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Health care

Earth to GOP: Define health-care “rationing”…rationally, please

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I see the Republicans’ latest maneuver to obstruct Obama’s health care plan is to flamboozle us senior citizens into thinking a public option for health care will mean “rationing.” It would be awfully nice if the GOP would explain, please, how it is that we don’t have health care rationing right now.

If you’ve had any ailment more dire than a runny nose, about your only option for obtaining health insurance is through a full-time job with a company large enough to afford a plan for its employees, or through marriage to someone who has access to such a plan. This lets out self-employment; it lets out buying an individual policy on the open market; it lets out working for most small businesses. Sometimes you don’t even know a “diagnosis” exists until an insurer informs you it will not cover you.

Refusing to cover people for this, that, or the other ailment—or setting up an obstacle course that causes people to avoid seeking medical care for fear of putting a metaphorical black blot on their records—amounts to health care rationing. If you can’t get insurance, you can’t get health care, because no one but the very wealthy can afford to pay out of pocket for a trip to the doctor.

A while ago, the State of Arizona offered only one health plan, which most of my doctors would not accept. Because I did not care to go to just any quack some company bureaucrat ordered me to see, I decided to buy an individual policy.

A year or so prior to that, I had visited my doctor for a routine physical. Delivering the usual clean bill of health, he asked if anything that we hadn’t covered was bothering me. I reminded him of the supposed neuroma on my right foot and remarked that I was tired of the choice of footwear the chronic pain left me: hiking boots or Dansko clodhoppers. He sent me to an orthopedic colleague, who had the foot X-rayed, did an examination, and said there was no evidence of a neuroma, nothing that he could see was wrong, and I should just learn to live with the foot discomfort.

So, a year or two later when I went to apply for this insurance policy, Blue Cross informed me that it would not cover me for any broken bones or for any back problems of any kind.

Say what?

Asked why, their bureaucrat said it was because I had “osteopenia.” I said I’d never heard of any such thing, no one had ever made any such diagnosis, and I didn’t even know what it was. He said there it was in my records.

Looking into this, I discovered it had been stuck there by the orthopedist, who thought the X-ray of my foot showed a slight thinning of the bones. Osteopenia is considered to be a precursor to osteoporosis, although that opinion is dubious.

At this point I trotted to my gynecologist, since at the time I was premenopausal. He ordered a complete body scan. When this returned, he said I did not have osteopenia, and in fact, my bones were stronger than those of most women my age.

By then, open enrollment had passed, I’d missed the chance to get private insurance, and I was forced to buy a health plan through GDU that I did not want and that did not cover the doctors of my choice.

So what we have here is insurance companies telling you…

• you will not be covered (therefore can not have medical care) for certain issues, whether or not those issues are related to the “diagnosis” the company dislikes;
• this limitation is based on a decision made by someone outside the doctor-patient relationship; and
• you may only go to certain doctors, none of whom are doctors of your choice.

If that’s not rationing, I’d like to know what it is.

If you’re older than about 50 and lose your job or decide to start your own enterprise, you’ve got a snowball’s chance of obtaining healthcare coverage. Whatever policy you can land will except every ailment even remotely related to any symptoms that have appeared in your doctor’s records, and the cost of whatever policy you can obtain will be prohibitive. Because of the costs, you likely will be herded into an HMO, where you will have no choice of doctors, where the doc who does see you will have about 10 minutes to make a snap decision about any problem that arises, and where some bureaucrat will say what treatment options you have and don’t have and what medications you may and may not buy.

The Republicans are trying to convince us that we don’t already have health care rationing, when obviously we do. Then they’re trying to whip up hysteria by telling us that the precious full choice we supposedly have now is going to go away. Evidently they think enough of us are morons that spreading stupidity will block any progress toward meaningful health care coverage for all Americans—and given the number of people who bought into that idiot Palin’s “death panel” fantasy, they may be right.

How did the Republican Party become the party of jerks, fools, and scoundrels?

I used to be a Goldwater Girl, believe it or not. Barry Goldwater signed my first straight-A report card at the University of Arizona. I’d just received it in the mail, and as I reached the top of the stairs coming up from the Student Union’s basement mailroom, there was The Man himself, strolling through the building with only one or two sidekicks in tow. In an instant’s whim I barged up to him and asked if he’d put his autograph on it. Amazingly enough, he did.

