Friday, April 11, 2014

Hospital Tales

When medical disaster strikes, there's no time to think about money. The helicopter zooms you to the trauma center and before you know it, you've had two surgeries and seven days in the hospital. But in the back of your mind is this niggling question: how much will this cost?

For years we had no health insurance. The kids (until they turned 19) had Medicaid, but Adam and I just trusted to God's mercy and protection and counted ourselves fortunate to be generally healthy and uninjured.

On January 1, we got insurance again, and for my readers who live in other countries, here's an American truth: if you don't have health insurance, you don't have health care. You can't get dental work, and doctors won't see you. The first thing the hospitals ask is to see your insurance card. You can pay all that stuff out of your own pocket, but ... (another unpleasant American truth) because most health insurance is attached to people's employment as a benefit, people who don't have jobs generally don't have insurance either. Thus, they don't have the cash to pay for the care. It's a mess.

The insurance we got in January is affectionately called Obamacare, or ACA. The government pays for most of our premiums, but the insurance itself comes from Blue Cross/Blue Shield, a huge insurance company. We had to enroll, by law, and we were happy to do so. I'm fully aware of several facts: 1) Some of my friends think it's criminal for the government to pay for our insurance and consider us thieves because it's taxpayers' money, 2) Many other nations have similar systems, or (horrors!) a single-payer system, and 3) The Obamacare model is the model the Republicans promoted back when the Democrats wanted a single-payer model. My take is this: I loathe the fact that people's lives and health have become balls that politicians, in their venomous competition, love to bat around. It's sad to me that people who are each others' neighbors are angry that their tax money might go to pay to preserve their neighbor's life. Obamacare provides insurance to millions of America's "working poor" -- people who work at businesses that won't or can't provide their insurance. And who are the customers of those businesses? Who are the customers who benefit from the fact that tens of thousands of businesses don't charge their customers higher prices to pay for those employees' insurance? It all boils down to the same fact: people pay for other people's insurance. You can pay in taxes, or you can pay in wares, or you can pay in high healthcare costs. But you pay.

I digress. American healthcare is complicated.

I took Adam's blood pressure medicine to the hospital and handed it to the nurse. "He needs to take one of these every day." I could have given them to Adam, but I figured the nurses needed to know what meds he was taking. She said, "I have to get this bottle verified by our hospital's pharmacy." Later she brought the meds back. "The hospital pharmacy would prefer for him to use their blood pressure meds," she said. "Is it the same as this medicine?" I asked. "Yes." "Well," I replied, "I'm sure they'd prefer him to use theirs. How much do they charge for their blood pressure medication?" And when she checked on the price ...

Their tablets were $3.00 each.

And Adam's meds cost us 30¢ each.

So I fussed and insisted, and she wrangled with the pharmacy, and at last I got my way. And I saved the American taxpayer $15 by stubbornly not allowing the medical establishment to criminally overcharge us on one item. One item. How could one possibly insist on reasonable charges for every item in a week-long hospital stay?

After Adam's discharge we drove to our local pharmacy to fill the prescriptions his surgeon had given us. Adam declined to get the percocet (pain meds), but he had to have the blood thinner. And then the pharmacist told me that Blue Cross would not pay for a penny of the blood thinner; it's a "non-formulary" drug (one they refuse to pay for) because it's fancy, non-generic, new, and $150.00 for only 14 of them. (Sigh!!)

So I'm standing in the pharmacy with my exhausted husband in the car after a 2 hour drive, wondering if I should go home without his blood thinner and risk a blood clot, or pay out $150 ourselves. If I told you how much we live on, we'd both be embarrassed, so I won't. (The church provides housing, but not a large salary, which is common for small-church pastors.) I save money any way I can. So I called the doctor's office and talked to the nurse. She said she'd get back to me.And I drove home without the meds.

When she called back, she said the doctor agreed Adam could just take a baby aspirin instead of the blood thinner. Adam is a young, healthy man, and a baby aspirin is adequate. So I drove to Dollar General and spent $2 on baby aspirin. But only because I insisted and refused to be overcharged by a pharmaceutical company for their new drug, and refused to accept the prescription of a doctor who didn't think it through.

What's wrong with our medical system? We all have our opinions, but I think perhaps the biggest problem is that healthcare is exorbitantly expensive -- ridiculously expensive, even criminally expensive. When each item a hospital provides is ten times more expensive than it is elsewhere, what mischief is produced? Is every med, every sheet, every bed pan, every procedure, every piece of equipment, every single charge, ten times overpriced? If Adam's final charge ends up being (I have no clue ...) $50,000, does that mean that it could have cost $5000, if the prices weren't inflated?

What are we paying for, when healthcare is that expensive? Is there wastage? (Of course there is.) What mechanism should regulate those prices, to keep them low? Is there a competitive mechanism in place? A government regulation? A watch-dog group? Certainly the patients and their families are in no condition to complain. Most will not fight against the overpriced medicine and insist on using their own. What if we all dragged our own sheets, wheelchairs, gowns, and ace bandages there? Can you imagine the chaos?

