Some (personal) Medical Insurance Facts

While the country is swirling with monumental discussion, facts, statistics, opinions, lies and myths about the medical care and medical insurance issues, I thought I would share some of my personal facts regarding my wife’s and my medical coverage; anecdotal though it may be.

Medical Insurance:

When we retired in 2006, our group (state public employee) medical insurance premium for our joint coverage began billing us $893.76 per month. Prior to retiring our employer paid for this coverage. Today our premium is $1,157.46 – a 29.5% increase in premium costs over 6 years. The current rate of inflation is 2%.

Last year our monthly health care premium actually went down from $1,159.52, to $1,157.45 this year – a $2.07 per-month decrease. However, the plan has changed whereby we now must pay $500 out-of-pocket before anything is covered. So essentially, our medical costs have actually increased 3.5% over last year.

This year, our insurance provider is requiring all customers to participate in a mandatory “Health Engagement Model (HEM) program”. A surcharge (penalty) of $17.50 per person will be added to our monthly premium if we do not comply with the HEM requirements, which consists of watching online training videos. Between my wife and me, we have spent six hours on this process. Emphasis for those of you who decry government interference regarding your health care, note that these are private company hoops we are having to jump through – not government.

Over these six years, our group coverage has forced us to change insurance companies four times. As a result, we have had to change from medical providers and facilities with whom we have established doctor-patient relationships over years. Emphasis again, for those of you who decry government making decisions about your health care, note that these are private companies, making choices for us who we will be allowed to see – not government.

Pharmaceuticals:

One prescription my wife takes cost $543.78 for a 3-month supply in 2007. This same prescription charges the insurance company $912.58 today. This is a 68% increase in the cost of this drug over five years. Our co-pay for this prescription was $15, it is now $75.

… researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion. [1]

Dental insurance:

We discontinued dental insurance as the premium amount plus the out-of-pocket costs for non-covered expenses was more than simply paying for services directly.

Final thoughts:

Our medical insurance premium, deductibles and co-pays consume one-third of our disposable income. I often wonder how many Conservative local business owners would much rather I spend that $19,800 a year in their local restaurants and businesses than send this money to out-of-town insurance companies? Multiply my $19,800 by the thousands of people like me – this amounts to millions of dollars denied the local economy.

Consider that for every car you buy, every bag of groceries, every movie ticket, every magazine, every gallon of gasoline… the cost of employee medical care premiums is factored into the price of what we pay for those goods and services. Why wouldn’t Conservatives rather want to either A) reduce the cost of their goods by that factor and increase sales, or B) pocket the additional profit from the reduced overhead, by having their employee insurance costs picked up by a single payer government plan? A single-payer plan seems like a win-win for every business in the county except medical insurance companies. Our business leaders must be the laughing stock of the remainder of the developed industrial world.

My final thought on the ACA (aka: ObamaCare)

It appears to focus of this law is directed entirely on insurance coverage but little on containing the rise in medical costs and the demise of medical outcomes. But hey… it’s a start.

References:

1. Big Pharma Spends More On Advertising Than ResearchAnd Development, Study Finds, ScienceDaily.com, January 5, 2008.

 

Pondering People and Pigs

It has been four weeks since my aortic valve replacement surgery; three weeks of being out of 23 days in the hospital. My life is currently weeks of multiple medical appointments and visits to the Infusion Clinic where my IV antibiotic pump connected to me 24/7 is serviced and my Coumadin levels checked and adjusted. I have good days and times when I feel extremely vulnerable; still I am lucky to be alive.

Constantly wearing this IV pump is a hassle; it is heavy and wearing it on a strap over my shoulder makes my already aching and healing chest ache even more. Yet this experience has also given me an appreciation of what others with more serious health issues must go through. I drop into the Infusion Clinic where my IV pump is quickly serviced and dressings changed. Most of the other patients there are required to hang out, enduring hours of infusion therapy, primarily for chemotherapy treatment. Again, I feel extremely lucky.

In the years prior to my mother-in-law’s, Wanda, death, her life completely revolved around hospitals and clinics. I now have some appreciation as to how difficult a time she was having. She suffered a cardiac amyloid condition; a condition similar to Alzheimers however affecting her heart rather than the brain. Her prognosis was that she would eventually decline, slipping into congestive heart failure. She was never going to get better, only worse. It was not unusual for her to have two or three doctor’s appointments every week, made even more difficult as she was by then wheelchair bound.

When Wanda was told that her condition had deteriorated to the point where she would require kidney dialysis, she decided that she had had enough dealing with needles, procedures and medications. Knowing that without dialysis she would die, she accepted that as the most humane way she could go. She died at home of kidney failure surrounded by her family.