If Barry Goldwater were alive today, he would be so revolted by the state of the party he would change his registration. Indeed, near the end of his life, he was heard to use the a****** word about the faction that was then just beginning to assume power in the party, whom he regarded as “a bunch of kooks.”

How right he was.

😀 In our hearts, we knew he was right. 😀

Of interest, along these lines
And this update

Retirement healthcare update

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A new development in the hoop-jumping contest that is figuring out how to get full coverage under Medicare:

The volunteer snail-mailed two thick brochures on Medigap—over a hundred pages, to go along with the hundred pages or so of data to be mastered before signing up for Medicare. Took an hour to shovel through the new stuff.

She apparently was wrong on two counts: First, COBRA is regarded as “credible creditable (!) coverage,” meaning that if you continue your employer’s coverage through COBRA between the time you’re terminated and the time you reach age 65, Medigap carriers can’t refuse to cover you for pre-existing conditions. And second, she didn’t know that attained age premiums (which start low but rise as you age, ending up costing more than you would have paid if you’d selected a pricier product to start with) are illegal in Arizona.

{sigh}

Well, I’m glad I finally got my hands on what appears to be definitive information. It’s a shame elderly people are expected to plow through over two hundred pages of dizzingly complex and confusing material just to sign up for something as basic as health insurance. And mighty annoying that the only people you can get on the phone are unpaid volunteers who themselves are a bit confused!

😯

Flaws in WHOSE health care system???

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Have you seen this AP story? In it, the reporter uses the swine flu episode to highlight the shortcomings of Mexico’s health care system (which, as anyone who has been injured or fallen ill in Mexico can attest, does have its challenges). As I was reading through it, I thought…this stuff sure sounds familiar…

Mexicans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness and pine-scented disinfectant.

Let’s tweak that to reflect the experience of citizens of another large North American country:

Americans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness and pine-scented disinfectant.

Exactly my experience. When I was suffering from acute appendicitis, I went to the ER of a major urban medical center, where I waited for hours—in exactly the conditions described above. After four hours of excruciating pain, I gave up, called some friends, and (at midnight) asked them to drive me home. I knew what was wrong with me, but figured I’d rather die in my bed than huddled on a concrete bench outside the ER in the winter cold. In that entire time, I never saw a doctor or a triage nurse and encountered only some surly staff who gave me a dirty look when I threw up into the bucket I’d brought. I sat next to a young woman who was miscarrying a pregnancy; she also had been there over four hours with exactly zero medical attention. There was no place inside to sit, and the floors were too filthy to sit or lie down on.

Many don’t see doctors at all, heading instead to the clerk at the corner pharmacy for advice on coping with a cold or a flu.

Good luck trying to get in to see a doctor for something as minor as a cold or flu! American access to medical care pretty much forces you to head for the corner Walgreen’s or the local naturopath to ask for over-the-counter nostrums.

Some patients suspected of having swine flu told The Associated Press that public hospitals turned them away or forced them to wait for hours for treatment even after the government declared a national emergency.

Some people at the ER where I waited had been sitting in the waiting room for eight hours. I was told the typical wait was six hours. No tweaking needed here to make this apply to the US experience.

“If someone is sick, he can’t simply say, ‘I’m going to the doctor’ or ‘I’m going to the hospital,’ because it depends on whether he has Social Security…”

Uh huh:

“If [an American] is sick, he can’t simply say, ‘I’m going to the doctor’ or ‘I’m going to the hospital,’ because it depends on whether he has Medicare or health insurance…”

And…

While access to health care is a right enshrined in the Mexican constitution, millions of Mexicans have no health insurance at all.

Heee!

Access to health care is most certainly not regarded as a constitutional right, and millions of Americans have no health insurance at all.

And, annoyingly enough:

Mexico spends only 6.6 percent of its gross domestic product on health care — less than half the U.S. figure. No country in the 30-nation Organization for Economic Cooperation and Development puts a smaller share of public money into its health care system.

Think of that. We have a healthcare system that in many ways, for the average Joe and Jane on the street, functions on a par with that of the most underfunded system in the OECD. What’s wrong with this picture?

