Sunday, January 6, 2013

Healthcare, Schmealthcare!!

I almost couldn't make it through the doctor's appointment without laughing. 

I did so much shaking of my head, I became a little dizzy. 

The Specialist entered third, after the nurse and his 'fellow', to reiterate what was, no doubt, the most preposterous statements I'd heard in a while.  And I hear some pretty kooky stuff, friends.

The Specialist's shtick began with why I would have to receive two prescriptions for drugs we've already determined won't help, and a third prescription for Physical Therapy, which they know won't help, at this point, either.  I'm supposed to 'make an appearance', get a home program then, and only then, can we discuss scheduling the surgery that should make me better.  Notice, I never say healed or cured.  That is not the "busy-ness" of doctors, these days.  They only treat symptoms, despite their origin as healers, once upon a time.  (I wonder if my insurance covers leeches.)

"It's all Medicare's fault."  He told us with some pretty funny gestures, shrugs and facial expressions as if to indicate, "Everybody has to go through this now...!"  I almost felt sorry for him.

Apparently, in the State in which I reside, Medicare is 'cracking down' on unnecessary surgeries by demanding proof that other (read: cheaper) means of treatment are documented, first.  Other States are falling into line right behind it, as well.  My understanding is that the treatments and prescriptions must be documented not necessarily done or taken, but ordered, and purchased and paid for.

Get this! They have a 2-year period in which they can go back and CHECK and if rules were not met, Medicare can demand their money BACK from everyone involved, and the doctors, et al, can, legally, go after the patients for their fees. 

Let's play the naive game, shall we? We can view this as Medicare just being frugal, or looking out for us, or being a pain in the neck to all those poor doctors and hospitals out there.  It's hard to say, isn't it?  It really depends on your perspective and on which side your bread is buttered.

Here's the kicker.  I am not on Medicare.  First question out of the mouth of the nurse was regarding my insurance carrier.  Being thoroughly cynical these days, I heard the KA-CHING of the cash drawer. I happen to have what's considered 'good' insurance. Lucky me?

Maybe.  The suspicion amidst medical professionals is that, as past behavior has proven, private insurance companies will follow Medicare's examples and rules in the future.  "Soooo....just to cover our asses....".
I nodded, sympathetically.

What, pray tell, do people who are uninsured or underinsured do? (Not you, Senator, we know you're covered for life.)

If I had no insurance, just one of my medications would be approximately $1200 USD per MONTH. 

If I had no insurance, I could not receive MRI's to track if that very medication is actually slowing down my disease or if we are all wasting our time and money.

If I had no insurance, I'd be like a departed friend, calling from a hospital bed (assuming they'd admit me) trying to figure out how everyone would be paid or if bankruptcy was imminent.  She was scrambling and digging for State coverage with a terminal disease, for Pete's sake!  NO ONE SHOULD HAVE TO DO THAT.

If I had no insurance, I'd be afraid to even go to a doctor for fear of what they'd find.  In all fairness, people with insurance do that, too.  Personally, I'd rather know and deal with it, than not.  But, that's where they've got us, between a rock and a hard place, as the old folks say.

Speaking of which, what if I received a diagnosis and THEN the insurance became effective?  As things stand, that's called a 'pre-existing condition'.  If you so much as took an aspirin for a diagnosis before you got the insurance, it has been treated and they don't have to pay for that diagnosis' treatment for as long as the policy dictates...90 days without treatment, a year, or forever!

I happen to have working knowledge of the spiderweb of denials stemming from THAT phrase, pre-existing.

What if I DID have Medicare and was an elderly person without knowledge of the inner workings of this craptastic mountain of information, red tape, and hoops to jump through to receive adequate healthcare?  After all the confusion, and the dust settles, and assuming the doc didn't cover his junk, some little old lady receives a bill a year later for surgery, radiology, hospital, anesthesia, and on and on.

No wonder more and more people are depressed, anxious, and remain untreated for physical and mental illnesses, now, more than ever, in the history of the United States!

So, here we are in a still-wealthy country with people who barely finished high school, following the 'policies' given to them, telling our physicians when or if they are 'allowed' to perform their jobs.  The doctor is, of course, able to take the risk, if he or she has it in them.  Good luck finding one of those. 

Doctors, insurance companies, government agencies/politicians, and pharmaceutical companies eat up ALL the money and defecate healthcare. There's no other way to view it from what I'm observing.

And, guess what?

We have to accept it. 

For now.

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