Just got a notice from the Great Desert University that my health insurance plan–the only one that covers my doctor–will be dropped this August. Thank you so much, beloved employer.
Well, I knew it was too good to last. After a long series of health insurance fiascos (including one year when the only provider they offered was so awful that none of my doctors would accept it-one doctor refused to see me at all, even after I offered to pay him out of pocket), the state started self-insuring a couple of years ago. They’ve had an EPO plan run by Schaller-Anderson, which, incredibly, covered all my doctors, including the Mayo Clinic, for a monthly premium of $24. This was a huge improvement over the $220 I was paying for the PPO, which sorta allowed you to go to your choice of doctors but two years ago quit covering the Mayo.
When Aetna acquired Schaller-Anderson a few months back, I thought “Okay…say goodbye to that!” Right on.
So now I’ll either have to find another doctor (which I do not want to do) or once again buy incredibly pricey insurance on the open market. The last time I bought my own insurance, I ended up with an MSA (medical savings account) plan. Though it offered total flexibility and generous coverage, it was very expensive–premiums were about $250 a month, and you had to deposit $1500 a year to a savings account with piratical fees. It’s probably moot, though. At this point in my life, I’d be surprised if I could get health insurance outside a group plan at all.
Other than the Mayo, healthcare providers in this state leave a lot to be desired. When I had acute appendicitis, I almost died while sitting fruitlessly in the waiting room of a much-touted major regional medical center. After sitting there over four hours in exquisite agony without even so much as a triage, I left and got some friends to drive me to the Mayo Clinic’s ER-the EMTs would not take me there, even though it’s no further from my home than the Third-World hospital that offered no medical care. By then the infection was very advanced and my appendix was about to burst. The Mayo’s physicians performed emergency surgery, and the care I received was excellent from beginning to end. And “end” could have been the operative word: for older adults, a burst appendix is a life-threatening event with a much higher mortality rate than for younger victims.
I want my choice of doctors, and I want to be able to see the doctor I’ve been seeing for the past 40 years, who happens to practice at the Mayo. When HMOs first started to take over the healthcare industry in this country, he saw the proverbial handwriting on the wall. Coincidentally, the Mayo opened its Scottsdale clinic about then. He had been trained at the Mayo, and as soon as he could he rejoined that organization. It’s a hellacious long drive for me to get to his office (the hospital is much closer), but I must say that the care I’ve received by and large has been worth it.
he state, of course, would like to herd us all into HMOs. I will pay out of pocket before I go into one of those things.
My mother died hideously in the “care” (a term best used ironically) of the first HMO organized in Arizona. As it developed, the doctors had a financial interest in the operation: if it made money, so did they; if it lost money, they lost money. So, it ran powerfully contrary to their personal interest to diagnose a patient with an expensive terminal illness. They simply refused to admit the obvious–that she had cancer. And it was so obvious, my cat could have diagnosed it. But the problem was, if they allowed that she had cancer, they would have had to treat her, and that would have cost the HMO a ton of money. So they denied she was sick at all-the day before they were forced by my father’s demands and the implicit threat of a lawsuit to open her up for an exploratory, her doctor told me and my father that that my eminently sane and practical mother needed a psychiatrist. When he did find her (predictably) full of cancer, he dropped her cold. They stopped providing doctors to see her or to advise my father and me on her care. I had to openly threaten them with my lawyers–repeatedly!–to get even the most basic nursing care for her.
She would have died anyway, but she didn’t have to suffer the way she did. Thirty years ago, there wasn’t much they could do for cancer, but they did have pain-killers. Even had they refused to treat her, they could at least have given her morphine, so she didn’t lie in bed suffering the tortures of the damned through the last weeks and months of her life.
After that and some other amazing experiences in the American healthcare system, I’m very picky about the kind of insurance coverage I get. I’m willing to pay to the max to get coverage that will allow me to go to any doctor I choose and that will pick up the tab for the astronomical bills presented by the kinds of illnesses one is prone to later in life.
So, this time around I’m going to look at concierge practices, where you pay a fee upfront in exchange for getting a doctor’s attention. In theory, you can get appointments promptly and the doctor schedules more than 10 or 15 minutes to talk to you. You still have to keep your insurance, but you might be able to get a lower-cost plan or even just a major medical plan. The annual fee is usually around $1,500…but that’s a far cry from the $2,640 a year I was paying for the PPO that canceled my doctor.
There are a number of drawbacks to concierge medicine, one of which is the obvious social issue: it pushes the practice of medicine even further toward elitism. The rich get care; the rest of us take what we can scrounge up, which often ain’t much. In my part of the country, precious few doctors subscribe to this system, and it’s hard to know what their qualifications might be. Or disqualifications. In the MDVIP network, for example, most of the physician members in my area practice at John C. Lincoln hospital, a scary affair whose Dickensian ER is…well, overworked, shall we say. That’s where a doctor decided, after a cursory exam and no tests, that the appendicitis just starting to make itself known must be inflammatory bowel syndrome and prescribed a drug whose manufacturer’s label said, loud and clear, that it was contraindicated for women with my symptoms. I can hardly wait to go back there!
Do I demand “Cadillac care”? You bet. It’s my life and my health we’re talking about here. And in America today, “competent” care is defined as “Cadillac care.”
By and large the offerings are abysmal. In Arizona, for example, only one hospital has been rated by HealthGrades as truly excellent: the Mayo. John and Cindy McCain go to the Mayo. You and I don’t, because our insurance won’t cover it. Three hospitals were rated as “distinguished” (a cut below “excellent”) for their clinical practice: the Mayo, Scottsdale Healthcare-Osborn, and Del E. Webb in Sun City. Only one of those is even remotely within driving distance of the central part of the city, where I live. In the entire state, just three landed “distinguished” ratings for patient safety: the Mayo, Yavapai Regional Medical Center in Prescott, and Yuma Regional Medical Center.
I guess I could get bare-bones major medical coverage and then pay my doctor at the Mayo out of pocket. In only two years I’ll be eligible for Medicare, which does cover the Mayo. If I raid my savings and pay off the Renovation Loan now-meaning I won’t be buying a car anytime in the near future-I could take the $220 a month I would be paying for the PPO and set it aside to pay medical bills. It’s awfully risky, though…all it would take is a heart attack or a tumor to bankrupt me once and for all.
I also could sign up for the flex plan, which in the past has been a bit of a waste. I sure do hate to cut my take-home pay drastically, given that it provides me a grand $29 of play in my budget. Contrary to claims, I’ve never found the flex plan did a thing to save on income taxes; every time I’ve subscribed, it just meant cash gouged out of take-home pay that I was forced to spend on medical stuff whether I needed it or not. This has led to many unnecessary doctor’s visits and purchases of redundant pairs of glasses.
I’m thankful that I can afford to pony up $1,500 for access to a doctor, if indeed I decide to do so. But…am I the only person who thinks that this is a damned ridiculous pass for the alleged greatest nation on earth? If America is so great, how come we can’t provide decent health care for all our citizens, at an affordable price?
1 comment left on iWeb site
TM
I agree. My father has recently had some major health problems and was transfered from a Mesa hospital to Scottsdale-Osborn, one on the “distinguished” list. He had to remain in the hospital for 10 days and the discrepancy in care was startling. Even the food in Scottsdale was better. In our society, unfortunately, the almighty dollar rules all…even for products and services such as healthcare.
