The Brady Bunch

Move over Oprah & Dr. Phil. I've had it with your anx. You no longer have priority status on my Tivo. I need peace, love, and happiness and I've found them. There's some new kids on the block..25 of them with one on the way...and I'm hooked.

TLC, the cable channel makes the fictitious Brady Bunch of the 1960's look like no big deal. Remember when six kids was a lot? Forget about it! Now we have real life families, like the Duggar's "17 Kids & Counting" and the Gosslin's "John & Kate Plus Eight" . Not since our adoration of the nine Osmond kids in the 1970's have us Baby Boomers had a feel good show to watch where we can relax, smile, and believe for an hour that there is hope in the world.

The fascination is not that the families have a lot of children per se. After having beautiful twin girls, Kate Gosslin beat astronomical odds by giving birth to 6 healthy sextuplets who are now 3 years old. During the show introduction, she shows a clip from her pregnancy...including a belly that is so fascinatingly huge, it defies belief. Except that it's real. Fast forward a few years, and now Kate and Jon are livin' the dream in suburban Pennsylvania. I don't know what's more fun to watch, the kids or Jon and Kate's end of day ("we made it through another day!") banter. On the latest episode, they're packing up the whole family for a trip to Hawaii to have their fantacy wedding which they didn't get the first time around.

On the other hand, Jim Bob and Michelle Duggar live in rural Arkansas in an enormous, gorgeous home that the whole family built themselves. They pay cash for everything and have no debt. Mom home-schools and buys in the thrift store. They have seventeen gorgeous, healthy, happy kids whose names all start with the letter "J" - Joshua, John-David, Jana, Jill, Jessa, Jinger, Joseph, Josiah, Joy-Anna, Jedidiah, Jeremiah, Jason, James, Justin, Jackson, Johannah and Jennifer with a girl due in January (Baby Jan for January?). I don't know how the parents keep their sanity.... let alone keep the kids' names straight...but they are deeply religious and obviously their faith plays a great part. Dad is a gentle leader. Mom has a voice that is so sweet and tender that that just the sound of it can make a misbehaving toddler turn her head in shame. The eldest boy, Josh, 20, was recently married to 20 year old Anna, whom he met at a home schooling conference. Viewers (that's me!) have been watching the courtship on the 10 week series. The newlyweds are going to live in a small house near the big house. In a few years, they may have a big house of their own.

If you've every watched ABC's Supernanny and seen the sad, suffering parents with the 2, 3 or 4 angry, fighting, and disrespectful children that Nanny Jo Frost is confronted with, you have to wonder. What the heck happened that allowed these much smaller families to become so frightenly dysfunctional and out-of-control? The juxtaposition between them and the Duggar's and Gosslin's is worth thinking about...and learning from. (Did someone say "old-fashioned family values?")

In the mean time, I can't wait for the upcoming episodes of Josh Duggar's wedding and the Gosslin's renewing their vows.

I wish they were on right now.

America the Fat

Time Magazine recently reported in their 6/23/08 issue, p.67, "In the 1950's kids had three cups of milk for every cup of soda. Today that ratio is reversed, (three cups of soda for every cup of milk) meaning they get all the calories and none of the nutrients."

When I was growing up back in the 50's, kids were expected to drink a glass of milk with their breakfast and again at dinner. In the school cafeteria we were handed a carton of whole milk with our nutritionally balanced lunch and we drank it dutifully. Every kid did it because we were instilled from a very young age with a personal responsibility to eat right and exercise in order to be healthy. Just as we implicitly accepted our polio vaccine on sugar cubes, as kids we were obligated to ourselves, our family, our community, and our country to drink our milk. It was a national duty. And during the Kennedy administration, we believed milk was some sort of perfect super food and our best defense in keeping us out of the doctor's office; a prophylaxis against illness. And healthy kids meant a healthy future for America.

But soda? I was 12 years old when I tasted my first Coke. In those days, Coke was a treat, and treats were taken seriously, forboden save for special occasions which were few and far between, like cake on a birthday or turkey on Thanksgiving. They were anticipated with excitement, savored, and appreciated; not indulged in at whim as they are today. A fat kid was an oxymoron.