Life in the Post-Recession Era: The third-worldization of America

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Ever think about what life will be like in America after the recession passes? If it passes? What if the economic collapse we’ve seen—and that’s just what it is, a collapse—does permanent damage to the U.S. economy, from which this country never fully recovers? Clearly the measures we’re taking to jump-start the faltering economy will have long-term repercussions, not the least of which may be some serious inflation. And many other forces are at work.

I have a creepy feeling that in the future—maybe not immediately, but over the next generation or so—we are going to see a steady third-worldization of America. Eventually, American wages will be driven down to the levels that workers in Third-World countries are forced to accept, the middle class will almost disappear, and our social structure will consist of a small, hyperwealthy upper class and masses of working poor. Really poor.

Ah, you say; she’s up on her pessimistic soapbox again! 

Well, let me tell you what makes me think this.

The Copyeditor’s Desk has lost its bread-and-butter client, a graphic design studio that packages books for print-on-demand publishers. “Book packaging” entails performing any or all of the various tasks that have to be done to create a book and take it to print. Our client has been copyediting, designing, laying out, proofreading, and producing camera-ready copy for its customers, and it has been hiring us to do the copyediting and proofreading. Suddenly, this nice little source of income  has dried up, despite raves of satisfaction from the client. 

Where has the wellspring gone? Well, I’ll tellya: There’s an Indian entrepreneur in town who lives here but owns a large operation in Delhi. This gentleman shows up at all the same trade meetings that we do…and at all the same trade meetings where our client goes. He told me that he can take a book from raw manuscript all the way through to camera-ready copy for $2.00 a page. That includes copy- and content-editing, fact-checking, negotiating with authors, book design, page layout, indexing, and generation of camera-ready PDFs.

Our lowest rate—for copyediting alone!—is $4.50 a page. Even when we’re reading pretty easy copy, that rate produces a just barely acceptable income. If we run into a problem that slows us down, it soon morphs into an hourly rate somewhere near minimum wage.

To compete with this guy, we would have to charge something like 30 cents a page, no matter how easy or difficult the copy. So editing a 300-page manuscript would earn us a grandiose 90 bucks. That’s a project that can take a week if the copy is clean, well written, and accurate, and upwards of a week depending how messy and poorly written the copy is (and self-published books can be very bad, indeed).

Ninety dollars a week. In a good week. Think of that.

You know, a print-on-demand publisher doesn’t care whether the book is literate, accurate, or correctly formatted in Chicago style. All he cares about is that the author gives the go-ahead to print it. Our client sees that most of her clients’ authors don’t know any better, and that a good 90 percent of them don’t care. So…why pay a living wage to an American editor when you can get someone in India to work for $90 a week?

This is the type of worker—competent enough and cheap—that Americans compete with in the global economy. With everyone and his little brother unemployed and not enough jobs to hire all the people who have been laid off, many Americans are going to have to accept wages on this order just to put bread (and only bread) on the table. As more workers agree to accept depressed pay because any income looks better than no income, pay in general will drop. Eventually, we’ll all be working for what people in India, Thailand, and Pakistan are paid.

Which ain’t much.

Remember, our country doesn’t have the safety nets required to provide lower-paid workers a decent lifestyle. We don’t have adequate access to affordable health care. We don’t have adequate provisions for retirement. We don’t have adequate child care. More civilized countries do: taxes and global competitive pressures push take-home pay down, but the taxes buy a social system that provides for citizens. Consider, for example, this interesting article by Russell Shorto. Recounting his experiences during a stay in the Low Countries, he reports that every parent receives an annual cash “child benefit,” cash underwriting for schoolbooks, and reimbursement for as much as 70 percent of the cost of child care. Employers are required to give workers four weeks of vacation time and a vacation payment of 8 percent of their annual salary; the unemployed also receive vacation pay from the government, “the reasoning being that if you can’t go on vacation you’ll get depressed and despondent and you’ll never get a job.” In addition, a third of dwellings in the Netherlands are part of a public housing system run by independent real estate cooperatives, which provide homes at below-market rates not as hovels of last resort but decent places even for people with respectable incomes. 

