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 I (Personal)

I’ve been exploring the health care system these past few months, not really voluntarily. This will be a multi-part series, probably every other or third day (and feel free to skip any and all segments; well, of course you will because this is a personal blog, not homework) and seems appropriate given the seemingly inevitable demise of the ACA (Obamacare) and implied threats to Medicare. Lucky for me, I

• married a nurse; if you don’t have one in your family, you might think about adopting, or marrying, or renting, or sponsoring a nursing student, or something….

• have invested in a “concierge” doctor who limits his practice to a manageable number of patients (about 600 or so)

• have practiced preventive maintenance re: health

• am generally healthy and independent

• am covered by the American version of (limited) socialized medicine (Medicare) plus a supplement

• can afford to pay for whatever isn’t covered

So bear in mind that your results may vary....

Cruise Diary 2014: Day 8, Costa Rica

Costa Rica is clearly several steps ahead of its Central American neighbors. It is a stable democracy with a higher standard of living than any we have seen. Free public education, K-12, is probably the backbone of its progress. Spanish and English are the required languages in school.

Let me digress here for a minute. I confess that the constant drumbeat of negativity towards education and teachers in the U.S. has discouraged me. But I’m starting to wonder where the symphony is coming from, because I have yet to meet, on these cruises, and we’re not talking the hoi polloi, or in my interactions with parents in any school with which I’ve been associated over the last 40+ years, almost anyone who has less than respect and admiration for teachers. Who are the politicians playing, to, exactly, besides themselves and a few well-heeled anti-public education donors? The election results on Proposition 3, which carried exactly zero (0, none, zilch, nada, etc.) counties across the state, indicate at least widespread general support for schools and teachers. Stand tall, my colleagues who continue the battle, and don’t get believe the negative propaganda.

Costa Rica was, and still is, way ahead of the curve on environmental issues. Recycling containers are everywhere, the country generates no carbon-based electricity, they work to protect their environment, and the people seem committed to the process. Who figured this out so far in advance of the rest deserves a medal.

They are proud of the fact that they abolished their army in 1948. I’m guessing they’re counting on us to defend them should someone get frisky, but that cost would almost certainly be less than what we’ve spent on some of the other hot spots in Central America over the past decades.

Costa Ricans also brag about their socialized medicine. If you’re sick, if you need medical attention, you get it. Built into those costs are a pension system. Now I have not done a lot of research, don’t know if it’s sustainable, but it seems as if the country is happy with its direction, and has probably generated fewer protests and riots than even our own.

Their taxes are not low, exactly, but seemingly are lower than Europe and perhaps even ours, in some places. If the information was accurate, you don’t pay income tax until you hit $70,000, and the minimum wage is based on two-weeks wages, about $600, not an hourly minimum. Our guide was stunned when I shared with him McDonald’s advice to its full-time employees: “You’re going to need another job to make a living wage.” Oh, and Wal-Mart is definitely here, but in disguise, running stores under different names.

Draw your own conclusions. I’m not suggesting a utopia – most of the houses, even those that are obviously less than affluent, have bars on the windows and doors to keep out thieves and robbers. But that, at least according to our guide, is generally the extent of crime in the country.

Our excursion was to an active volcano. There are nine of them in Costa Rica, all interconnected as part of the Ring of Fire (not the Johnny Cash song). Only one is conical; not the one we saw. These volcanoes don’t spew lava, like Hawaii and other places, but do emit gasses and even stones when they erupt. Geothermal energy provides about 10% of Costa Rica’s electricity. Lots of earthquakes and tremors, about 500 per year, on average. But a beautiful country.

The last couple pictures show the creativity of their wood-carving artisans. The first is the world’s largest oxcart, beautifully painted and decorated. The last, well, just whimsy on their part and mine.