to worry about, generally speaking.” She slowly removes a cough drop from a bowl on her desk. “Unless something has changed.”
The man nods. The pain in his side has worsened. With a sharp breath, he turns and slowly, carefully steps toward the door to the hospital. At the last moment, he turns back. “So if I enter through this door, and the hospital is in my network, then my treatment will be covered?” The gatekeeper regards him skeptically. She sucks slowly on her lozenge. “You’ll be covered for what your coverage covers.”
“And for the rest?” he asks.
“That is between you and your insurer,” the gatekeeper says. “Our only concern is to make you well.”
Sighing, the man decides to call his insurer. He returns haltingly to his seat and attempts to call. Hours pass as he waits to speak to a human being. He is disconnected, and transferred, and disconnected again. Finally, a person at one of the extensions takes pity on him. The person tells him that he does not need any preauthorizations or referrals, and that he may enter the hospital. “The costs of my treatment will be covered, then?” the man asks. “Once I have paid the deductible?” “And the co-pay.” “Once I have paid the premiums, and the deductible, and the co-pay, the costs of my treatment will be covered?” The person tells him that there is no way of guaranteeing that his costs will be covered until the details of his treatment are known. “There could always be exceptions. Procedures not covered. Covered procedures performed by out-of-network physicians. It is impossible to say.”
The man sighs weakly and shuffles back toward the gatekeeper’s desk. “How about this,” he says. “Could the doctors ask me for permission before they do anything not covered by my insurance?” The gatekeeper stares at him impassively. “That would be impossible, because the doctors do not know what is covered by your insurance,” she says. “They’re only here to make you well. All you need to do is enter.”
The man’s vision is unclear now, and the pain has spread outward from his side. He has trouble forming thoughts. Shaking his head, he staggers toward the door to the hospital. Then he turns back a final time. “If I have to pay, the costs will be reasonable, won’t they?” he asks. “I assume the costs will be reasonable.”
The gatekeeper slowly raises her eyes. Her lips contort into a grimace. It seems to the man that laughter reverberates from the narrow walls. “What is it that you want to know?” the gatekeeper finally says. “You are insatiable.”
“There is money enough to provide health care for everyone,” says the man, “and everyone seeks health just the same. Why has no one entered the hospital today?”
The gatekeeper sees that the man is on the point of collapsing and, in an effort to reach his diminishing sense of hearing, she shouts at him: “Here, everyone has access to health care. This hospital was designed just for you, and you have always been free to enter it. Now I am going to lock the door.”