Today one third of American children are obese. Not only is this group endemic with Type II Diabetes, but the American Academy of Pediatrics now endorses the use of statins such as Lipitor for these kids to control their dangerously high cholesterol levels and avert the heart disease which can lead to heart attacks.

Many of the senior patients we see at the clinic also struggle with these same diseases. Some have spent their adult lives indulging in poor life style choices and now they're suffering the consequences. How ironic that these patients will find their own pre-adolescent grandchildren struggling along side them with the same life-threatening, preventable maladies.

Remember the 900-pound man seen on the Discovery Channel or Dr. Phil who is bedridden from obesity? Every day his mother still serves him the liters of soda and high-calorie foods that she fed him as a child. Now as an adult, he is so profoundly addicted that despite his agony, he still demands more of the same. And the mother, despite her son's morbidity, accommodates him.

Obese kids who regularly drink soda, eat high-fat fast-foods, and are sedentary lack basic health education and a supportive environment to reinforce it. Blame is rampant, but irregardless, our youth are our future and they must once again become a national priority in this country. We should vote for a President who will genuinely advance the mental and physical health of our children...from birth through early adulthood. Surely this will require extraordinary changes in our society and an extraordinary leader to bring them about.

Obama or McCain?

Blossom

A professional songwriter friend of mine and I launch a volunteer after school mentoring program and Blossom is referred to us by social services. She is 12-years old. One evening as the kids are singing, I notice she is staring at the lyrics handout. She hides it well, but something is wrong. This American-born girl can't read.

When it is time for the kids to be picked up, I tell Blossom to ask her mother to come to the music room. I need to talk to this woman whom I have never seen before and know nothing about. And she comes in, eyeing me nervously with four little children in tow. We sit facing each other, mother to mother. I speak softly and gently, "Why can't Blossom read?", I ask. And as if a dam breaks open, she responds in a sudden, frantic torrent of broken English with a thick accent. "I ask for help! I talk to the teachers! I try and try! No one will listen to me! No one will help her," she wails.

"A 12-year old girl who can't read?", I think to myself. "How is this possible? How humiliating for this beautiful young lady about to start middle school."

I look over at Blossom crying in shame. I look into her mother's eyes. "I will help her," I hear myself say. "Bring her to my home every Sunday for 2 hours. I will teach her to read."

As I sit on their living room couch, I learn the family is Muslim, the mother from Nazareth, Israel, the father from Syria. I tell them I am Jewish lest this will somehow alter their desire for me to tutor their daughter. To my surprise, they are happy with this disclosure and express their gratitude with cups of tea and a plate of homemade baklava.

I take Blossom to the library for books. I assess her reading. I am appalled. I call the school and arrange a formal meeting with Blossom's teachers. "How can this happen?", I challenge them. They tell me that in the third grade, Blossom was determined to have an auditory learning disability. I am told that reading isn't taught after 3rd grade, so since she couldn't keep up with the other children, she was placed in a special education tract. And, as I see it, essentially forgotten. Here she is, entering 6th grade, and she is unsure of how to sound out vowels. I can hardly believe it. It's pitiful. But Blossom is hungry...ravenous...to learn.

That was three years ago. My involvement in the after school program has long since ended, but my mentoring Blossom continues today. She is 15 now and wears a hijab unlike the other women of her family. In a high school rampant with teenage pregnancies, her head covering is her unspoken declaration of modesty and self-assuredness. In my home, her learning extends beyond books. She delights in frying perfect latkes and shares in the lighting of Chanukah candles with three generations of my family. Her mother pays me in tabbouleh with fresh mint and stuffed grape leaves with rice.

And Blossom reads abundantly..at about a sixth grade level right now. In spite of her challenges, she has a fierce determination to keep practicing and improving. She calls me on the phone five or six evenings each week and we go over lists of vocabulary words together.

And as long as Blossom works hard, I will continue to push her and encourage her...and be there for her.

