Tag Archives: health insurance

The State of Medicine in the U.S.

Which is pretty sorry.  Let me tell you a story.  Last Thursday afternoon, I went to the pharmacy for a refill on one of the two medications I take for hypertension, and found out the prescription had expired.  I asked for a small supply to get through the next few days until I could get the prescription refilled, and they said they couldn’t do that, because it’s a “controlled substance”.  What?

It used to be you could call your doctor and ask for a refill, but now they (at least the clinic where I go) requires the pharmacy to do that.  Which the pharmacy does by sending a fax.

On Friday, I went to the pharmacy, but the prescription had not been filled yet.  They hadn’t heard from the doctor.  My clinic is closed on weekends, but I hoped they had called it in late Friday.  So I called the pharmacy.  No luck.

I waited until Monday, which was Christmas Eve, and called the clinic.  They were closed.  I got a recording which said, “If this is an emergency, please hang up and call 911 or go to the Emergency Room”.  Well no.  I’m not going to the Emergency Room (an $800 minimum charge) for a $10 generic prescription. So I called one of their sister clinics–there are seven in the area–and they said, “We can’t help you. We don’t have access to your records. But if is this is an emergency…”

One of the initiatives of the President’s health care plan is moving toward electronic records, so that any caregiver has access to your history.  I confess I was somewhat leery of that, but now I get it.

The thing is, while I wouldn’t go to the ER, it was becoming something of an emergency.  Saturday, after missing a day and a half of the medication, I had a massive headache, which I knew meant my blood pressure was up.  I chose to try to be very quiet and still and wait.  And hope I didn’t have a stroke in the meantime.  The headache never went away, and plus, I felt sick.  The kind of “sick” that you are when your blood pressure is high is not easily described.

It was no use calling either the clinic or the pharmacy on Tuesday.  It was Christmas Day, and both were closed.  On Wednesday, I called the pharmacy.  Still no prescription.  I called the clinic.  They said, “Yes, we do have the fax from the pharmacy, but the thing is, it’s still on the doctor’s desk. She’s been the only doctor here today and has had to see all the patients”.

On Thursday I called the pharmacy back.  Still no prescription.  On Friday I called again.  They had it, and it was ready.  By this time, I’m very, very sick, and was having trouble contemplating the idea of moving from the couch.

So here are a few things that are wrong:  no electronic record.  Not enough doctors.  The fact that doctors in the U.S. expect to be rich.  Which is understandable, since the cost of medical school is astronomical.  Assuming you ever make it out of that debt in your lifetime, then you’re faced with malpractice insurance, which is equally astronomical. The cost of going to the Emergency Room–which is the primary source of medical care for those without health insurance. So if you do have it, then you are paying for all those who don’t.  (Thus the $800 minimum.) So wouldn’t it be better if everyone had it?

Having said all that, I’d say that in order to have a good medical professional, you also have to be a good patient.  For instance, don’t fail to notice that a critical prescription is expiring just before the Christmas holidays.

To Hell in a Handbasket

Judging from the hysteria of my conservative friends, we are already there.  Only they noticed the gradual drop of the handbasket.  The rest of us were blissfully ignorant.

I am of course referring to the confirmation by the Supreme Court of the Allordable Health Care Act.  Of course, what is lost in the hysteria is what the Supreme Court actually ruled.  They didn’t say it was a good idea (although I think it is, in a flawed sort of way).  They said Congress had the power to pass the law under their powers of taxation.

Which is very, very interesting.  I always understood it to be a tax.  But I was surprised to learn that Congress went out of its way to avoid the word “tax”.  The Supreme Court said the govenment’s argument that Congress had the power to enact the law under the Commerce Act did not hold water.  I completely understand that.  The Commerce Act enables the federal government to regulate interstate commerce, not to force people to buy a product.

In what seems like a hair-splitting move, the Supreme Court said Congress can’t force you to buy a product, but they can tax you if you don’t.  What’s the difference?  Congress called this tax a penalty–but it’s paid to the IRS and is based on income.  Chief Justice John Roberts said, if it walks like a tax and quacks like a tax, it’s a tax.

What stuns me is the lack of understanding about what the law is supposed to do.  Perhaps particularly that those who need it and could benefit from it the most are the people who hate it most.  Immediately after the Supreme Court decision, one of my Facebook friends posted “Bend over America.”  One of my employees said, “They will just have to take me to jail, because I can’t afford insurance”.  You have to hand it to the Republicans.  They’ve done an excellent job of mixing up the ideas of personal freedom and patriotism with the idea of personal benefit.

