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.