Angry at the Wrongs of Our Health Care System

So currently, I and my family are among the supposed lucky ones in our nation to have insurance, an HMO. You'd think that if anything was wrong with us, we'd have at our resources the best people available to solve the problems. And we'd be able to pay for those solutions because we have insurance.
[Big Angry Buzzer] Wrong!!!

So a family member of mine has had two different pain conditions for the longest time. And since I love this person so much, I've tried everything I can to figure out how to fix it or ease it or something.

With the first pain condition, we saw our primary care physician a few times (all at $25 a pop) and then we were referred to a neurologist. No offense to the good neurologists that I'm sure must exist somewhere in Atlanta, but the two different ones we visited for my family member SUCKED. They tried to tell us it was carpel tunnel syndrome (something I've seen first hand and KNEW wasn't it.) But NOOOOOO, the doctor knows everything and was so positive it was carpel tunnel that my already in-pain family member had to go through an extremely painful nerve induction test to find out that guess what??? It's not carpel tunnel.... something I told both doctors during the first visit... Total of primary care and specialist visit copays: over $200.

So basically, we paid these doctors to torture my family member with that damned nerve induction test and then tell us that they had no idea what was causing the problem, go see another specialist. At this point my family member gave up on the system and just learned to deal with the pain and loss of hand dexterity.

So lo and behold, over the last month, the other pain condition flared up, and my family member refused to go to the doctor because they didn't want to get their hopes up and have them shattered again. After it gets too painful, we agree to go to our primary doctor (a different one who happened to graduate from Yale School of Medicine). I thought to myself, okay this time it's going to be different.

As soon as the primary doctor examines my family member, she immediately refers him to a general surgeon because she thinks something is torn inside. $25.00 to find out this possible diagnosis. Two days later when we're able to get in to see the surgeon (and by now the pain is at a 10 on a 1 - 10 scale), and after a ten minute exam at 3:40 yesterday... and without sterile gloves even, the surgeon says sorry I can't help you, it's not the problem your doctor thought it was. So essentially, I paid $25 for this other doctor to hurt my family member even more during the probe of the painful area.

I walk back into the primary doctor's office yesterday around 4pm and demand the doctor find the cause of my family member's pain so they can get some relief. Doctor has no idea what to do other than tell us to go to the emergency room... Yay, we're going to the emergency room in the middle of a flu outbreak.

4:15, we walk into the emergency room door, sign in and after a 20 minute wait, are seen by the triage nurse. She tells us the rooms are all full but we're the next in line. 5:15 rolls around and they finally call us back to a room. And when we get into the room, that's when we have to pay the $50 copay for an ER visit. A doctor comes in and spends ten minutes doing the same kind of exam that surgeon did earlier in the day. Then he decides to order a CT and an ultrasound. Whew, I think. We're finally going to get an answer. But my family member is still in pain and finally around 8pm they come in and give him a shot of something for the pain.

Now keep in mind, my family member hasn't eaten anything since midnight because they thought they were going to have surgery that day. But eating is still not allowed because it might mess with the tests.

IT TAKES 3 1/2 HOURS FOR THEM TO TAKE HIM FOR TWO TESTS THAT LASTED 15 MINUTES A PIECE, INCLUDING TRAVEL TIME TO AND FROM THE TESTING AREA. Total time spent actually doing something: less than an hour.

We then have to wait for over another hour to get the test results back. Guess what?!?!?! Everything looks normal except for a teeny bit of extra fluid somewhere, but that fluid shouldn't be causing the pain because it's seen on both sides of the body and the pain is only on one side.

Bottom line, we paid people to poke and prod my family member, cause more pain, waste lots of time only for them to say we have to go to yet another specialist. We didn't walk out of the emergency room until after 11pm last night.

So for all these people who are screaming and scared about having to wait in lines for the boogeyman of socialized healthcare... WAKE UP PEOPLE, WE ALREADY ARE! And those of us with insurance are actually paying for the privilege of doing so.

$100 personal money spent and over 8 hours of our day wasted. (And that $100 may not seem like much to some people, but when you're laid off and trying to save every penny, that's way too much to have to spend for little to absolutely NO results) Speaking of results... our end result, a prescription for a pain med and a referral to another specialist who I doubt will be able to help us.

And guess what, my family member is so disgusted that if this next specialist can't figure it out, that's the end and they're going to stop trying to get it fixed.

