Wednesday, August 19, 2009

Unhealth Care

In late 2007, we had a meningitis scare in our house. Fortunately it was viral & everyone is now well. Unfortunately, we spent a good bit of time in the hospital to find out it wasn't bacterial for Gabe, Robert, and Katy and to find out that Mark and Joseph did not have it at all, I guess.

Robert and Katy were both very sick and in different rooms in the adult emergency room. Gabe was in the infant section of the children's hospital, with Bob and me by his crib-side. Katy & Gabe had Medicaid, but Robert was uninsured. They ran tests on Katy & Gabe, figuring that if they had bacterial meningitis so did Robert.

At the urging of Gabe's doctor, we brought Mark and Joseph to the emergency room. They both had flu-like symptoms and at that point, bacterial meningitis was a possibility.

Joseph was brought into the adult emergency room, where he stayed in a pod for two days until they decided he probably had the flu. Mark was seen by a doctor in the pediatric emergency room who looked at him, pronounced him well and sent him home. Mark's bill was almost $600. Joseph's was over $1200. We had met the family deductible of $700, so we only had to pay $125 special co-pay (for following doctor's advice and taking them to the emergency room), plus regular co-pays for about $250 each.

Everyone survived, and this is the lesson:

The health care debate is about the wrong things... for the most part.
Many Opponents of health care reform have put up a straw man and are fighting him well. "Medical care should be between a patient and the doctor." "Don't let the government get between you and your doctor." My elderly neighbor announced that all people in the US have perfectly good health care, why change it if it isn't broken?


Proponents have presented plans that will essentially make the government the insurer or which will subsidize private insurers, and that doesn't really solve the problem, either.

Medical insurance does not equal medical care.

More recently, I was waiting to see a doctor at a Doc-in-the-Box (where I read almost all of A Portrait of a Lady by Henry James, a short but dense book), when a woman brought her son in for care. She presented her insurance card --- the same insurance as I have --- and was told she'd have to pay $300 that day in order for him to be seen because she had not met his deductible. She didn't have $300. Also, the billing clerk should have said "up to" $300, because it wouldn't have cost that much. Anyway, HIPPA violations aside, this well-insured woman took her sick son home. I finished by novel and saw a doctor two hours later.

Remember, insurance companies are there to MAKE MONEY. They make money by RECEIVING MORE PREMIUM MONEY than they PAY OUT IN HEALTH CARE. This is only possible if THEY DENY HEALTH CARE CLAIMS.

Medical decisions are not made between a patient and a doctor, but between a billing clerk at either the insurance company or medical facility and the potential patient.

I have been prescribed medication only to find that my insurance company doesn't agree with my doctor. My doctor's office has to explain to my insurance company why I need a mammogram or a colonoscopy. Preventive health care is rarely provided, even though it would be beneficial economically and medically. Health Care professionals do not call the shots. The Insurance companies do... if you are luck enough to have insurance.

A "death panel" does not decide if you get life-saving treatment, your bank account decides.

Sarah Palin does not believe that Trig's worth should be determined by his mental or physical abilities, but by his parent's bank accounts.

She is not the only parent struggling with a child's illnesses and health needs. She can be cavalier in suggesting Trig might not get treatment, because, unlike many parents, she knows he always will.

Sit in the chemotherapy rooms at any oncology center and listen to the people there wondering if they should pay for another round of chemo or for groceries. Listen to older adults wondering if it is right for them to spend their families' money on what may be hopeless.

Sometimes we just don't need that extra test...

I'm sorry Dr. D, I love you, but I really did not need that nuclear stress test. And did they have to hook me up to a monitor every time I gave birth? (Well, in my cases, probably... but that's not my point.) Can you please send me to a nutritionist instead of prescribing cholesterol medication? Tell me to get off my a$$, quit smoking, put down the donut? I know it doesn't sound doctorish, but does all medicine have to come in a bottle or by way of a trillion dollar machine with bells and whistles signifying nothing? Do I have to go to a specialist to have ear wax removed? (OK, it was fossilized and the size of a grape, but that's not my point.)

We really need health care reform, but I don't think we are going to get it until we have a clear picture of what we have right now. Then we can figure out where the problem is and what we can do to fix it.

But this atmosphere in which the word "compromise" is coupled with "wishy-washy" and "flip-flop" is damn un-American... on everyone's part. To everyone involved, I say: take an aspirin and let's talk about this in the morning.

3 comments:

annie kelleher said...

sometimes we dont need the extra round of chemo, either. i think we need to redefine what we call "health" before we can even begin to think about how to best take care of it. and certainly, the insurance companies need to be eliminated from the discussion. they should have no say at all in this... if the issues really ARE between the patient and the doctors, then THEY should be the ones having the public discussions. the politicians and the insurers should be told to sit in a corner until the people and the doctors have decided how to handle it.

Brandy said...

Amen! I too had to get my doctor to sign off on my meds b/c the insurance company obviously didn't believe that a prescription written by MY DOCTOR was proof enough that I in fact needed that medicine.

Having said that, I have told my primary physician no before when she suggested lap band surgery & was seemingly trying to talk me into it. I know that I'm capable of losing weight without surgery & that's what I told her.

The point is that you should know YOU better than anyone else, so a good relationship with your doctor is VERY important & should be regarded with respect.

That goes for insurance companies & politicians alike.

Anonymous said...

I think you should have your own TV show.
Carolyn