My Coumadin treatments will eventually end in a month or two; likewise I should be free of my IV pump in a few weeks. I am in otherwise good physical condition and expected to make a full recovery. Eventually I will be able to do the things I enjoy; building and remodeling, yard work, riding my bike. I’m told I can expect to feel better than I before getting my new “pig” valve.

But my situation has reminded me of the countless others whose lives currently revolve around simply staying alive, who live within the restricted world of hospitals, clinics, therapies and procedures; many often painful or causing great sickness. My thoughts, at this moment, are for their difficult fight for life.

Did I mention how really lucky I am feeling right now?

Hospitals are Not Recommended for Sick People

I had originally intended to share some of the (relatively few) humorous anecdotes that occurred during my 23 days of hospitalization. However now that I am home, I am finding that recalling details of my recent ordeal have been actually causing me a fair amount of anxiety.

Though we offhandedly think of the hospital as a place for cure and healing, the required practices one encounters there seem to contradict that very goal. Though I was fortunate to be attended by lot of very caring and professional staff, at other times I was forced to challenge people who appeared to be conducting procedures by rote and, seemingly, without any thought as to what they were doing. Take for example the nursing aid that, at 4:00 AM, I fortunately stopped from wrapping a blood pressure cuff around the arm in which my IV infusion was flowing.

There also appeared to be some undercurrent of professional controversy between a few of the many physicians on my case as to what treatments I should receive. One day I found myself being wheeled back into ICU to have my heart “restarted” when a different cardiologist intervened, suggesting the procedure was unnecessary. At another point I had been convinced by one cardiologist that I needed a pacemaker. Hell, if getting a pacemaker would get me home safe-and-sound, I was all for it. But that decision was overturned by a second cardiologist. Though I had little influence on the outcomes, I’m happy to say I did not come home with a pacemaker planted in my chest.

I was trying my best to remain informed and involved in my treatment. But I am not a doctor, I depend on getting the (consistently) best advice I possibly can. When the professional advice was contradictory, it caused me a lot of emotional stress. I wondered that if one were a cardiologist who specializes in pacemakers, wouldn’t you naturally be a biased advocate for their use? Like the saying goes – When you have a hammer, every problem looks like a nail.

Any form of sleep is nearly impossible in a hospital, particularly if one does not have a private room. My nights were continually interrupted. There seemed no end of tasks, no reason too trivial, to motivate the staff to enter the room and disturb the patient. One night the door opened, the lights came on; an aid simply taped a piece of paper to the wall across from my bed. I often couldn’t see any purpose for the interruptions.

A number of different (noisy) roommates cycled through sharing my room; at least four of them had the television blaring Fox News 24/7. Often they slept through the din of noise pollution. One day I hadn’t noticed until Nancy came to visit that my roommate had long since been wheeled out of the room for some procedure – the TV blaring Fox with no one there to watch. I spent most nights wearing earplugs and a face mask to shade my eyes.

Naturally I did everything within my means to demonstrate to the physicians and staff that I could be released at the earliest; I walked, I assiduously performed my breathing exercises. It paid off – on the evening of March 20th, a Sunday, the wires and tubes were disconnected from my body and I was packed off for home. I was in pain, but I must confess… to sleep in my own bed next to my living wife was as close heaven as anything I can imagine.

Dust in the Wind

Senate Republicans attempted to filibuster the bill but the “9/11 First Responders Health Care Bill” was passed by the Senate this month and the president is expected to sign it into law. Republicans, philosophically opposed to increasing the Deficit, were cornered into looking like the Grinch who stole Christmas through their opposition for the bill which provides medical coverage, to the tune of $4.3 billion, for September 11th emergency response workers.

The underlying claim is that, in working continuously around the toxic dust and chemicals surrounding the collapsed World Trade Center buildings, emergency responders have suffered a myriad of health related issues. It certainly is not a stretch to conclude that asthma and other pulmonary conditions could result from working in such conditions. However, it appears that pretty much any and all health issues arising with emergency responders working at the site, such as cancer, are now being tied to those hazardous conditions.

I recall the years of litigation regarding the Dow-Corning and the leaking silicone breast implants. Women were claiming a broad range of illnesses on the defective product. Dow paid out millions of dollars in damages after losing their case in court. However subsequent studies have since shown that the illnesses claimed by the women occur no more frequently in the implant recipients than in the general population at large who did not receive the implants.

Though scientific advances in detecting and curing cancer have increased in recent years, various cancers are still one of the largest causes of death in our society. How are we to objectively evaluate that all the claims of diseases suffered by the 9/11 first responders stem directly from their working at the World Trade Center site?

Science will take a back seat to emotional appeals, in this situation, as the "heroes" we all love to love ask of us to acknowledge their sacrifice. But in the run-up to this legislation, I have not seen any independent studies which compare the types of diseases (excluding pulmonary related) claimed from the WTC site exposure and comparing them to the prevalence of the same diseases in the general population.