Not only do I feel taken advantage of by the system, but I feel emotionally raped. We get our hopes up time and time again that someone's going to actually find a solution only to hear, Nope, we don't know, and ha ha... you had to pay us to tell you that.

Maybe I should start learning the words to Oh Canada... my Canadian friend tells me this would never have happened there.

My whole life, I've worked hard to tone down emotional reactions and be calm and rational. I don't pass the buck and I try to fix as much as I can and not try and throw blame around, but if I or my family member has caught one of the flu viruses after all the rest of this mess we had to deal with, I am so going to verbally throttle someone.

Last night was finally the straw that broke this long patient camel's back. I've tried to be good and do the right thing, and all I've gotten for it is wasted money and the horrific chance to see my family member clenching teeth through pain. Do you know how much it hurts me to see my loved one hurting—really hurting—and not be able to do a damned thing about it???

So I don't care who has to do what. Mr. President and Members of Congress, get off your collective asses, stop dilly-dallying around with lobbyists and special interests (corporate or otherwise), and actually do something for our substandard American Health Care system instead of talking about it all the time!!!

A different idea in the healthcare debate

So I just read an article on HuffPost called: "Public Option Plan Will Cover Few Americans, New Statistic Reveals." A quote from one comment on how the public option should have been:

"Here's how it should have been: Open up clinics for citizens who don't have health care insurance. Require proof of citizenship for access. Done. It really is that simple. And no one should have a problem with that. I could have written the bill for this in ten days and it would have nothing to do with the insurance industry..."

I think the person who commented is on to something here to provide access to everyday health service needs, especially with the public option sounding as watered down as it is... Further suggestions for improvement would be to include legal immigrants (who have to file taxe returns like citizens do) in the ability to access services and include preventive care as services provided.

Study after study shows that preventive care reduces costs across the system, yet our current system is not based on any preventive care incentives. Instead, it's based on reactionary care... fixing things after they've gone wrong instead of focusing on wellness.
About Health Care
Read the Article at HuffingtonPost

To Be or Not To Be: The Public Option and thoughts on politics

As one of the former employed who will be losing my health insurance in March, I strongly and sincerely call on Congress to pass health care reform containing a full and robust public option. That is one of the reasons I worked so hard to elect President Obama and the Democratic majority in both houses of Congress. This is the time when the proverbial rubber needs to meet the road.

We the People created a huge call for change during our last election, yet I haven't seen very much change in the way legislation is being crafted. Kowtowing to industry and corporate welfare seems to be the message of the day. We the People elected you, and if you can't get Our Business done instead of getting Corporations' Business done, then I will work even harder to elect people who will actually live up to their campaign promises.

Speaking of which, there was once a thing called truth in advertising, and this whole mess has me thinking about starting a grassroots effort to sue elected officials who break their advertised campaign promises.

And since we're on the topic of advertising... am I the only one who's noticed that healthcare costs started skyrocketing immediately after we removed or watered down the regulations regarding advertising for prescription drugs???

Perhaps the politics of the day is too entrenched in the culture and we need to work to make it easier for parties other than Dems and Repubs to be in power. Maybe other parties could do a better job and create the change we demanded (and so desperately need) in our last election. If a majority in the House and Senate can't make this happen, then we have a very serious problem on our hands.

Either way, not a dime of my now limited money will go to support any political campaign or organization that does not support real reform in our healthcare system.

Grayson Not Backing Down: "I Apologize To The Dead"

I'm glad to see someone standing up for We the People instead of the big corporate interests involved in the health care bill! Thank you, Rep. Grayson!
Read the Article at HuffingtonPost

Mixed feelings about the Baucus bill

While I've not learned enough about the regional non-profit co-ops mentioned in an AP article I read this morning on the Baucus bill, from what I've heard I'm not completely opposed. I do have to share that I participate in an electric co-op currently.

I do like the idea of mandating that preventative and mental health services be included in insurance plans and that only US citizens and legal immigrants will be able to access these services. My heart goes out to the plight of many illegal immigrants, but if you choose to be in a country, you should do so legally. I believe our current immigration policy also needs to be completely overhauled, but that's a topic for another day.

But, if this is the bill Congress plans to try to push through, then I've got to state some hard and fast objections to a couple of the provisions:

First of all, one of the platforms Obama campaigned on and one of the biggest reasons why I supported him is that he did not want to require people to purchase insurance. He simply wanted to make it available to people who wanted it through a public option that was similar to the insurance our government already provides to our elected officials, federal employees, veterans, etc. If the co-op idea can provide the same kind of service, I won't be opposed provided it is affordable and provides the care those of us who are living paycheck to paycheck need.

