The real question should be why socialized medicine. When I posted this on Daily KOS someone suggested a better name would be "Civilized Medicine," so I'll go with that. The answer is really quite simple because capitalism and compassion do not go together. For at least 2 decades, our country has been governed politically by a mindset that making profits, increasing personal wealth, shameless consumerism, and endless financial growth were the “Holy Grail” of civilization, and that from these all good things flowed. Cutting taxes, cutting operating costs, lowering prices, increasing credit availability were all strict tenants of policies to further its progress. I believe that the root cause of the medical availability issue runs much deeper. As a society, we have embraced a culture where these goals have superseded all others. The casualties have been any element of business or government that does not further these ends, such as health care benefits and funded pensions.
2007 has not been a very good year around our home. Two visits to the ER, two hospitalizations, one because of a botched colonoscopy that resulted in a perforated bowel. That also led to a second colonoscopy in one month. One illness, that has gone on now for seven weeks. All of this together has revealed even more loopholes in modern health insurance.
Many people have this loophole in their policies and are unaware. The bowl perforation led to an emergency bowel resection. I was in the hospital, I had met my deductible and wasn’t worried about the bills everything should be covered and it was because it was an emergency. However the other surgery was not an emergency. So the hospital was paid and the surgeon was paid, both in full. The anesthesiologist was not paid in full. You see anesthesiologists for the most part do not participate with health insurance companies, at least according to my health insurance company. So while your plan will pay the doctor usual and customary fees, the anesthesiologist can bill what they want and you have to pay the rest.
Not enough to get on board, OK how does this sound to you? Approximately seven years ago my primary care doctor threw me out of his practice. Now I had been going to him for about ten years and thought he was a compassionate practitioner. Once when I was out of sick days and vacation days he did his very best to keep me out of the hospital. When I finally ended up in the hospital with viral pneumonia, both he and his partner came and visited my bedside to check on my progress.
So why ask me to change doctors? Two reasons why, first I was upset, that this doctor refused to learn anything about my Post Polio Syndrome (PPS). He was too busy and I was his only patient with PPS. The second was because I insisted that he do his job as “gatekeeper” of my overall healthcare and actually read the reports that other doctors sent. You remember the term gatekeeper. That’s what they told us our HMO primary care doctors were going to be. The reality is that to be profitable doctors have to see too many patients to be able to read every report, so I’m told. Primary care physicians prevent patients from going to one specialist after another, when it really isn’t medically necessary. This was going to cut down on the ballooning healthcare costs in America. They have been around now since 1973. These plans have even mutated to something called a PPO. Under PPO plans like I have now I can self refer. Or in other words pay enough and you can see who ever you want.
For along time now healthcare advocates have suspected that the basic structure of HMO plans rewards doctors by allowing for greater profits for both if, in fact these doctors limited their referrals to specialists. Though, I’m unaware of anyone actually proving that there are “kickbacks” going from insurance companies back to physicians. It is only because the way the plans work between doctors and insurance companies does not fit the true definition of a ‘kickback.
Recently I learned of another way primary care doctors can increase their profitability. They simply do not qualify for hospital admitting privileges. So in other words, you might be going to a doctor for regular check-ups, go see them if you have a sore throat, maybe a stomach virus and they will diagnosis then treat your illness. However, if you arrive at your primary care doctor with a dangerously high fever they can’t say I have to admit you to the hospital. They may ask that you call someone to take you to the hospital or even call 911 so an ambulance can transport you to a hospital. They can not pick up a phone, call a hospital admitting department, and say “I’m sending Mr. Jones in, he needs to be admitted to a medical floor, or he needs to be admitted to a surgery floor or intensive care.” That is exactly what happened to me when I had pneumonia. In that case I was just a less than three percentage points of O2 saturation away from being admitted to the intensive care unit. That doctor (the one that threw me overboard) was a throw back to the days when doctors routinely qualified for hospital privileges.
Your doctor may still maintain his hospital privileges and may spend a certain amount of time each week going to the hospital to check on patients. My wife’s doctor, again the same one that threw me out of his practice, has decided to join a new group of physicians. He has announced that he is joining the ever increasing group of doctors that are practicing concierge medicine. Under these arrangements you pay the doctor a retaining fee, say $1,500.00 a year to be able to go to that doctor. My wife’s doctor quickly points out that you can pay this retainer with your flex spending accounts. Like everybody has a flex spending account. These concierge doctors are on the rise with a bullet. They are a result of the medical communities fear over universal healthcare. The other side of the equation is health insurance companies and pharmaceutical companies working together to increase their profits.