"Doctors aren't sure, though, exactly how many people are ill, and scientific doubt persists about just how many of the hundreds of illnesses are actually linked to the trade center dust. Doctors still don't know whether there is any connection between the dust and potentially fatal illnesses like cancer" ¹

The political irony here is that police and fire fighters generally tend to lean politically conservative and usually support Republican candidates. During the upcoming election cycles I hope these workers remember which party was the one arguing AGAINST their interests.

For me, the bottom line is that the controversy over this bill would be completely unnecessary were we to have in place a National Health Care System which would take care of ALL sick people, whatever their cause or reason. Why do a few select Americans, who by the way chose a hazardous profession, get to have their health care covered and not their fellow citizens who worked in fields or factories or have simply had the unfortunate luck of having been a victim of probability? Who in Congress speaks for these "heroes"?

The legislation is named for James Zadroga, a police detective who died at age 34. His supporters say he died from respiratory disease contracted at ground zero, but New York City's medical examiner said Zadroga's lung condition was caused by prescription drug abuse. ¹

1. 9/11 First Responders Health Care Bill Faces Key Test Vote In Senate - Huffington Post, December 24, 2010

Turn your head and cough.

Much of my time now is spent in the the Medical Delivery System. The medical industry has become, well… an Industry! The friendly family doctor has been replaced with a “Doctor Factory” where your health issues are processed. The System consists of three interlocking components, the medical Provider branch, the Insurance branch, and the Pharmaceutical branch, which are tied together under a single unifying goal: amassing huge profits from your illness! Here’s how the system works:

Provider Branch – These are the factories where the doctors labor in indentured servitude in a hopeless attempt to pay back their huge medical school indebtedness. Here the Provider employs a mult-pronged security team of receptionists, physician-assistants and nurses dedicated to one goal: preventing the Patient from having any contact with the doctor. The Physician Assistants are employed by the Provider to remind the doctor that he/she can be replaced with a lower cost alternative at any time.

Insurance Branch – These entities thrive, much like a parasite, to suck money from the patient and dole it out to their co-conspirators, the Provider. Insurance companies have worked out an extremely complex monetary transfer system with the Provider whereby the Provider accepts a lower fee than the Insurance Company wants to pay them, under the threat of breaking the Provider’s kneecaps. By the way, the Insurance Companies get the reduced rate – you don’t.

Pharmaceutical Branch – Like its street smart brethren in the criminal underworld, the Pharmaceutical Branch gets the public hooked on drugs through incessant television advertising. For example, convincing middle-aged men that they need have “Cialis for Daily Use” so they can be ready to spring a boner at any moment. The Pharmaceutical Branch also visits the Provider Branch, offering golf junkets and vacations to Bermuda to motivate the doctor to push unnecessary drugs onto their patients.

The system works flawlessly. The following is a working example of a typical Medical Delivery System event:

1. Patient pays Insurance Branch a huge monthly premium.
2. Believing they are sick, Patient calls the Provider for an appointment.
3. Provider receptionist puts the Patient on hold hoping Patient will die in the interim.
4. Patient persists. Provider receptionist gives Patient an appointment time, scheduling it far enough in advance in the hope the Patient gets better (or dies) before showing for the appointment.
5. Patient shows up for appointment thinking they will be seeing a doctor. Patient is seen by a Physician’s Assistant instead.
6. Physician’s assistant, not being a doctor, (therefore unable to determine if Patient is sick) advises the patient to quit their job, take Tylenol, and drink lots of fluids. Patient is sent home.
7. Patient doesn’t improve, repeats steps 1 through 4.
8. Patient shows for appointment and is now allowed to see a doctor - not to exceed 15 minutes in length. Doctor is only allowed to touch the computer, but not the Patient.
9. Doctor asks what TV advertisements Patient has seen then prescribes the most expensive pharmaceutical. Doctor then plans his/her two week vacation in the Bahamas.
10. Patient takes the pharmaceutical prescription to the drug store, which contacts the Insurance Company for payment.
11. Insurance Company refuses payment for the expensive pharmaceutical suggesting instead, a more reasonably priced generic knock-off manufactured by a lead toy factory in China.
12. Patient ingests the pharmaceutical which either, A) Does no good, or B) Side effects make the Patient sick.
13. Patient repeats steps 1 through 11.
14. Patient is now starting to irritate the Provider, so Provider, A) Refers Patient to a more costly specialist, in an attempt to intimidate them out of being sick, B) Sends Patient to a Lab to be poked with needles, in an attempt to annoy them out of being sick, or C) Convinces the Patient that they are fine and sends them home.
15. Patient receives multiple separate bills for each individual contacted during Provider visit, and a statement from the Insurance Company explaining why it will not pay the bills.
16. Patient pays Insurance Branch a huge monthly premium.

What’s the best part of the American system of health care delivery? It’s not considered "Socialism".