What Things Cost: Healthcare

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Back in July, I had a sudden, severe headache and thinking I was having or about to have a stroke, I went to my local, rural emergency room. Thankfully, not a stroke, but very high blood pressure, now resolved with a combination of mainstream and alternative medical intervention.

My bill for that emergency room visit was $4300. Ouch.

But when my insurance explanation of benefits arrived, I saw that the discount to my insurance was more than 75 percent. Actual payment for the visit was less than $1,000.

So I was dismayed when I read a financial agreement at a new-to-me medical practice. I’m paraphrasing, but it basically said, if your insurance doesn’t pay within 60 days, you pay in full.

Yes, the IN FULL was the kicker. Why am I–a not-rich individual–expected to pay full-bore? Why don’t I get a discount?

Consistent with my resolution to complain when things seem wrong, I added an objection to the financial agreement and only then signed it.  Hopefully, my insurance will pay within 60 days …

 

Alternative Medicine

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I’ve had such amazing results with alternative medicine.

In less than two weeks: Blood pressure, lower. Blood sugar readings, almost normal. Headaches, gone. Discontinued the proton pump inhibitor medication. Granted, that one was painful but the pain diminished gradually in a relatively short period of time.

Getting to the root cause of a health issue makes more sense than masking symptoms. Now if only we can convince mainstream medicine to expand its thinking.

 

 

 

Simplify Healthcare, End Greed

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The way folks talk about healthcare seems overly complicated to me. Maybe that’s because I worked in healthcare–sort of–for more years than I like to count.

The problem with healthcare in the US is profit. Too many middlemen have their fingers in the healthcare pie. And we let them.

Say you’re sick and go see the doctor. You have insurance that you’ve paid for in premiums. Your insurance tells you to pay the doctor a bit up front. Your doctor sees you, helps you, and then …

The provider bills the insurance that covers you for the premiums you’ve paid. Your doctor needs a special ‘insurance’ clerk, able to ‘work the system’ so that your insurance pays. Seem complicated? You’re right.

Why so complex? Simple answer. Insurance isn’t there to help you or your doctor. Insurance is there to make a profit.

How much simpler would it be to have single-payer healthcare? You show up with a health problem and the provider helps you. The doctor gets paid. And no one makes a profit.

Now before you start singing hallelujahs, single payer health isn’t free health. It’s paid for in taxes. But you and your employer will no longer pay the premiums, copays or deductibles that support insurance company profits.

When no one’s making a profit, healthcare gets cheaper, and people have a better chance of getting the help they need.

Oh, the flower? An African Violet hybrid called Bob Serbin.

That’s Just the Way It Is

Today I planned on writing about my Face Book withdrawal symptoms, and I guess this is one of them. If I was political at all on Face Book, it was all about health care. So, here’s a story I would’ve put on Face Book.

First, some backstory.

I have high cholesterol. Not an unusual condition in this day and age, but I’ve had it for so long that I’d been taking cerivastatin for 18 months when it was taken off the market in 2001 for causing deaths. My doctor tried a variety of ‘safer’ statins, but the new and improved meds caused painful side-effects. Enter Zetia, a non-statin cholesterol lowering drug.

For years, my co-pay for a month’s worth of Zetia was $50, with my employer’s insurance paying the rest. Okay, $600 per year out of pocket—but I was working, had a paycheck, could afford it.

When I retired in 2014 and went on Medicare, I discovered that my plan D wouldn’t pay for Zetia. I had to self-pay, and the price with a Good Rx coupon climbed to more than $950 per month.

Yeah—you read that right. Just under $1,000 per month. Why? Because Zetia was about to go generic, and I imagine the manufacturer wanted to make hay while the sun shone.

So I waited, and did without for three years. It went generic in 2017 and on my plan’s formulary in 2018.

Finally! With my scrip in hand, I trundled off to Walmart and they charged me $75 for a 30-day supply. When I complained, they lowered the price to $62, while warning me that the price could and probably would fluctuate, month-to-month.

I came home and looked up the Good Rx coupon. At a local grocery store, I could get a 30-day supply of ezetimibe (the generic Zetia) for $10.65. Well, that seemed reasonable.

Except the coupon states, essentially, that anyone on Medicare is not eligible to use the coupon.

Really?

Two calls later, one to Good Rx and one to my insurance company, and this is what I’ve learned.

The company supplying the coupon to Good Rx also contracts with the government. They have a different price for government recipients of plans like Medicare and Medicaid. Folks without insurance can get the med for $11 but retired folks—most on reduced incomes–must pay about $60 more per month.

My insurance company told me the generic is a tier 4 medication, which means they’ll pay a miniscule amount, if anything. And that the price could and probably would fluctuate.

And the answer to the question, why? Or the bottom line, if you will?

That’s just the way it is.

I know that y’all know that the whole healthcare issue is a bucket of pits in a world full of cherries. Until the donkeys and elephants stop arguing about insurance and focus on healthcare, nothing much will change. But we need to stop fooling ourselves about the quality of healthcare available in this country.

So do something. Write or call or email your representative and ask him or her to make healthcare affordable for everyone.  And tell them they need to focus on healthcare instead of insurance. Use my mantra–I offer it freely–

People Not Profits.