You say, wait they can’t do that what about anti-trust laws, and price fixing laws, won’t they prevent this. Well they haven’t so far. Ask yourself this, how many times during the current administration, have you heard about prescription drugs going from prescription to over the counter medicine. It is always the pharmaceutical company asking for the change so more people can by their drug over the counter, which increases their sales potential. The insurance companies love this because every time that happens it is one more prescription drug they don’t have to pay for. An example of this is Prilosec, the maker Proctor & Gamble Pharmaceuticals successfully lobbied the FDA to allow for over the counter sales. So when my doctor prescribed the prescription strength Prilosec, the insurance company made me first try the over the counter version. Claritan D or the generic Loratadine D went through the same process. The FDA allowed for a change of status again freeing health insurance companies from the expense of paying for yet another prescription drug.
Next find out just exactly what you are going to have to pay for physical therapy (PT). Under my various coverage’s over the years it has averaged out to about $47.50 per session. What exactly does this mean? It means that if you fall off the ladder, after you pay the hospital co-pay and the physician co-pay and the X-ray or MRI or CAT scan co-pay, you will still have to pay for the physical therapist. Now sometimes this co-pay is the same as a doctor’s office visit co-pay but more frequently it is a percentage of the therapist’s bill. Say you are one of the luckier ones and you have to pay your $30.00 specialist co-pay. If you are unlucky you will pay 10-20-% of the therapist bill. For me that has been as high as $65.00 per session. The doctor is going to routinely prescribe 12 visits at a rate of three times a week. So in the month that follows an injury it might break down like this. I’m using my figures from the past. Co-pays – ER $50.00, X-ray $50.00, MRI $50.00 (you will probably have both x-rays and an MRI because x-rays don’t always show everything that might happen during such a fall), ER doctor $30.00 for a grand total of $180.00 before PT. So that is $180.00 for the ER visit your benefits coordinator told you would be only $50.00. Not that they were lying the ER did only charge you $50.00 but whoever sold you your health insurance probably stresses the fifty dollar part and glossed over the other charges involved in going to the ER. Now we get to PT, so let’s average out between $30.00 if it is billed as an office visit and $65.00 if it is a percent of the fee. That would be $47.50 per visit times 12 which is $570.00. It adds up doesn’t it, a slip and fall easily can run you $750.00 before any medicine is bought and what ever your prescription plan if you have one will cover. What a great system we have. I love it, don’t you?
In 2004, one of the most important elections of the last one hundred years only slightly more than 55% of eligible voters actually cast votes. This time out the two parties are once again dividing the electorate. The Republicans are stressing the need to stay engaged in Iraq on foreign policy. All the while they are insisting that we don’t need universal healthcare on domestic policy. Conversely the Democratic candidates are calling for a pull out of our forces from Iraq. The top three candidates are insisting they have the universal healthcare plan that will cover every American. Senator Edwards says we don’t need to work with health insurance and pharmaceutical companies we need to beat them. Senators Clinton and Obama have very nearly the same plan but insist that each has the better, more universal healthcare plan. I sorry Senators if your plan does not cover absolutely every person fully and paid for with tax dollars it is not enough. There are many nations around the world that have figured out that this is what modern societies do. They take profit out of the equation. Many when they hear this idea grab their chest like Fred Sanford exclaiming “it’s the big one.” It is the big one. It is possibly the single biggest thing we can do to better this nation.
One of the biggest reason politicians refuse to entertain such a comprehensive health plan is the cost. They look at Medicare and Medicaid costs then extrapolate them out to cover every one which is what causes them to do the Fred Sanford thing. The thing is these programs cost so much because they have been raped by fraud. NBC recently had an example of a $5,000,000.00 wheelchair. I have an electric wheelchair, recently I had to find out how much it cost initially so my insurance company would pay for replacement batteries. The cost was just under $4,000.00; a lot less zeros in that number don’t you think.
So while on the subject of my wheelchair, see if you think this is fair. I am disabled. I have to use my chair when I go out of my home. My home is too small to practically use the chair inside. So when I go to the grocery store or the mall or a stadium event or just a walk around my neighborhood I use my chair. I keep it in my mini-van. I have a lift to put it in and take it out. Do you think the insurance company or Medicare paid for this lift? NO. Medicare won’t pay for it unless I’m working but if I’m working then I’m not disabled and don’t qualify for Medicare. My insurance company feels that a lift to get the chair they readily paid for in and out of the van is – wait for it – a luxury. A fucking luxury that’s what they consider having the mobility to do some of what is necessary to live life.
There you have it my reasons why our healthcare system is out of control. Insurance companies make beaucoup bucks. The pharmaceutical companies make beaucoup bucks. The heads of these companies personally make obscene beaucoup bucks. And how do they do it by declaring the ability to go to the movies with my daughter is a fucking luxury. The system is ripe with fraud because it asks for it. The little guys see what these behemoths do with all the money that comes their way and decide maybe it’s time for a little Bonnie & Clyde or Jesse James only against the healthcare industry this time. So before anyone else can be seriously hurt by the criminals committing fraud to get what they see as their fare share of the profit pie, lets take profit out of the equation. That doesn’t mean that mean people won’t get paid for doing the various tasks with in the system it means we wont pay costs plus. We’ll just pay costs.