Some day I hope to dance at her wedding.

08-08-08 0lympics 洪水 0h My!

I'm tantalized by Planet China.

Ever since my university independent study on the Sino-Soviet conflict, Mao Tse-tung, and the Cultural Revolution, ever since the table-tennis match and Nixon's visit, I've been fascinated with that Quiet Giant composing one-fifth of the world's population. I disdain the communistic thought control yet I am in awe of the culture and the physical beauty of the country. I worry about China's emergence as a powerful leader into the world market buying up U.S. Treasury Bonds as we sink deeper into debt.

But, hey, TGIF! The Olympic opening ceremonies are on TV tonight. I've been looking forward to these for months...years. The Olympics are incredible enough, but from China? It's probably one of the most significant events in the history of human civilization. I am exhausted and stressed from work and I want to get home and watch the extravaganza!

I can't wait!

And there it is on the big screen! Beijing and the massive architectural wonder of a Bird's Nest where ninety thousand athletes, dignitaries and spectators from every country in the world are converging in 65% humidity as a statement of global unity! The promise of the future of mankind! I am transfixed. Only fire, flood, or pestilence will steal me from this pleasure! Bring it on!

An hour later, I haven't blinked. I am mesmerized by the performers, the children, the costumes, the colors, the faces. I am watching George W and Vladimir Putin on camera 'yuckin it up in their stadium seats. Suddenly I hear blaring alarms. The TV screen goes black and a bold message appears across it. "What's this?!" I think to myself. "Am I witnessing the Chinese censoring of American television?"

Not so lucky! It's a Civil Defense weather warning. "A dangerous storm is passing over certain parts of the city." "FLOODING IS IMMINENT!", it yells at me.

"Is it raining?" I'm downstairs totally unaware. And within seconds, Niagara Falls breaks through the windows and water is pouring into the basement! "HELP ME!", I scream. The family bursts into action. Buckets, mops, towels, fans. My husband is outside in the torrential rain looking like a sailor bailing out his ship to keep it from sinking.

Another hour later the storm passes and the flooding is over. And so are my Olympic opening ceremonies. I'm exhausted from sopping up gallons of water and running up and down the stairs.

But, hey! Ninety thousand people may be sweatin' the big stuff in the Beijing humidity, but I ain't sweatin' the small stuff here in the States. What's so bad about a couple of rooms with soaking wet carpeting that already smell of mildew? Through the wonders of cable video, the hoopla has been magically recorded and I can still watch it, tomorrow, commercial free, with the push of a button.

And...I can't wait!

Oxycodone Known

Since our State Board of Pharmacy recently published an on-line prescription history database for doctors, we've verified that some of our patients who we suspected were abusers, are abusers. They're addicted to oxycodone and other narcotics, and they've been going from doctor to doctor, making up stories, and getting multiple prescriptions filled. Now we have the ability to screen new patients carefully for prescription drug abuse and while we're on the phone setting up the appointment, I can download the entire prescription history in 3 minutes.

Some of the patients genuinely need oxycodone like the patient with the shredded rotator cuff which was verified by an MRI. But sometimes we have to remind ourselves not be suspicious all the time, that is, ever since we met Mr. Kidder (sic). He walked into the office unexpectedly one morning, stating he had fallen in the shower and hurt his tailbone. "Could he see a doctor?", he pleaded sincerely.

One look at the patient and Dr. Richard informed me that he believed Mr. Kidder to be a drug-seeker. To prove his point, and squelch any doubts among the staff, the kind doctor gently conducted his physical examination which, due to the nature of the so-called injury, included a rectal digitation. In that, according to Dr. Richard, the patient didn't flinch, the coccyx was determined to be not fractured, and Extra-Strength Tylenol was prescribed for the professed discomfort. The patient, upon realizing that he would not conclude his visit with the desired oxycodone prescription in hand, discreetly departed the premises in a state of profound consternation.

He left behind a balance due, his bogus address and phone number, and a lengthy narcotic abuse report, freshly downloaded and printed.

