Thursday, June 22, 2017

I Have Some Questions...

I have some questions and I might actually want answers to them.  Feel free to comment.  I shouldn't have to post a reminder to keep it clean and respectful but I will anyway because well, let's be honest; being respectful is becoming a lost art.

Why should only the very wealthy be able to afford health insurance?

Why is healthcare so expensive?

Maybe I should have typed those in reverse order.

Before I got sick, I didn't think much about health insurance.  I had it but other than bi-weekly deductions from my paycheck and the occasional co-pay, I didn't use it much.  I really had NO CLUE how lucky I was.

Did you know when you are diagnosed with non Hodgkins Lymphoma on January 16th; you pretty much have met even the largest deductible on January 16th?

Before getting sick, I didn't know what an out of pocket maximum was.  Do you know what it is?

I have made it pretty clear where I stand on the current state of the cost of healthcare and health insurance in the US these days.

I find it interesting and more than a little ironic that there are those in this country that want to blame everything that is wrong with the healthcare and health insurance industries on the 44th president of the United States.  To them I say, "Get a grip."  Both industries were a mess long before 44 was old enough to be president.

Healthcare costs are increasing (sorry for the Captain Obvious statement).  Isn't part of why they are increasing due to increased costs of malpractice insurance?  Maybe you shouldn't be able to sue your doctor for malpractice if you have a hangnail.  I am not suggesting if there is true negligence that people do not sue but clearly the system is being abused.  Don't think for a minute that a doctor is going pay ginormous premiums to cover themselves in case the human part of them makes a mistake and a patient wants to sue them for $451,586,325,669,541 and they aren't going to pass the cost on to the very patient taking them to court (and every other patient visiting their office).

You know I read somewhere a person was blaming Obamacare for the fact that they had to wait an extraordinary amount of time in the waiting room and then the exam room of their doctor's office.  I hate waiting as much as the next person but let me ask a couple of questions...

Were you the only patient there that day?
Are you the only person on earth?
Are you more important than anyone else?

The day I was diagnosed, my first stop of the day was in my general practitioner's office.  I hadn't slept a night through in weeks, I wasn't keeping food down, I had lost roughly 30lbs in a matter or weeks.  My GP had read a CT scan that had masses on it.  She shared that info with me and I went to pieces.  She spent more than an hour with me while I processed what she was telling me.  I am sure I jacked up her patient schedule for the rest of the day.  In the waiting room there are posters that apologize in advance for any delays in service due to unforeseen circumstances.  I am grateful for the time she spent with me when I was an unforeseen circumstance.  I think about it often when I am passing the time in a doctor's waiting room.

Did you know that the cost of a head, abdomen and pelvis CT scan went up $1300 in 6 months?  Did you know I was scanned in the same machine each time?  I am guessing that the machine is paid for.

Each of my chemo treatments cost roughly $25K.  That doesn't include the $6500 Neulasta shot I got the day after each treatment.  Neulasta is a wonder drug.  Kept my immune system from imploding each time we sent poison into my body to kill the cancer.  If you google the cost of Neulasta, it appears that it bills anywhere from $3000 to $9000 per dose.  So, we're paying for development costs, testing costs, advertising costs.  I am sure there are more costs but $3000-$9000 PER SHOT?  Don't even get me started on Epipens.

When is the profit made "enough"?

When did hospitals become profitable businesses?  Who is footing the bill for these profitable businesses?  Look in the mirror.  Do the Teslas and Porsches in the hospital parking lots belong to the doctors or the hospital administrators?  I know where my money is.

Maybe some of the outrage at Obamacare should be re-directed.

Time to look at the health insurance industry.

Insurance is a means of protection from financial loss. It is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. --from Wikipedia

We pay for this protection.  Over the last several years (yes, even pre-Obamacare) we would pay more each year for less protection...unless you were lucky and your company (or the American people) paid for your insurance.

Have you ever read an Explanation of Benefits (EOB)?  Some are easier than others to decipher.  You have the cost of service (what the doctor or hospital bills), what is allowed by the insurance company (what the doctor or hospital is allowed by the insurance company to bill or a discounted rate), what the insurance company is going to pay, and the balance owed.  Why don't we price health care services more realistically?  Insurance would cover more and not need to be so expensive.  Yes, I know I am over simplifiying.  But why do we need to over-complicate?  The hospital can bill at $6000 but if they only collect $3000, their "income" is $3000 not $6000.  So the hospital bills $3000 and the insurance company covers 80% because the hospital is in network...out of pocket = $600.  If costs are more realistic, maybe insurance companies go back to covering 90% or 100%. 

Insurance companies want to make money, I get it.  So do doctors, drug companies, and hospitals.  Trust me, I get it.  It goes back to an earlier question...when is the profit made "enough"?

Where does the line get drawn?  Should the CEO of Mylan have 5 homes or should the average citizen be able to afford life saving epinephrine when their child is having an allergic reaction?  Should chemo only be available to those whose combined household income exceeds $200K?  How many people reading this have lost their jobs in their lifetime?  How many have had to figure out how to pay for what insurance doesn't?   

I hear a lot of conservatives talk about what should and shouldn't be covered and who should and shouldn't have to pay more.  I hear it from progressives too.  

What about those suffering from mental illness?  We've established that there is a good part of the population that think everyone should have a right to bear arms.  So you give someone suffering from mental illness access to a gun...but there are those that would deny them access to affordable mental healthcare???  We're NOT living in a third world country.
I am not even going to entertain the topic of immigrants in the US.  That is another blog post entirely.
So...who should get good healthcare?  Only those who work?  Only those who can afford it?  What is a fair price?  What should that price cover?  Should you get to choose a doctor you are comfortable with?  Should you have to mortgage your house to cover the cost of your prescriptions?  Yes, I know some of my questions are absurd but it goes back to...when is the profit made "enough"?
People are so quick to blame Obamacare for all of the world's problems which is misguided and frankly fairly ignorant.  The cost of healthcare and health insurance was an issue before 2008.  Where is the outrage against the forces driving up the cost of healthcare and in turn the cost of health insurance?  

I wish I had answers to all of these questions.  I know I think differently about my health/healthcare/health insurance as I get older.  Getting older is inevitable (unless you die).  What may be perfect health today could be a chronic disease tomorrow.  Maybe it's time to start asking some questions and seriously pursuing answers.

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