God Insurance

Why does religion sometimes leads people to throw all common sense and judgment out the window?

Although this kind of thing may sound like a good idea on the surface, the reality is that one big chronic illness could send this whole thing toppling down and leave someone who is really ill and in need of care, with crippling medical bills. Not only does not having health insurance mean there is no legal guarantee of coverage (or, at least as much guarantee as you have under the current system where insurance companies frequently find technicalities to avoid paying their bills) but it also means that, as individual purchasers of medical services, these people do not have the collective bargaining power to negotiate better rates. So, they're probably paying the highest price for the services they receive.

Add to that the fact that many health providers these days (as I found out during my mother's hip surgery) do not actually take cash patients any more, and you've got a recipe for disaster. Meanwhile, that person will be left with the inability to find private medical insurance that will cover them because their condition will be then classed as "pre-existing" and no profit-hungry insurer will touch that with a 12-foot bargepole.

Now, I don't know about you but, unless God is thinking of planting money trees sometime soon, I don't think faith alone can solve those problems.

Back on the hip wagon

It's been a while since I posted anything about my hip. Hopefully a long enough hiatus to ensure that you're not all groaning in misery at the mere mention of it - but then, maybe not! ;o)

Anyway, if you've been following my titbits on Facebook, you'll know that I finally decided to make a doctor/PCP and medical group switch, and today was my first appointment with my new PCP.

Since my insurance is an HMO, my medical group is a big deal, in fact more of a big deal than my PCP, ultimately, becuase it dictates which specialists I can see. Long story short, I was originally with Hill Physicians when I first moved up to the Sacramento area several years ago and was very satisfied with all the referrals I received BUT hated my backwater doctor at the time. I switched to a younger doctor, with computer medical records (woot), who I loved (love) but she was a part of Mercy Medical Group - sort of like a mini Kaiser around here. Unfortunately, the "mini" meant mini service and mini options but with all of the same restrictions as KP. I had to fight to get my hip surgery done arthroscopically because Mercy didn't have a surgeon who had done it before (finally having to get a surgeon affiliated with Hill to scrub-in, so I wouldn't have to have open surgery). I then had to go out-of-network and out-of-pocket for physical therapy after my surgery because the Mercy therapists kicked me out the minute I was walking. Finally, to get the Osteopathic Manipulation my doc felt I needed to progress, I had to drive 45-60 minutes each way, to a town called Lincoln, on a 2-lane highway.

Although I loved my doc and honestly believe it is unlikely that I will ever find someone with a bedside manner that so completely suits me, the reality is that, aside from all but the basic cold, flu type illnesses (which I rarely have), she refers me out and so I spent more time with disparate "specialists" than I did with her. And, as I said, the specialists in Mercy are not all that special, in my humble (yet increasingly experienced) opinion.

It pains me to have to start this whole process again for the third time but I've plateaud with my hip in a place that is not acceptable for me at this time in my life. I honestly don't know if moving around like this is the solution but what I do know is that I've got to keep trying. I won't rest until I turn over every rock, trying to find the magical combination of treatment and care that will help me get to a better place.

Unfortunately, I've eliminated "recovery" or "pain free" from my vocabulary these days, as I'm not sure these are reasonable goals. Honestly, I'd just like to be able to get in and out of my car without worrying about twisting or turning the wrong way, pulling something, or clicking or popping something. Not to have to think about every little movement and make adjustments all the time would be victory for me. I want to be able to chase Daisy around the garden and perhaps even ski down a bunny hill with her for the first time - no black diamonds or anything, just a gentle little slope and some amateurish ploughing. Beyond that, I don't know what I'm going to achieve but I know I'm going to work hard to make it the best result I possibly can.

With all this in mind, I went to my doctor's appointment this morning.

The new guy is literally a quarter of a mile up the street. I practically passed his surgery every day without even paying it a second notice! I found him through my health insurance's online doctor site, by looking for another D.O. (Doctor of Osteopathy.) I have a lot of respect for doctors who do the extra time (2-6 years more than a regular doctor) and become a D.O. and, so far, I like their approach to treatment, so it was important to me not to lose that, if possible, in the switch.