Mr. Kidder, indeed.

InSecure Horizons

My mother calls me. Her dearest friend, 93-year old Miss Bessie, wants to know if I will look at her bills from the rehab facility she stayed in two years ago. The balance due is over $5,000 and Bessie can't understand the paperwork.

Miss Bessie is no frail, old lady suffering from dementia. Far from it. When I visited her in the rehab facility where she was recovering from a broken shoulder, she was sitting in a chair with a new Apple laptop shooting off emails to her family. She's a retired librarian and sharp as a tack. She may be 93, but she looks and acts 20 years younger.

So, at my mother's request, I, being the good daughter that I am, dutifully drive to the assisted living center where Bessie now lives and pick up her plastic grocery bag full of bills and health insurance policy documentation. I adore Bessie, but I dread this. It's like doing a jigsaw puzzle with 500 pieces and no distinct picture. It's so anxiety provoking that I make up my mind that I will not even attempt it until which time I am fully rested, calm, and in a good mood. And most importantly, when I have a window of opportunity to tackle this at work. I'm thinking in about 5 years.

It takes me about a week to psych myself up. The bag is sitting on my desk next to the laser printer. I pick it up, look inside, see all the puzzle pieces, and spread them out on my desk. I open up a new excel spreadsheet on my computer screen to enter and track the charges and I start with the rehab facility bills. ("No wonder Bessie couldn't understand these," I think to myself. "This is ridiculous!") Then I comb through the Secure Horizons contract. Then I call Secure Horizons who refuses to talk to me until I tell them I'm with a doctor's office and give them all the secret information that allows me to get past their HIPPA gatekeepers and convince them that we can discuss Bessie's billing problems behind her back. I challenge their reimbursements to the rehab facility and point out their mistakes. It turns out that Secure Horizons reimbursed the rehab facility at a different daily rate than was on Bessie's contract. There was a $800 error in Bessie's favor.

I call the rehab facility, email them the excel spreadsheet with all the reconciliation detail and wait. Three weeks later Secure Horizons sends a check to the rehab facility, but not for the full $800. I have to call them again, B.S. my way through their umpteen layers of HIPPA security and once again point out the error of their ways. And finally they pay up. Bessie gets her bill reduced by $800. She's elated. Probably more from the peace of mind knowing that she wasn't taken advantage by the rehab facility and Secure Horizons than the money itself. She pays off the rehab facility. She's smiling her beautiful smile again.

Now, you tell me, how in the heck was Bessie suppose to do this herself? What about all the other hundreds of thousands of other seniors receiving bloated bills from rehab facilities, hospitals, and doctors? There is no possible way these innocent, naive, trusting people will ever know they're overpaying. The bills are nearly impossible to understand and so difficult to dissect that I'm sure most never are.

Bessie's health insurance, Secure Horizons, is one of dozens of the Medicare Advantage Plans, marketed to seniors with the promise of giving them an advantage over straight Medicare and a supplemental plan. An advantage?

In our office, we call most of them Medicare disadvantage plans.

"Hi, Ray Charles!"

Charles wasn't really his last name, but Ray was really his first name and he had been a patient in this practice for 25 years. I only knew him for the last two. Ray suffered from schizoid disorder. He lived in a group home. A social worker brought him to our office every six weeks to monitor his delicate health issues. One thing I noticed was that when Ray came in, the staff got excited. They treated him like he was a member of their own family. They took care of him with so much tender loving care that I couldn't help loving him too, even though he was quiet and not particularly communicative, and he didn't really know me. Ray was tall, refined, and always wore his gold chains. He walked with a cane.

One day, Ray called and I answered the phone. The deep, monotone voice said, "This is Ray." And, I, in an impetuous moment responded enthusiastically, "Hi, Ray Charles!" And Ray cracked up laughing.

And then I did it every time he called and every time he came in and it always broke through his depression, even for a few seconds.

On Monday, Louise the social worker brought Ray to the office. He was AMA from the hospital (Against Medical Advise) for a GI bleed and only wanted to come to our clinic. I walked into the exam room and saw him sitting there waiting solummly, and exclaimed, "Hi Ray Charles!" He and Louise both cracked up laughing.