Well, say you, that’s fine if you don’t mind the government confiscating half your salary.

But folks. Half of our salaries is confiscated! My take-home pay is about 60 percent of gross, and that’s only because I have ridiculously cheap health insurance—when I paid $220 a month (for one person) my net was closer to 50 percent of gross. Shorto paid $390 a month, no copays, including dental coverage, for insurance that covered all his family of four’s medical care and also paid 90 percent of the cost of his daughter’s braces; in the U.S. he paid $1,400 a month for a policy that covered no dental care and was shot through with copays, deductibles, and exceptions.

Health insurance, required retirement savings, required parking charges, long-term care insurance, and disability insurance are, in fact, forms of taxation. You have to pay for it—you don’t have a choice. You’ve got to have health insurance; no one should have to choose not to be able to go to a doctor. If you have any assets, you’d bloody well better have long-term care insurance, especially as you get older. If you have a family to support and you think you’d like to continue eating after you get hurt or seriously ill, you’re a fool not to carry all the disability insurance you can afford. If you have kids to put in day care and health insurance full of copay holes, you’ll be needing that Flex plan. What is the difference whether you’re forking over a chunk of your pay to a private party or to the government? You’re still forking it over.

If you’re not earning enough to afford amenities like health insurance and halfway decent child care (if you can find it!), you’re out of luck. So…what is going to happen to Americans’ standard of living when large numbers of us are permanently out of work and when folks who can find jobs are looking at wages competitive with those in the Third World? It’s hard to conclude anything other than that we will have a Third-World standard of living.

We need to take another long look at social systems such as the one in the Netherlands, which, as Shorto points out, grew out of a private-enterprise tradition and a deep religious tradition, much as our own has done. If we’re to survive as a “developed” nation in the post-recession global era, we’re going to have to revise the ways we provide for our citizens.

Health Insurance: Is your employer paying its part?

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One of M’hijito’s good friends, a young newlywed who had just purchased a house, was sideswiped by a fifth-wheel while he was on his motorcycle. Because he was wearing a helmet, the young man survived. However, he’s lost a kidney and his spleen, and he broke three vertebrae. He’s still in the hospital, a very sick puppy indeed.

As you might surmise from the fact that he and his bride qualified for a mortgage in these tough times, he had a good job with good benefits. Or so he thought.

Well, come to find out: his employer was not paying the employer’s half of his health insurance premiums. That means he’s not covered. He’s now relying on the state’s half-baked indigent health-care system to keep him in the hospital until he recovers enough to roll home in a wheelchair. The bills the kid has racked up will ruin him and his wife financially just as they are beginning their life together.

Lawyers say the employer is apparently broke—this is why he was welching on the health insurance policy—and they hold out little hope of getting any blood out of that turnip. The kids probably will have to declare bankruptcy, and that won’t get them out from under a mortgage that likely requires two paychecks.

I have no idea how a young person in good health who generally stays away from doctors would find out whether an employer really is paying its part of the health-care premiums, especially if it’s a small business with no HR department. Probably you could call the insurance company and confirm that you’re still on its rolls. Given the nature of our deprecession, if you have no recent confirmation that you’re enrolled in your health plan, it might be a good idea to check.

And please. Stay off motorcycles!

Suzuki photo byRich Niewiroski Jr.

Awww, C’mon! Am I really that dumb?

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Seriously. How dumb DO they think we are? And more seriously: could they be right??

Late in October I dropped by my doc’s office to get a flu shot. I was there for all of 10 minutes, 8 of them spent in the waiting room.

Friday, comes a statement from my insurance company: the doctor has charged my insurer $86. The insurer is disallowing it, claiming the Her Doctorness is not in the RAN+AMN network. So now I’m expected to pay this bill.

Yup. You read that right. EIGHTY-SIX BUCKS for a $10 flu shot.

So I shot off an e-mail to her, she also being one of my coreligionists who sang in the choir with me ($86 for a flu shot: ain’t that Christian?). She replied that she was shocked and would get after the office manager. And so she did. Yesterday morning, comes this missive from that worthy:

I am very sorry for the inconvenience. We deal with hundreds of insurance plans and our front office MA should have known that we are out of network for Ran+Amn. You must understand however that your card also has BENEFITOPTIONS and BEECH STREET in large letters. We do participate in these plans and it is the ultimate responsibility of the patient to make sure hisor her primary care physician is on the plan.