Remember when it used to be a “government takeover of healthcare”? Last week on TV, John Boehner said it’s a “government takeover of the insurance industry”. (Like that would be a bad thing?)  Of course, he’s still wrong.  It’s regulation of the insurance industry.  It amazes me that Republicans have been able to convince people with no insurance to rally around the insurance industry, in the name of personal freedom and patriotism.  Neat trick.  Government and regulation are four-letter words.  First they will go after the insurance companies.  Next step:  they will be at your door trying to take away your guns.  Please.

It’s hard to even have a semi-logical conversation about this.  I didn’t even try until yesterday, and it fairly quickly devolved into “You don’t know what you’re talking about.” (From him to me.)

To some extent, both sides start with a philosophy.  His is: whatever you get takes away from what I get.  I talked myself blue in the face about how he is already paying for other people’s health care, and this is at least an attempt to even it out.

Back to the employee who said they would have to take her to jail. So, my take on that is that as far as she’s concerned, things are just fine the way they are.  She does get health care.  It’s just that I’m paying for it.

I’m not entirely a bleeding heart liberal on this.  Because it slays me that rather than pay a miniscule amount to contribute to her own health care, she is willing for me to keep paying for it.  How fair is that?

And I am rapidly approaching the inability to pay for both of us.

I don’t know if the AHCA is the answer.  But something has to change.

Getting Old(er)

I am not going gently into that good night.  Getting older just pisses me off.  So mostly, I just ignore it.I know there is no turning back.  That is a foolish fantasy, but I’m having trouble “accepting” what it really means.

Case in point:  Exactly a month ago, I sprained my left knee.  It still hurts.  Once I’m up and either sitting or standing, it starts to swell, and so does my ankle.  Lesson One:  you don’t heal as well or as fast.

I should go back to the doctor, but what for?  It will mean an MRI or CT scan that I can’t afford (even though I have insurance which will pay for most of either.)  So then you start to do that weighing thing:  on one hand…and on the other hand…So, do I want to do this (no) or do I want to have trouble walking forever (no).  Great choice. No versus no.

I don’t want to take any more medications.  I take two for high blood pressure already (take the pills, or have a stroke).  Okay…that was easy.  I take one, once a week, for osteoporosis, and that REALLY pisses me off.  Why do I have osteoporosis?  For one thing, I am the queen of dairy, not to be confused with the restaurant of the same name.  I drink milk with every meal.  I eat ice cream and cheese like it was going out of style.  But…that’s only since I was 17, when it was probably too late.  And I seem to have some problem absorbing Vitamin D, which is critical to your ability to absorb calcium.  Plus, I had radiation therapy, which leaches calcium.

So what are you gonna do?  Answer:  take the drug.

What I would like is the magical nystery pill.  Not one that promises to make me younger, but one that makes me happier about getting older.  Or smaller or larger.

Hands Off My Health Care..and Yours Too

You may have noticed that insurance companies aren’t getting any love lately.  And there are indeed some horror stories out there, mostly concerning health insurance, but let’s not forget the world of auto and homeowner’s insurance policies.  They too are mostly unloved, but no one is even paying attention to them now.  That is especially cruel.  Not only to be unloved, but unmentioned.  Like the saying goes, there is no such thing as bad publicity. 

Naturally, Fakename has a few opinions about the subject that might be construed as political in nature, but she will keep them to herself at this time.  She personally was the recipient of a massive payout by her health insurance company back in 2006, and therefore has little to complain about.  Not that that would necessarily stop her.  The massive payout, however, did not come without occasional glitches.  Warning:  the story to follow will not be particularly graphic, but it will mention body parts. 

So back in 2006, the day came when I had to have two biopsies on the same day.  When the EOB (Explanation of Benefits) came back from the insurance company, they had paid one and denied the other.  On the EOB there is a number to call if you have questions or wish to dispute the decision, which, by the way, you have 30 days to do.  Try having a serious illness and figuring out what the EOB is saying, much less keeping track of the number of days since you received it. 

Somehow I got two brain cells to rub together and called “Customer Service”, two words which have a hard time standing next to each other in the same sentence as “Insurance Company”.  The Customer Harassment Representative informed me that the reason one of the claims was denied was that it was physically impossible for me to have had two separate types of biopsy on the same day. 