Yesterday, Louise called and said that Ray had been readmitted to the hospital. He'd had a very successful GI surgery. But something had gone wrong. She was still trying to find out.

And Ray had passed away.

I hung up the phone, sank into my chair, and wept. I informed the staff.

"Goodbye, Ray Charles." I thought.

"Thank you for all those times you made me smile. You never knew how much they meant to me."

Paper Travail

I'm experiencing the reality of something I read in a Time magazine article a long time ago. Something in the article was so profound that it resonated with me then on a personal level and it's resonating with me now on a professional level... years later. Usually when I read something that truly impresses me, I want to save it. I tear it out of the magazine or save the magazine or copy the article. But in this case I didn't and I regret it because the gnawing feeling is bugging me.

Today, with the patient chatter in the front office particularly subdued, I search for the Time magazine archive website and search...and search. What key words should I use? I try this and that and this again. I concentrate on staying calm as I maneuver through thousands of articles. I focus. And low and behold, Eureka! I find it!

It's the cover story, "10 Ways to Cure the Health Care Mess", from the November 25, 1991 issue by Janice Castro.

Here's the quote I'm looking for: "The U.S. has more than 1,500 different health-insurance programs, each one with its own marketing department, complex forms and regulations. Doctors, nurses and clerks are buried in the paperwork needed to keep track of whom to bill for every aspirin tablet. It's a massive waste of time. U.S. health-care providers will spend as much as $90 billion this year on record keeping, according to a Harvard study."

And that was written nearly 17 years ago!

Today, amidst the ever increasing absurdity of having to keep track of every single patient's individual insurance company (of which I count 60 companies among our records) and specific plan (of which there are too many to count), which by the way the patient frequently changes from year to year, (and we have to keep track of that too or we don't get paid) or if they're on Medicare, to bill to Medicare first and then bill again to their supplemental insurance plan (if they have one) and bill to each private insurance company separately, and recognizing that when we do eventually get paid, a sizable chunk of it will go to the billing company who slogs through this mess for us, and don't forget we must also keep track of each patient's network of specialists when trying to refer because they don't have a clue how to navigate the system themselves (how could they?) and, oh, keeping track of that plan's medication formulary because Plan A doesn't cover this drug or that drug and requires a physician's letter to document the justification, and while your fighting that battle with the insurance company and they're stone-walling you as long as possible, the patient dies and then the issue goes away on it's own...

Stop the insanity! Yes, Janice Castro articulated the situation perfectly, "It all is a massive waste of time." And the waste has grown exponentially since 1991.

What have we created? A health care system that forces our doctors to spend a substantial portion of their 24-hour day coping with a bungling administrative quagmire constructed by a billion dollar profit-focused insurance industry instead of allowing them to spend most of their time, attention, energies, and advanced education on what is important - practicing medicine.

Oh, and by the way, many of our best and brightest minds are opting out of medicine altogether because they can no longer stand dealing with this "Health Care Mess".

It's shameful.

Livin' in the 90's

Last summer, my then 94-year old father-in-law was gallivanting around Europe with one of his sons. He had always wanted to visit the towns that bore his last name. One was in Germany, one in Czechoslovakia. And he did so. And he was having the time of his life, that is, until one morning while staying in a little inn in Poland, he couldn't lift his head off the pillow. His body wasn't working. An ambulance was summoned and Zaidy was rushed to the small, nearby hospital. He had suffered a stroke.

I'll spare you the terror that went through our minds when we received the phone call. It was bad enough that Zaidy was deathly ill in a foreign country, but this was in the very same country that turned over his whole family to the Germans back in 1943 so they could be transferred to the concentration camps in cattle cars never to be seen again...his parents, grandparents, sister, 9 brothers, their spouses, and children. As a young adult, Zaidy was out of town when it happened.