Grocery store flu shots are less expensive because they are purchased in extreme bulk for the masses. They also have a greater incidence of sideeffects, Dr. Wallbanger [my doc friend’s senior partner in the practice] tells me.

In our practice, we normally do a nurse visit taking the vitals of thepatient receiving the flu shot. Insurance billing requires that we bill $40 for this procedure and insurance pays whatever they like.

Billing code 90471 is administration of the flu vaccine and the going ratefor insurance billing is $26. The rate for the vaccine itself is $20.

We administer flu shots in our practice as a service to our patients, andwhen billing insurance there are set amounts for each service provided.

As our front desk did make the error, we will write off all but $20 of the remaining balance for your flu shot.

Total price for a cash pay flu shot is $30, you already paid $10, so
remaining balance is $20.

Again I am very sorry for the inconvenience.

Okay. Are you following this?

Item 1: The head partner in this practice is actually suggesting, with a straight face, that the vaccine he’s getting is BETTER than the second-rate vaccine dispensed at Walgreen’s or Safeway, where, if I’d had the time and patience to track down a flu shot clinic event, I could have had the shot for a $10 copay.

Oh, dear Dr. Wallbanger: can you spell S-P-E-C-I-O-U-S?

You understand: he and his office manager assume I’m so stupid I will buy this story.

Item 2: We’re told the insurance company requires that the practice overbill, in the amount of $40, for a grand total of 2 minutes of a junior college graduate’s time.

And Item 3: We learn that really, we shouldn’t believe anything we’re told by the front office staff. Just because the staff says the practice is in-network doesn’t mean it is in-network. In other words: it’s the patient’s responsibility to read our minds. And BTW, try to read RAN+AMN’s corporate mind, too, since that worthy organization does not publish a list of participating providers online, at least not that three Google searches will bring up.

What’s being said here is either “we try to gouge your insurance company and if we can’t get away with it we still overcharge you but only by about half of the overcharge we try to extract from your insurer” or “we think you’re dumb as a post.” Or maybe some combination of those.

Okay, okay, I admit it: They could be right!

This afternoon I donned some garden gloves and rolled the compost bin into the alley by way of trying to salvage it after the Great Bee Fiasco. By the time I got it where I wanted to dump the contaminated compost, wisps of white vapory stuff that looked like smoke were leaking out around the lid. It kept on leaking. “Is it on fire?” I wondered. Felt the side to see if it was hot: no, not especially. So I waited a while till this phenomenon settled down.

Finally opened the lid. White airborne powdery stuff was still floating around inside.

Waited a while longer. Then rolled the thing upside down and tried to dump out the compost.

No luck. It really needed to be pulled out a fistful at a time, not a practical option with weird (stinky!!!!) white powdery stuff drifting in the air.

Went into the garage to drag out a little hand-sized pitchfork-like thing. Held my breath and tried to fork out the bin’s contents without inhaling any powdery vapor.

This did not work well, and soon I was fairly certain that if I breathed much more of the “beekeeper’s” crud, it was gunna make me good and sick. Rolled the composter over to the bulk trash pick-up place, where it will sit for the next two and a half months, providing the Trash Cop doesn’t wander up the alley before the next pick-up is scheduled. He hates that.

By the time I finished, my throat was burning and I felt dizzy. Luckily, I’m going to dinner at the home of friends, one of whom is a nurse-practitioner. A psychiatric nurse-practitioner (where was she when I was busy hiring the bee dude?), but a nurse nonetheless. Matter of fact, this is the very friend who gave me the composter as a lovely and much-valued gift, some years ago. She should be able to recognize if I start to croak over during the salad course.

The bee dude’s bill is in hand: Contrary to his listing online as such, this guy is no “beekeeper.” He works for an outfit called “Atomic Exterminating Company.” Atomic, indeed: young Dr. Strangelove nuked my bees, nuked my composter, and damn near nuked me.

Well: Dumb tax, eh?

I’m still left with the question of how we’re supposed to know when service people are lying to us! I guess that requires you to be smarter than this Ph.D. is.