Hello, I said.  I have two breasts.  One biopsy was on one breast and one was on the other.  The CHR allowed as how that was not her problem, and I would have to take it up with the doctor’s office.  So I did, and they said, “Oh, we must have coded it incorrectly”.  Ah yes.  The Codes.  Be aware that if you have a cold, you don’t really have a cold.  You have a 460.0.  Apparently the doctor’s office had neglected to include the part of the code which specified “left” or “right”.  Be aware that any body part you have, or affliction thereof, has its own code.  They resubmitted the claim, and it was paid.  Happy ending. 

Then there was the time when my doctor wanted me to go to a specialist, and made an appointment for me with a local and very esteemed one.  He, however, was not “in the plan”.  Now the rules say that if there is no one in the plan within 50 miles, the “out of plan” doctor has to be treated as if he or she is “in the plan” (translation:  the insurance company has to pay a higher percentage.)  The insurance company’s website claimed there was such a doctor within 50 miles, in a town I knew to be further away than 50 miles.  In fact, it turned out it was 62 miles.  (I was not about to go to a specialist in some one-stoplight town in Georgia if I could help it.)  We all had a huge fight.  Me, my employer, and the insurance company.  It all had to do with Mapquest, which is where the insurance company got its measurements.  50 miles was from the state line.  I argued that it was not 50 miles from me, it was (according to Mapquest!) 62 miles–minimum.  Whether you started from my personal address or the city limits of Tallahassee.  I won.  But what a lot of wasted energy.

In closing, there is the auto insurance issue.  Like a Good Neighbor, State Farm cancelled both my auto and homeowner’s insurance policies after 13 years.  Then I bought a new car, which is a neat trick when you don’t have auto insurance. I got a new company and paid for six months in advance; next thing I knew, they were sending me bills online.  I deleted them.  I did that for two months, then week before last, I received a bill for $44.20 in the actual mail. 

So I called the agent.  It turns out that buried in those emails (the amount of the bill being Zero) was a demand to respond in order to retain my ” paperless discount”.   This is a scam of major proportions, in my opinion.  They agreed to let me pay half–$22.10.  In return, I get to keep my auto insurance.  What a deal.  In this case, as they say, it isn’t the money–it’s the principle. 

So in closing, I lied.  I do have a political comment.  Have any of those people chanting “Hands Off My Health Care” ever had to deal with a real-life insurance company?  The system works just fine as long as you aren’t sick.  When you are, good luck.

How to Fix Health Care…Part 1

From December 15th through the 31st, Barack Obama is asking Americans to come up with ideas on how to fix the health care system.  Here’s the report about that from the Washington Post.  http://www.washingtonpost.com/wp-dyn/content/article/2008/12/05/AR2008120503322.html?hpid=topnews

Here’s what’s astonishing about that.  They’re not starting out with a question, such as “Do we have a problem?”  They’re starting out with a statement.  “We have a problem, what do we do?”

Here’s what’s even more astonishing:  our President-elect is giving us homework!  He’s suggesting that during the holidays, as people get together and have more time to think, that maybe this could be a topic to discuss.  This seems to me to be no less than an attempt to engage people in their own government.  After decades of top-down government, culminating in the 8-year long monarchy we’ve just endured, this is practically a revolution.  Sign me up. 

So I’m wading in.  And it won’t take long.  What’s wrong with the health care system is the profit motive.  I’m not opposed to profit.  I’m employed in the business world.  What we do is sell stuff, and charge as much for as we can without shooting ourselves in the feet.  In other words, you can price yourself out of business.  But health care is not a commodity like computers or shoes or cell phones. 

The whole health care system should be not-for-profit.  The argument is, if you make the system non-profit, then no one will do it any more and then where would we be?  Not true.  Not-for-profit doesn’t mean you can’t make any money at it. 

The big players in the health care system are doctors, hospitals, pharmaceutical companies, and insurance companies.  If you don’t pay the people in those fields well, then it would probably be true that fewer would go into those fields.  Plus, all of them have to have a way to have some sort of reserve, whether it’s just for the occasional rainy day or to do research or to pay for catastrophic occurrences.

But when you make huge profits and split them up amongst yourselves, rather than putting it into research or treatment, that’s thievery.  There is a lot of finger-pointing amongst the groups I named above, and let me jump in there too.  The villain, in more ways than you can count, is the insurance industry.  All you have to do to verify that is this:  pay health insurance premiums your whole life, then make a claim. 