But now this Holocaust survivor was at the mercy of the Polish doctors to save his life. What a paradoxical situation to be in. What an enigma he must have seemed to them. Trust me. They probably had never seen a Jewish patient in that hospital before, let alone a near-centenarian who survived World War II! He sure got their attention! Zaidy was the talk of the entire hospital, the entire town. And call it collective guilt or old-fashioned medical professionalism, they saved his life.

After a week or so, Zaidy was transferred to a major hospital in Germany to further his recovery and receive physical therapy. He speaks German as well as Polish and though his speech may have been slurred, he could still communicate very well with the staff. Much to our tremendous relief, Zaidy got superb care there too.

Amazingly, although incontinent and unable to walk, our barely 110 pound Zaidy boarded a jet a few weeks later and made the transatlantic flight... ...back to the States and the American health care system. Taken to the ER immediately upon arrival, Kaiser Permanente relinquished him directly to a rehab facility in which he was allowed a maximum stay of 21 days or so. That is, as long as he was showing improvement. Otherwise, we were informed, he'd be discharged sooner.

The day after Zaidy's admission, I arrived to work bright and early for our monthly staff meeting. In addition to our clinic practice, we also visit 60 facilities throughout the city. I looked around the table. I think there were 9 or 10 doctors and nurse practitioners that day. What did they think of this particular care center that Zaidy was in? "Was it good?, I asked, hopefully.

Dead silence. Nobody said a word. They all just starred at me.

Finally, Candy, one of the Nurse Practioners answered. "The truth is," she said, "you never want one of your family members to go to one of those places, if you can possibly avoid it, especially THAT one. But if you have to do it, remember, it's up to the family to make sure that the family member gets the care he needs. They need to be all over it!

Long story, short...in that rehab facility, my family became omnipresent!

And Zaidy got the care he needed. Excellent care, in fact.

And after 21 days or so, he went home back to his condo, albeit fragile and weak.

It was difficult. Lots of physical therapy. Lots of effort and determination on his part. It wasn't long however before Zaidy celebrated his 95th birthday. Soon he was walking again without a discernible limp and cooking in the kitchen. He renewed his driver's license. He was playing golf again.

And just recently, with some amazing tutelage from his eldest grandson, Zaidy started using a computer again. He signed up for high-speed Internet and registered an email address. Now we can hardly break him away from UTube where he watches his favorite Yiddish videos.

What a guy. Yasher Koach, Zaidy!

Health Care as a Commodity

National Public Radio (NPR) is featuring a series on health care systems around the world. Today's segment, which I listen to as I drive home from work, is about how health care is rationed in Britain in order to afford universal coverage. The interviewee, Sir Michael Rawlins, Chairman of the National Institute for Health and Clinical Excellence comments,

"And we, in Britain, as in most of Europe, actually, have a health care system, based on a principle of social solidarity, that we look after each other in times when we’re sick. And that’s very precious to us. And I think that’s what we find so difficult to understand about your health care system (in
America). You don’t have that."

I agree.

Why don't we have a system of social solidarity? Why don't we look after each other more when we're sick? And why isn't this precious to American society?

Is it greed?

Is it because we treat health care as a commodity?

If you've got deep pockets, you can buy some. If not...well...too bad for you and your children. Do without. Sorry.

Well, the difference is we're not talking about buying a new car here. We are talking about access to a quality service that has the potential of preserving life!

Does my life have a price point? What is it?

I personally struggle with the reality that throughout much of human history, human life has been regarded as cheap. Even expendable. In fact, even today, in many parts of the world, it still is. Somehow though, post-World War II, I thought our country was different. This is the United States of America, by God! I grew up with the Declaration of Independence etched in my brain:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness."

Life? Could that be construed to suggest that we are entitled to the security of knowing we have access to life-preserving health care if we need it? Is health care an unalienable right endowed by our Creator that our government assures us?

Hubert H. Humphrey once defined the moral test of a government as:

"how that government treats those who are in the dawn of life- the children, those who are in the twilight of life-the elderly, those who are in the shadows of life-the sick, handicapped, and the needy. "

Who are the needy?

