Adventures in Health Care, Part IV: An Encounter

Just a quick story and some observations/conclusions from my most recent visit to the doctor to check on the progress of the bone implant to try to give me right-side hearing (this is a physical description, not a political one).

As I was exiting the office, I held the door for a young man and his parents following me. The young man was blind, using a cane and relying on his parents for help, as well.

His mother asked me if I was getting a cochlear implant too. I shared my cyborg connection and my story, which included why the cochlear implant was not an option for me (insurance in the United States considers a one-sided cochlear “experimental,” although it’s common practice {and covered} in Europe). We also discussed the costs of hearing aids, which I assume had been his only option prior to the implant. Although they apparently worked okay for him, the costs were prohibitive since he needed new ones frequently.

Mom and Dad noted that insurance does not cover the cost of hearing aids, whichI knew from both Carolyn's and my experience, but even for someone like their son. “How the insurance companies can say his lack of hearing isn’t a medical condition, I just don’t understand,” she said. “It’s not like he can read lips!”

I commiserated, noting, and they agreed, “If for profit insurance companies are in charge of your medical treatment and care, you can be sure of one thing: a patient’s needs are NEVER going to be the top priority.”

While I would not even suggest that a government run, single payer program would be problem free, at least the theoretical priority is patient welfare, not corporate profit. And while government bureaucracies are notoriously inefficient, I’ve found the same to be true with corporate (especially insurance) bureaucracies. By the way, did you know that despite their complaining, health insurance companies have had record profits and are experiencing record stock levels. (See link here or picture below)

My experience with the system can be used to identify one problem that has a pretty obvious solution. Do you know how much I have paid for all the tests, procedures, etc? $0. My only charge will be an “activation fee.” Apparently it costs nothing to implant the device, or even buy the device, just to start it up. (I know there are costs, of course, but all are covered by my socialized medicine plan, aka, Medicare.) And that’s ridiculous. I’m fully covered just because I’ve reached a certain age, no matter my income or assets. I wonder how much money could be saved with, say, a $500 deductible for people whose AGI exceeded a certain amount the year previous, with a sliding scale and perhaps a cap (adjusted for inflation as the years roll by, like social security income and Medicare premiums) for the very affluent.

I understand the philosophical and political objections, but I would rather decisions be made by doctors and even a bungling bureaucracy than a for profit insurance company.

Stay tuned for Part V. Who knew health care was so complicated? Uh, besides almost everyone?

Adventures in Health Care, Part III -- My Family is More Than a Burned Down House*

The week before Christmas my granddaughter, Becca, began her own introduction to the health care system. This will ongoing and lifelong as she was diagnosed and will now live with, T1D (Type 1 Diabetes, formerly known as Juvenile Diabetes). She is adapting remarkably well. She started doing her finger sticks shortly after being discharged from the ICU and has progressed to giving herself shots. Of course, she has witnessed her mother (RA) giving herself shots for years.

So now both my daughter and granddaughter have, through no fault of their own, contracted chronic autoimmune diseases. Thanks to medical advances, there are treatments for both of these diseases. However, the treatments are extremely expensive, and without insurance, good insurance, I’m not sure how well we could afford for them to be covered.

Prior to Obamacare (aka the ACA, less than 8 years ago), those pre-existing conditions would have eliminated them from being eligible for any kind of insurance coverage except through an employer’s plan. And when my daughter lost her job (which she did, an early casualty of the recession, right after Becca was born), she became dependent on her husband for that coverage. Not only that, in those less than “good old days,” she would have been virtually forced to conceal her disease in order to get hired at another job. Why? Because with employer-provided health insurance, a company wouldn’t hire her and thus raise their exposure to the expenses associated with the disease. 

Back when I was negotiating contracts (including health insurance) for Hancock teachers, we knew exactly who were the few teachers exposing the pool to risk and causing our rates to go up. Because that is what any kind of insurance is. We all contribute to expand the pool and spread the risk. We are all helping to pay for someone else. Fortunately, my daughter has a husband with skills and a good job, complete with good insurance. Even so, the expenses they face for their meds are significant. And what would have happened had he lost, or should he lose, his job, an outcome never beyond the realm of possibility in our modern economy? 

My brother, with a serious heart condition, also needed his wife’s employer-based insurance until he finally qualified for socialized medicine (Medicare). I’ll draw conclusions and make some further observations about the system in Part IV, but I unmistakably have a vested interest in the pre-existing conditions issue. Please forgive me if I take your opposition to all things Obamacare-related personally. And, for obvious reasons, I also clearly prefer to have health care decisions in the hands of a doctor and not a for profit insurance company that does not want to cover the $2,000+ a month life-saving medical treatment. 

* See PA Senator Pat Toomey (R) for this analogy. To be fair, he didn’t leave it at that and did suggest there might be other ways to cover people without overburdening the poor insurance companies. I, personally, am not that big a fan of insurance companies, but he apparently is sympathetic to their plight. I am guessing their donations to his campaign are more significant than mine.