But the idea of our government ordering me to support an entire industry that I already think has a lot of crooked shenanigans or paying a fine if I don't is completely an invasion into my personal life.

In addition to it being an invasion in my personal liberty, I also think this is a completely classist provision. There is no guarantee that this bill will make health insurance affordable. So when the government says buy insurance or you have to pay a fine, I have a problem for the millions of us who may not be able to afford it.

One point of the article struck me:

"Not carrying insurance could result in a steep fine, as much as $3,800 per family, or $950 for an individual. People who can't afford their premiums would be exempted from the fine."

However, after further research, I found a WSJ article that linked to a summary of the proposed bill which shared some info about the exemption:

"An exemption from the penalty is permitted if coverage is deemed unaffordable – defined based on a circumstance where the lowest cost premium available exceeds 10% of a person’s income. Exemptions from the penalty are also allowed based on hardship, for Native Americans and for individuals below 100% of poverty. Additionally, in 2013, individuals at or below 133% of poverty will be exempt from the penalty.

For taxpayers between 100-300% of poverty, the penalty for failing to obtain health coverage is $750 per year with a maximum penalty per family of $1500. For taxpayers with incomes above
300% of poverty, the penalty for failing to obtain coverage is $950 per year with a maximum penalty per family of $3800."

Now after doing the math, I've determined that I'm definitely paying more than 10% of my income on health insurance premiums... to the tune of 16% of my income and that doesn't even include all the copays for prescriptions and office visits. I'm hoping this means the changes they're proposing will actually work and reduce prices on insurance.

My next objection is that this bill refuses to allow federal funds to be used for abortions except in the case of rape, incest or the life of the mother (not health of the mother). Let me be plain, I am personally against abortion for myself. I've never had one and never will; although I have to admit to a scare one time that made me do some hard thinking about it. I've also had friends who have had abortions, and while I wish they could have made a different decision, I supported them and helped them. According to the AP article I linked above, insurance plans can include the option, but the woman would have to use her own money to pay for that coverage. This again is a classist provision and will leave many women without the ability to choose, which last I heard was still one of our rights.

To have an abortion is a difficult decision for anyone, but if the government is going to stick its nose into my body's business, it should do so fairly. As it stands now, I'm feeling a lot of hypocrisy in this provision.

If the Right to Life value is so important to our government, then why have we been responsible for thousands of deaths (our soldiers, their soldiers, enemy combatants, and innocent foreign citizens) in all the wars and military actions we've waged during my lifetime?

Why is Right to Life always defined as an unborn child and not all the perfectly wonderful living people who are already here? Why can't Right to Life actually mean right to life, liberty and the pursuit of happiness? Isn't that what life's supposed to be about?

So here's my response to this one... If federal funds may not be used to provide legal abortions to women in need of them, then federal funds should not be used to cause the deaths (especially of innocent people) in any military action. A life is life, is it not? And from what I heard from several Right to Life acquaintances of mine, "Every life is precious."

Last but not least, I'm also confused by this provision in the summary:

"Employer Responsibility. Employers would not be required to offer health insurance coverage. However, employers with more than 50 full-time employees (30 hours and above) that do not offer health coverage must pay a fee for each employee who receives the tax credit for health insurance through an exchange. The assessment is based on the amount of the tax credit received by the employee(s), but would be capped at an amount equal to $400 multiplied by the total number of employees at the firm (regardless of how many receive a credit in the exchange). Employees participating in a welfare-to-work program, children in foster care and workers with a disability are exempted from this calculation.

As a general matter, if an employee is offered employer-provided health insurance coverage, the individual is ineligible for the tax credit for health insurance purchased through an exchange. An employee who is offered unaffordable coverage by their employer, however, can be eligible for the tax credit. Unaffordable is defined as 13% of the employee’s income. The employee would seek an affordability waiver from the exchange and would have to demonstrate family income and the premium of the lowest cost employer option offered to them. Employees would then present the waiver to the employer. The employer assessment would apply for any employee(s) receiving an affordability waiver. Within five years of implementation, the Secretary must conduct a study to determine if the definition of affordable could be lowered without significantly increasing costs or decreasing employer coverage."

Why is insurance considered unaffordable for a penalty exemption at 10% of one's income, yet unaffordable is defined at 13% when it comes to employer-provided coverage? And how does this change in employer-provided insurance comply with Obama's campaign promise that those with employer-provided care would be able to keep their insurance unchanged?