With the way our health care system is sucking the life blood out of the working family with its crushingly high premiums, 5-figure deductibles and $100+ medications, the needy is now the middle class...the heart of American society.

Today that heart is broken.

Today would our government pass Hubert Humphrey's moral test?

How our Health Care System Fosters Stress, Anxiety & Depression

Two word: Medical Bills.

There's nothing like coming home from the hospital and finding a fistful of medical bills waiting for you. From the doctors, the hospital, the health insurance companies, and all kinds of people and places you don't even recognize. There's nothing like the sight of those anxiety provoking medical bills to trigger your adrenal glands to shoot out cortisol, for your palms to get sweaty, for your heart rate and blood pressure to skyrocket, for your struggling immune system to plunge, and for your recovery to come to a screeching halt. Just in case you weren't really sick when you went into the hospital, you can be sure that you're really sick now, confused by the cold, callous bills that keep appearing in the mailbox that require intense concentration to make any sense, if that's even possible, and imply that you're going to have to take a third mortgage on your home to pay for. The experience is so overwhelming that by the time you see your doctor for a follow-up visit, she wants to prescribe Zoloft for depression to help you cope with the punishing experience of recovering, not from your illness, but from wading through the incessant stream of paperwork that requires so much of your time and energy when you should be resting and regaining your health. If there's one positive thing to say about Kaiser Permanente, they don't put their patients through this torture.

Remember Michael Moore's movie, SICKO? Whether or not you believe the health care systems in England and France are inferior or superior to ours, or that Michael Moore is a jerk, let's be honest. There he is in an English hospital at the cashier window and he's told the only financial concerns discharged patients have when they leave the hospital is to make sure they stop by and receive their parking money. No bills then and no bills when they get home. Huh? But the scene that REALLY gets my attention is the young man in France who has been discharged from the hospital with doctor's orders to take 6 weeks and rest to fully recover (on the beach, no less) before returning to work. (Is this for real?!) None of this American stupidity of returning to work while you're still recovering for fear of losing your health insurance! That is really sicko. Just last week, we saw a nurse practitioner in our office for free because she had been laid off when a hospital closed and couldn't afford the COBRA. She fell in her backyard, broke her arm and needed a letter that she was fit to return to work. She wasn't. The fracture was still fresh and not healing optimally. She should have had surgery. The woman couldn't pay her rent. We wrote the letter anyway.

There are a myriad of reasons why our health care costs are so high. But in an insidious, twisted way, one reason is because our own health care system fosters not health, but illness. Stress isn't just a state of mind. It effects the entire body, particularly our digestive and immune systems, cardiac function, brain chemistry, and hormone balance. Everything goes haywire when we're stressed. With rising gas prices and worries about global warming and national security, can't we just have some peace of mind when it comes to health care? Is it so much to ask for a system that we can count on when we're ill and need to be cared for? A system we can trust in and be proud of? A system that doesn't constantly threaten us with personal bankruptcy?

We spend billions of dollars on expensive drugs, invasive surgeries and hospital stays, but we fool ourselves into believing that many are anything more than temporary panaceas to treat physical illnesses brought on by chronic emotional stress. Imagine a health care system structured to minimize stress, anxiety, and promote mental health.

Health insurance providers need to focus their efforts on absolutely minimizing the crushing stress they create for the average consumer. This shift would go a long way in minimizing illness and improving the overall health of our citizens. The positive impact this could have on the well-being of our nation would be incredible.

No doubt about it.

Medicarelessness

Today our R.N., who cares for all our patients as if they're her own family members, reached into her purse and handed me her personal VISA card. Out of frustration, she decided to pay for a patient's Plavix because he's run out of pills and he's run out of money...and Medicare won't pay for his meds now. Remember that darn Medicare doughnut hole? The one you sink or swim in when you've spent x-amount of dollars on medications in a given year? When it's your time to swim in the doughnut hole, you have to pay 100% out-of-pocket for awhile. Otherwise, you sink.