All I'm saying is this: if the care weren't so expensive, the insurance wouldn't be so expensive, and many people would be able to pay for their own insurance or care. Perhaps if it weren't so expensive, people wouldn't even need insurance! Perhaps they could feasibly pay for the care out-of-pocket, without help from anyone. The insurance companies would be out of business, and that would crimp their style. I do believe that both the healthcare industry and the insurance industry have great incentive in keeping costs as high as possible. As long as they do, they get lots of $$$, and the American population pays, one way or the other -- because the payment mechanism is rerouted so many times.

Meanwhile, the working poor, families with children, living on under $25K/year, unable to find a job that would provide healthcare no matter what they did, are viewed as the "bad guys." Everybody hates the moochers, the ones who live on the taxpayers' hand-out, who accept the government's help. They get help, but it's very grudging. People actually tell them, "You should pay for your own insurance!" As if a family that doesn't even make $2K a month can afford premiums that cost $2K a month. They couldn't afford $500/month. They couldn't afford anything. And no, Medicaid does not cover parents in that situation.

And so a system that overcharges at every turn and impoverishes the nation, then produces a large group of people who can't afford the services and are vilified for their poverty.

I don't have a solution, but I know there are politicians paid hefty salaries to come up with one, and they haven't. Obamacare is far from an ideal model, but the Republicans didn't care to improve such a broken system when they had the chance; they had other items on their agenda more important to them. This post is no defense of either party. But my eyes were opened a bit more in the past week to some of the weaknesses and abuses of our healthcare system, and it was not pretty to see.

(If you care to leave a comment, please do not leave a political rant. If you have something useful to say about healthcare, that's fine.)

10 comments:

  1. Hi, MK. You and I don't agree on some aspects of the health care debate, but I think you really put your finger on the central problem -- expense. All through the previous system, though it worked well in many ways, there were incentives for overcharging. The more complicated the system, the more layers between the provider and the individual who receives the service, the more tendency there is for costs to rise. The question is, HOW do we curb these tendencies? Proactive people like you can help to do this and all praise to you for fighting the good fight and getting what Adam needs without being outrageously overcharged! One might think that tighter governmental oversight would improve things, but an experience that I had today makes me wonder. Our endocrinologist told us that without a 30 day record of bloodsugar readings Medicare will no longer cover the cost of test strips. (we are both diabetic). For us (brains still working fairly well) this is just another annoyance. The info will not be accepted as just a printout from our test monitor software, which wouldn't be a pain at all, or even as the record kept by the monitor itself, but only as a paper chart which we must fill in every day and the office staff then must copy into the doctor's records by hand. I'm sure that this measure WILL cut costs, in that a large number of elderly diabetics are just not able to perform this task. So, no test strips, no testing at all, die sooner, everyone wins. ;-) My doctor tells me that this is a requirement of the ACA imposed on her, no matter what insurance her patient has.

    So what do we do to reduce costs, whatever system we are dealing with? Fraud is rife in Medicare and Medicaid, to the tune of billions annually. Overcharging is ubiquitous. People care more when they directly feel the cost of care, rather than just thinking, "Oh great, the insurance covers that." but being without insurance isn't the answer either. Most who are covered by insurance are paying only a small fraction out of pocket of what meds. and care cost. Only the truly wealthy can afford full cost on these things. All of us (patients) working together to explore less expensive choices, as you did and as I have done in the past, CAN make a dint. There must be other ways to improve the really crazy system that can get away with charging $30. or more for a pill when there are 30 cent similar medications available.

    I really hope that Adam gets better soon and that you can get some help while you serve as nurse and health care expert. It sounds like you have a lot on your plate right now. Hang in there!

    Karen K.

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  2. SO frustrating, M.K.! But, I have a little ray of sunshine for you, sweetie. You won my book giveaway! Please email me at toosillysisters@cox.net with your address so I can it to you!:) Lori

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  3. I could not agree with you more M.K. I just spent last weekend volunteering in a 4 day health clinic attempting to bridge the gap created by our broken system. I believe that if most Americans could truly see and experience for themselves the impact of our failed policies they would be far more compassionate and fired up to find a true workable solution. Most don't realize for instance that Medicare, a so called entitlement program does not cover dental care and this weekend I saw many, many seniors waiting in lines for up to 6 hours to have teeth pulled because they had not had care and the teeth could not be saved - disgraceful.

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  4. In the UK we constantly complain about the faults of our NHS system, and it DOES have many faults. But we are really very lucky to have it.

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  5. Dear MK ~ My husband and I did not have insurance, I am now on medicare since I just turned 65. The whole insurance issue is one that always bothered us as to not being 'right'.