I know I've mentioned several different issues. I'd really love to hear some other perspectives.

Phoney protests are baloney!

When will this country be able to have a real debate on the pros and cons of the health care reform issue instead of being overwhelmed with propaganda and fear tactics? Here's another story about health care protests being funded by people who are heavily connected with the insurance industry:

More than 70 percent of the American public agrees that a public option for health care is a good idea. That fact is terrifying to insurance companies that have hustled billions of dollars out of a dysfunctional health care system for decades. The insurance industry is so worried that they now have phonied up protest groups showing up at town hall meetings to disguise the fact that 70 percent of Americans want a choice between private insurance and a government run plan.

When did greed (whether it be corporate or personal) become the prime motivating factor in doing business?

What happened to quality products and services for fair prices?

What gives?!?!?!?!?! Wait, I know... the economy, that's what... and it's given until it's plain tuckered out. Sigh.

Stepping off the soapbox now and would really like others' opinions on this one.

Freedom of Information: Debate of facts vs. fiction in healthcare

This morning I planned to discuss how the current debate on health care in our country seems to be a farce versus a real discussion of the actual facts. But before I waxed indignant about it, I discovered that my friend Chuck already had on his TERRIBLEMINDS site:

Let’s see. It’s early. I’m only halfway through my coffee. I can’t quite herd my stray thoughts into a straight line.

Perfect time for a spirited debate about health care!

Except, the debate has been rigged. Public opinion against the public option is a paper tiger, yet it’s a paper tiger that we’ve been led to believe has real teeth and an angry roar. We believe this because we’re at least a little bit stupid, and because the media has approximately zero interest in doing its job.

I recommend you give him a full read, but be warned, he's a lot more raw on this topic than I would have been. I think it's a necessary intensity, though, in this frustrating stage of the non-issues debate, and I'm glad he was able to go where my manners wouldn't have let me. Here's another point he made as an example:

Hitler? Hitler. Hitler?! Really? Comparing Obama to Hitler is easily, handily, totally the most ludicrous goddamn notion this side of a faked moon landing. Actually, it’s worse. You’d be smarter thinking that you can eat dog shit for dinner and poop out pennies. I don’t even want to refute it, because then I feel like I’m somehow giving the argument credence.

How on earth people can actually believe that Obama is like Hitler is beyond me. I have tried, but I just can't wrap my head around it. I don't know whether to be sad, completely outraged, or laugh at the complete hypocrisy of those who are behind this imagery. When the comparison was first made, I just shook my head and thought "Wow, that's too crazy for anyone to take seriously." And then it was.

When did we become a nation of sheep to be led around by our noses by people who don't know what the words honor or truth really mean?

There was a long time in our nation's history in which your word was your bond and having a reputation for honesty meant something. I think that all changed the moment that journalism became a business for shareholders instead of a business to give people real news. Now it seems we've returned to the good ol' days of the robber barons and yellow journalism.

When are we ever going to learn from our history instead of repeating it?

Freedom of Information: About Your Doctor!

Patrick Malone and I must be on the same wavelength... His article on HuffPost captures exactly why it is so very important that we as consumers be able to learn more about our doctors.

I know I've mentioned some of my family's experiences about unnecessary doctor visits, misdiagnoses, etc., in previous posts. For anyone in Atlanta, let me know if you're investigating neurologists, there's a couple out there who are absolutely horrible, and I'll happily share their names with you offline so you don't have to bother seeing them.

But getting back to the article at hand... Malone makes a great point about something he calls:

"no patient left behind" -- a simple report card system to give patients a heads-up about their doctors' credentials and safety record, something almost impossible to get now.

I think I've finally found a good neurologist for my family, (fingers and toes crossed), but in order to do so, I had to:

• get lucky enough to find a very caring employee at my insurance company who went through the entire doctors' list looking for the information that they had on the doctors... where they went to school, when they graduated, where they did their residency training, etc.
  
• call all the offices to see which were accepting new patients
• talk with people who worked there to get a feel for how skilled the doctor was, would the staff actually go see him/her for their problems, etc.
  

All in all it took me a few days to get all this researched. And even so, there are no guarantees. So I'm in a wait and see mode at the moment. Here's hoping that our doctor who trained at Emory lives up to the hospital's reputation.

As for Malone's "no patient left behind" idea. I think it makes nothing but common sense. We can all go online and look up reviews on lots of different products and services that we may or may not need. For something as important as our personal health and well being, we should at least be able to look at a safety record.