Actually I’m simplifying, because that has not been my exact experience.  But for the most part, once you need them, the insurance company’s job is to try to find a way not to pay you.  Because that’s how they make money.  Denying your claims, making it difficult, and hoping you’ll die before they have to pay.     

The solution is simple:  take profit out of the equation.  And how to do that?  No need to reinvent the wheel.  Countries throughout the world are operating workable and compassionate health care systems.  Use their model.

Men Seldom Make Passes…

…at Girls Who Wear Glasses.  This little poem by Dorothy Parker said everything there is to know about why I hated wearing glasses as a young woman.  Often I just went without them.  I found that I had the ability to sort of squinch the muscles in my eyes to see normally, although after a day of that I’d have to hide in the privacy of my own home and gratefully put the glasses back on.  (I will say this for Sarah Palin:  she’s made wearing glasses cool again.)

Before that, I hated wearing glasses as a child (and I’d been wearing them since age two) because of the taunting.  “Four-eyes” was the popular chant, but in all fairness, that applied to both girls and boys with glasses. 

I so longed to wear contact lenses, but I was totally put off by the concept of poking a piece of glass in my eye, and I’d heard horror stories of what damage they could do.  And then came the miracle of soft contact lenses.  Although it took some practice, I wasn’t so put off by putting something in my eye that reminded me of a tiny piece of Saran Wrap. 

I’ve now been wearing contacts for about 30 years, and in that time I’ve seen so many improvements.  It’s quite amazing.  Lenses you can wear overnight.  Lenses you can dispose of, instead of having to laboriously clean them.  Lenses which can correct all sorts of vision problems, rather than the simplest ones. 

I no longer care so much about the aesthetics of the whole thing, I now hate glasses because I can’t stand to have them on my face.  I don’t like the way they feel. You constantly have to adjust the damn things.  I tolerate sunglasses as a necessity, but you don’t have to wear them all the time.  I don’t like waking up and pawing through the stuff on the bedside table to find them.  I like waking up wearing contact lenses that you can sleep in, which allow you to see normally the minute your eyes pop open. 

But last week, I ran into an unexpected problem…this is the primary cause of my Week From Hell.  It’s been a year and a half or so since I had an eye exam, and so for several months now I’ve been wearing my glasses since I ran out of contacts.  My optometrist’s office, to their credit, is religious about you having an annual exam before renewing your prescription for either glasses or contacts.  So I dashed in on Tuesday morning for the exam, expecting to walk out as usual with one complimentary pair of contact lenses while I waited for the six-month supply to arrive.  But during the exam, no matter what they did, they could not get my right eye to correct.  Taking another look, the optometrist said, Aha!  No wonder!  The problem is, you have a pool of blood on the retina in your right eye, near the macula.  I felt like I had been thrown into a telephone pole.  Instant panic. 

I’m bleeding in the eye?  Macula?  I didn’t know what that was but somewhere in the recesses of my brain I dredged up the term “macular degeneration” which I thought means inevitable blindness.  (In some cases, it does.)  So the exam came to a halt, and I was referred to an opthamologist, whom I saw the next day.  For three hours.  Sometimes it helps a lot when you’re faced with unexpected medical emergencies to focus on how cool the technology is.  And the tests they did and the equipment they used were indeed fascinating.  I was mostly amazed by the cameras which take pictures of the retina, all the way through the eye. 

So next Wednesday, they are going to inject a drug into my eyeball to try to stop the bleeding.  I’m not too scared, because I don’t think it will hurt.  You don’t have any feeling on the inside of your eyeball, and they will deaden the cornea before sticking the needle in.  Nevertheless, there is a huge Ick Factor here, wouldn’t you agree?  However, I’ve learned that the unendurable is in fact endurable when the alternative of doing nothing leads to sure and certain disaster. 

Another of the fascinating issues is that there are two drugs they can use, one of which is not approved for use in the eye.  The other drug is, but it’s ten times more expensive.  I had another jolting experience as a result of this…I had a heart to heart talk with my insurance company about whether they would pay for this treatment.  The answer was yes, they would pay for either one, even the one that is “off-label”, whatever the doctor decided, and they offered to voluntarily call the doctor and say so.  What?  Insurance companies normally top my personal list of the Axis of Evil, and here they are saying yes without saying no first?  Actually offering to help ease the way?  Hmmm.  It appears I’ll have to revise my list.