Sammy, who has been a patient of ours for 30 years, is in his 60's. He lives with his mom, Gladdy, who is in her 90's. She keeps calling us crying because she can't find a way to pay for Sammy's pills. Safeway Pharmacy already called us that he owes them $400. Who knew Safeway took pity on poor people and allowed them some slack paying for their meds. Sammy is out of slack. The R.N. is desperate to find him some medication. She calls his cardiologist and begs for samples. (They’re rationing.) They reluctantly allow one week's worth. They, in turn, promise to apply for Plavix assistance through the generous folks at Bristol Myers. I agree to try to apply for emergency assistance from Medicare...on Monday.

I take the R.N.'s VISA card and click on the link to my favorite Canadian pharmacy and order 3 months worth of Clopidogrel, generic Plavix, which isn't even available in the United States. It's $77.00. In the U.S., the brand name stuff would have cost Sammy about $270. Eventually, the medical practice will end up reimbursing the R.N. and paying for Sammy's Clopidogrel because we don't want him to die.

Lately, we've been paying for some patient lab tests and not charging the health care workers who come in to see us because they work hard and take care of our patients in the nursing homes. Most of them are overworked, underpaid, and underinsured. So, we try to take care of them when they ask, so they are healthy enough to take care of our Medicare and Medicaid patients who reside in those pathetic warehouses that you never want to send your family member to if you can possibly avoid it.

Anyhow, Sammy needs more than Plavix. His mother needs her medications too.

There are a lot of Sammy's and Gladdy's now. Many are just not getting their medications...and ending up in the E.R., where they get meds for a while and recover, which Medicare will pay for. Then they're discharged.

Once back home, some still won't have found a way to pay for their medications and will just sink down into the doughnut hole...never to come up.

MediCARE? or Medicarelessness?

A Taste of My Own Medicine

We see primarily Medicare and Medicaid patients in our private medical clinic....mostly the patients the other doctors don't want to see anymore because the reimbursements keep dropping. I get calls all the time from sick people telling me their doctors are dumping them because they are on Medicare. As far as the Medicaid patients, most were already dumped a long time ago. "Are we accepting new patients?" they ask hopefully. And when I say "yes we are", I can hear the familiar sigh of relief through the phone. But, this is a topic for another blog entry.

Today I am the patient. I have been sick for 2 weeks with a progressively worsening sinusitis. Never mind the stressors in my life that have compromised my immune system and allowed me to become ill from all the infectious bacteria on the doorknobs and elevator buttons I have touched. Those stressors are also topics for another blog as well.

Today I desperately need an antibiotic to treat the infection in my body that my own white blood cells are struggling with. And...drum roll, please....that antibiotic of choice, after much conversation with the R.N., the N.P., the M.D., and the Pharm.D. is..Levaquin! Okay! The script is called into our pharmacy. I retreat to my office and place a few phone calls with my raspy voice that disguises who I am and then race downstairs to pick up my prescription. The cost? Why, it's a mere $148! And that's AFTER the newly implemented Anthem Blue Cross plan health savings account discount (The medical practice recently switched from Humana when we received notice that our monthly premiums were being increased; mine to $1,600). Sticker shock ensues. Suddenly I feel sicker than I already felt...and that was sick enough. Let me sit down please in one of your two chairs facing Suze Orman on Oprah.

One hundred and forty eight dollars for the 7 white pills which will eliminate the thick green snot, the coughing, the sneezing, and restore my sense of smell and taste. Okay, I get it now. The insurance company wants to discourage me from buying medication to treat my illness. Their plan is working. Next time I get sick like this, I may be disincentivized from getting treatment. After all, my premium only costs $1,000/mo for my husband, son, and me with a $10,000 annual deductible. Isn't that great? We only have to pay the first 10 grand (including medication costs), plus our annual premium of 12 grand and THEN any further expenses are covered 100%. I’m still paying off medical bills from 2007 that the insurance didn’t cover.

Who can afford this? I can't. If the doctors who I work for didn't pitch in a little to cover the costs, I know firsthand what the consequences could be. Tragedy.

And that is also a topic I will expound upon in another blog.