Doing a little research on him, I was intrigued. In these days of computerized medical records, where doctors half-listen to you while they busy themselves with typing on a keyboard or fighting with an "F" button of some sort, he is an old-fashioned type doctor with an old-fashioned family practice. He "specializes" in total health care, from infancy and childhood, through adulthood, everything from pediatric to women's health, dermatology, nutrition, chiropracty, osteopathic manipulation, in-office minor surgical procedures and physical therapy - all in his surgery. (I KNOW!) I met with him briefly before I made the switch and he bristled at the very mention of referrals. "We like to take care of as much as we can here," he said. "For us, it's about continuity of care." Although I know this could either be a blessing or a curse, it was different enough to make me curious. The PCP >>> referral route hasn't served me too well as yet, so a truely different approach is probably my best chance yet at a different result.

Not that old-fashioned equals "old" or out of date, at least where it matters. No, he doesn't have computerized medical records and has had his local practice for 20 years but he's a fit, energetic, attractive, 50-ish man, the chief physician for the local Hill Physicians region and is involved in academic testing on the California Osteopathic State Board. These things tell me that he stays up-to-date yet is experienced enough to know what's what, especially within his own medical group - and knowing how to negotiate the system is an under-valued quality in a doctor, I am finding.

In person he turns out to be the typical "A-type" personality. A short, brusque, multi-tasker, who knows what he's doing and likes to get to the point. He is constantly on the move with purposeful energy, walking around his surgery simultaneously signing-off on charts, texting on his mobile phone, making and answering calls between patients, and conversing in harried-tones to his staff. He takes notes by verbally recording his voice on his smart phone, presumably because he doesn't want to take the time between patients to sit down and write (or type) something. He moves from one task to the next fluidly and his staff orbit around him in the kind of practiced way that makes you realize that he demands a lot of them but is admired by them; they've also obviously been with him as a team for some time.

His bedside manner isn't touchy-feely and sitting in front of him to explain the reason for your visit is an exercise in summation and verbal bullet-pointing - state your needs up front and remove the unecessary words; get to the point! He's a jolt to the system if you've been used to someone chatty and sympathetic, as I have. And if you're looking for someone to talk about how you're "feeling" non-medically... this guy is not for you.

But, I think I'm going to like him. He's definitely an adjustment for me but one I can easily make with my "get on with it" personality. Although I like to think of myself as a fairly friendly individual, I have come to value expertise and capability over friendliness. I've had friendly and look where it's got me. I go to the doctor to get "fixed" not to socialize, so I can look past this if I get results.

Within five minutes, we'd moved beyond my long-winded hip history (which he rushed me through) and determined that there wasn't much point in looking at what had already been done: Surgery - check; Orthopedists - check; Physical Therapists - check; Osteopathic Manipulation - check; Results - notsomuch. What did I expect to gain from seeing him? he asked me. I couldn't provide a concrete answer because I don't know what it's realistc to expect. It's an open-ended objective, really. We settled on someone different doing something different for, hopefully, a different result.

He immediately whisked me away to his manipulation treatment room where he cracked (and I mean popopopopopopop) my back, my ribs, my hips and pelvis in 3 swift and yet painless movements that took less than 30 seconds to perform. He then told me that I hadn't had really good physical therapy until I had been to a local lady, just half a mile away. He said she was the (and I quote) "best in the west" and if something was "fixable" to any extent possible, she would be the one to fix it. He told me she wasn't within my medical network but that he knew her well enough over the years that he his patients had a special cash rate with her of just $45 per visit (only $20 more that I would have to pay with insurance anyway.) He scribbled illegibly on a pad to refer me to her as we walked out and back to the front desk, mentioned a follow-up appointment in two weeks and said goodbye as his receptionist took his cue and had three appointment times/dates ready for me to pick from.

Not ten minutes after I had first shook his hand, I walked out of there, having been assessed and dismissed in short order. It was like being at the Dennys of doctors: good, solid food you can rely on, dished-out quickly by a busy and well-practiced kitchen. (I like Dennys, by the way. If you don't have a favorable opinion of Dennys, just replace with your favorite fast-and-yummy diner-food joint.)

Of course, as we say in the UK, the proof is in the pudding. Meaning, the results will speak for themeselves. But right now, I'm just happy to be on a different course.

I called the Physical Therapist, by the way, and have an appointment for 8:15am tomorrow morning. So, more after that...