I think the reason I am most passionate about this idea is that I lost my Gram to an unsafe doctor a few years ago. Her mom (my great-grandmother) had died just a couple of years earlier, so based on my family's health history, I honestly expected her to be with us for at least another decade. Unfortunately, the doctor did not follow Mom's instructions (she had medical power of attorney for Gram). The end result was that Gram had to live the last year of her life suffering from the effects of stroke and congestive heart failure. And just when we thought she was going to get better, she didn't.

I have missed one of my truest and best friends ever since.

If we had had access back then to more information about her doctor, including his safety record, Mom and I would have known to take Gram to a completely different doctor, instead of the one who made such bad decisions about her care.

Now I know that some who read this post may say that knowing more info about the safety records may lead to more malpractice suits... but I think it would actually cause the opposite to occur.

If we knew the skills and abilities of our doctors, then supply and demand suggests that we would go to the better service... given that those doctors are in our insurance networks. Those better doctors would probably have more accurate diagnoses, resulting in prompt treatment of conditions and fewer unnecessary visits to a whirlwind of specialists. Bottom line, health care and malpractice suit costs would be reduced, not increased.

Your thoughts?

Health Care Debate--I'm frustrated!

As an addendum to my previous post about health care, I found a great article by Brian Unger on NPR that seems to sum up a lot of my feelings about the current health care discussion:

The health care debate is toxic, revealing a lot about us as a nation. And it feels embarrassing — like the whole world can see our underpants. Or hear us fighting in the kitchen.

I wish our leaders would recognize and address the hypocrisy of the whole "government health care" is socialism fear tactic and actually do things that don't solely help big business. I agree that a strong business sector is a very important part of a healthy economy, but I am so tired of short term gains being the focus of business, who have lots of powerful lobbying efforts, which in turn can cause our own government to look at short term benefits instead of long-term benefits.

Shouldn't both the short term and the long term be taken seriously?

Any others' experiences or thoughts are welcome!

Healthcare frustrations

I've ended up having quite a few discussions on the topic of health care recently, and the bottom line from all the discussion is that while some may have it better than others here in our country, we still have a long way to go before we get it closer to where it needs to be. Now many people have their ideas that they passionately believe when it comes to health care. Some are worried about socialized medicine... i.e. government run health care... Isn't that what Medicare is?

And the one chorus I've heard from lots of seniors is "Don't you mess with my Medicare!" So if this government run plan is what so many people are scared they're going to lose, what's the big deal with providing another government run option for all the people who are not lucky enough to work for a big company that provides healthcare?

When I worked for a big company, all I was concerned about was that I'd be able to keep my own health insurance and that the government wouldn't take away my freedom to choose.

Now that I've been laid off, I'm really interested in that possible government plan b/c I'm not sure I'll continue to be able to afford to stay with my current insurance provider. And if I switch, then there may be a whole lot of pre-existing conditions that might not be covered anyway.

One of the things that everyone talks about is problems, but not solutions. I think one solution is to get the insurance companies out of the doctoring business. My doctor should be able to tell me what is wrong and not have to wait for an approval for an insurance company as to when and how to provide treatment.

Another problem we have is that often, your primary doctor may not be able to diagnose the condition because they're often not allowed to run the right tests and then you have to go see specialists... Well, if enough prep isn't done on the front end as to what type of specialist you really need to see, then you could go to one pointless doctor appt to another to another and still never find out what is truly wrong with you.

This has been a personal experience of mine. A few years ago I got Very sick... It was kind of like mono, but worse for me, and I knew it wasn't mono because I'd already had it a few years earlier. This particular virus made me so tired it took all my strength to climb up 6 stairs. No one could figure out what was wrong. First I went to my doctor, then an ENT. Nothing they did helped, so after a few weeks, they sent me to an infectious disease specialist. By the time I got to the right specialist, the virus had almost worked its way out of my system. Then I had to fight with the disability insurance people because they didn't want to cover my time away from work because the diagnosis of the infectious disease doctor wasn't absolutely certain. Ugh! Finally won that one, but I shouldn't have had to fight at all.

So both the insurance companies and I were stuck with paying useless bills and copays until I got to the right specialist. That was 3 or 4 visits that could have been avoided. If my primary doctor had had the time and support behind her from the insurance companies to run the right kinds of tests in the beginning, those useless visits could have been avoided, and I might not have gone through the terror of wondering what was wrong with me for over a month and would I ever get better.