    FlowerLady

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  6. Boy, I sure don't understand the health insurance industry very well. When my husband was in the hospital and nursing homes for several months before passing away he was covered by Medicare and Medicaid (medical assistance) took care of most of what Medicare didn't. I was so relieved. I don't know what I would have done otherwise. We live in a very poor area and I do have health insurance through work, but it takes a chunk out of my already small salary. It's through Blue Cross/Blue Shield and just about everything except some wellness tests is out of pocket for the first $5,000. That would be good deal if you had a major disaster, but for those of us who don't we're basically paying cash for anything we get done. So, the result is, you don't go in until you're in bad shape. (The deductible does roll over from year to year, so eventually they will cover things.) I've gotten three teeth pulled because I can't afford to get crowns. Not fun. There are a lot of toothless people in my county! I have no answers. I just put myself in God's hands and am thankful that this isn't all there is! :)

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  7. I assume some of those inflated charges in the hospital make it possible for their staff, e.g. nurses, to get the kind of pay that motivates them to go into health care jobs. I think of nurses because there are several in my family.

    Adam is certainly lucky to have a wife like you who will research these things and be proactive so you can find out exactly what to do without or do yourself.

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  8. This topic makes me need blood pressure meds. I just got through with several dr trips and filling prescriptions. I'm healthy, these are just weird little things I need maybe once a year, and I paid 4 times or more what I did last year. I hope someone somewhere is benefiting and if it is you that makes me even happier because otherwise I am not happy about what happened to my insurance this year. But I know...it is complicated and I don't have any answers. Oh...and then guess what I did? I can't find one prescription I picked up anywhere in the house but I have the tag from the bag. I'm pretty sure I threw it away. So good grief. I may need another sort of prescription for whatever would cause me to do such a dumb thing. Okay....thinking about flowers now.....

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  9. MK,
    I am so sorry to read of your experience. We live in such a strange country, where the best medical care in the world is available to all but affordable by some.

    So here's another perspective.

    In terms of the BP meds, exceptions like the one given to you are infrequent. The problem is that medical professionals are legally responsible for giving the correct medication, correct dose, etc. You wouldn't believe what people bring in - mixed bottles, wrong meds, outdated meds, pet meds, old prescriptions, bags of stuff ...the list goes on and on. So even with a pharmacist completing a pill identification, it gets tough. And the cost passed on to patients aren't just for the pills - it's for the pharmacists, pharmacy assistants, equipment, department costs, nurses, etc.

    I am privileged to work in a clinic now that does not turn anyone away for lack of money. It is not a free clinic or intended to serve the "underprivileged". We just get it. Many people need help, insurance or not. We have financial assistance programs, we work with a local agency and collaborate together to provide a loan closet for medical equipment, and if we know, we are always able to provide some things and visits without charge. Again, for legal reasons there are some items we cannot "recycle", but we do the best we can to accept donations of supplies and equipment and pass them on to those who need it most. We lean heavily on our reps and suppliers to provide equipment and services in emergency cases, and because of the trust we've developed over the years, we've never been turned down.

    The answers are complicated, but most of us are trying hard to do what we can. We can't change the gov't or the system, but we try to influence our little corners of practice and that things may improve. In the meantime, I am thankful that Adam is doing better and that he has you in his life to advocate for his needs! If you were here, I'd be on your side helping...and I'd throw in an extra shoulder rub for you. =)

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  10. Thank you, Nancy. It's people (and clinics) like you that make it bearable for those who would be consumed by the expense of regular healthcare. I understand that the inflated costs are designed to cover bigger expenses that hospitals incur. They're paying for costly facilities and lots of staff. I just felt that a 10X increase was too much. Double? Maybe. But 10X?
    We make use of a local clinic that is much like yours. It gives care on a sliding scale, and it was a Godsend for us when Adam developed high blood pressure. I went there to get a breast lump examined and get referred to an imaging center. It helps a little, but honestly a clinic like that can do little in the case of a huge emergency.
    The hospital sent us home with a supply of dressings for Adam. They lasted a week, which was nice. I was told I could buy more at any pharmacy, a CVS specifically. I checked at CVS, and at two local pharmacies. Not only do they not carry them, they can't order that size of bandage either. The closest thing they could order would cost me $95 for 20 bandages. We use 2 bandages each day to change his wound. This is a "hospital dressing," I was told. Thus the "hospital prices."
    It's this kind of thing that makes the average person feel overwhelmed. Adam has viewed his initial medical costs at the BCBS website: $52,000. I'm sure it will continue to mount as all the bills arrive. We could not pay that back on our income if we worked for the rest of our lives. Tens of thousands of people experience this same situation all the time, and they begin the long haul of paying $100 every month, for the rest of their lives, until the people tire of waiting for their money and start sending collection agencies instead.
    I'm thankful for the caring clinics. Our county is a poor one, and such clinics really aid the very poor and the working poor -- both groups disenfranchised by our current healthcare system.

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