Shame on US.

A compassionate, yet rational, perspective on our health care crisis.

"As many people die every three weeks from lack of health insurance as were killed in the 9/11 attacks." -- WOW.
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NEW YORK TIMES
November 12, 2009
Op-Ed Columnist

America’s Defining Choice
By NICHOLAS D. KRISTOF

President Obama and Congress will soon make defining choices about health care and troops for Afghanistan.

These two choices have something in common — each has a bill of around $100 billion per year. So one question is whether we’re better off spending that money blowing up things in Helmand Province or building up things in America.

The total bill in Afghanistan has been running around $1 million per year per soldier deployed there. That doesn’t include the long-term costs that will be incurred in coming decades — such as disability benefits, or up to $5 million to provide round-the-clock nursing care indefinitely for a single soldier who suffers brain injuries.

So if President Obama dispatches another 30,000 or 40,000 troops, on top of the 68,000 already there, that would bring the total annual bill for our military presence there to perhaps $100 billion — or more. And we haven’t even come to the human costs.

As for health care reforms, the 10-year cost suggests an average of $80 billion to $110 billion per year, depending on what the final bill looks like.

Granted, the health care costs will continue indefinitely, while the United States cannot sustain 100,000 troops in Afghanistan for many years. On the other hand, the health care legislation pays for itself, according to the Congressional Budget Office, while the deployment in Afghanistan is unfinanced and will raise our budget deficits and undermine our long-term economic security.

So doesn’t it seem odd to hear hawks say that health reform is fiscally irresponsible, while in the next breath they cheer a larger deployment of troops in Afghanistan?

Meanwhile, lack of health insurance kills about 45,000 Americans a year, according to a Harvard study released in September. So which is the greater danger to our homeland security, the Taliban or our dysfunctional insurance system?

Who are these Americans who die for lack of insurance? Dr. Linda Harris, an ob-gyn in Oregon tells of Sue, a 31-year-old patient of hers. Sue was a single mom who worked hard — sometimes two jobs at once — to ensure that her beloved daughter would enjoy a better life.

Sue’s jobs never provided health insurance, and Sue felt she couldn’t afford to splurge on herself to get gynecological checkups. For more than a dozen years, she never had a Pap smear, although one is recommended annually. Even when Sue began bleeding and suffering abdominal pain, she was reluctant to see a doctor because she didn’t know how she would pay the bills.
Finally, Sue sought help from a hospital emergency room, and then from the low-cost public clinic where Dr. Harris works. Dr. Harris found that Sue had advanced cervical cancer. Three months later, she died. Her daughter was 13.

“I get teary whenever I think about her,” Dr. Harris said. “It was so needless.”

Cervical cancer has a long preinvasive stage that can be detected with Pap smears, and then effectively treated with relatively minor procedures, Dr. Harris said.

“People talk about waiting lines in Canada,” Dr. Harris added. “I say, well, at least they have a line to wait in.”

Based on the numbers from the Harvard study, a person like Sue dies as a consequence of lack of health care coverage every 12 minutes in America. As many people die every three weeks from lack of health insurance as were killed in the 9/11 attacks.

Health coverage is becoming steadily more precarious as companies try to cut costs and insurance companies boost profits by denying claims and canceling coverage of people who get sick. I grew up on a farm in Yamhill, Ore., where we sometimes had greased pig contests. I’m not sure which is harder: getting a good grip on a greased hog or wrestling with an insurance company trying to avoid paying a claim it should.

Joe Lieberman, a pivotal vote in the Senate, says he recognizes that there are problems and would like reform, but he denounces “another government health insurance entitlement, the government going into the health insurance business.” Look out — it sounds as if Mr. Lieberman is planning to ax Medicare.

The health reform legislation in Congress is imperfect, of course. It won’t do enough to hold down costs; it may restrict access even to private insurance coverage for abortion services; it won’t do enough to address public health or unhealthy lifestyles.

Likewise, troop deployment plans in Afghanistan are imperfect. Some experts think more troops will help. Others think they will foster a nationalist backlash and feed the insurgency (that’s my view).

So where’s the best place to spend $100 billion a year? Is it on patrols in Helmand? Or is it to refurbish our health care system so that people like Sue don’t die unnecessarily every 12 minutes?