What's All This Then?

commentary on the passing parade

Agree? Disagree? Tell me

My Other Blog

Monday, March 09, 2009

With Health Care Reform……

O.K. It was fairly good speech. The almost State of the Union speech that the president gave to a joint session of Congress on February24 . But 60 plus interruptions for applause? It was silly for all the joint session speeches of the past and it was just as silly this time. I feel sorry for whoever sits behind the president - whether it’s Nancy Pelosi and Darth Vador or Pelosi and Joe Biden. They look ridiculous jumping up and down like jack-in-the-boxes.

But there were some parts of the speech worth applauding - particularly the assertion that we have to do something about health care. Sure we do. It’s a mess. We may have the best doctors and the best hospitals in the world - but we have a cockeyed, convoluted, way too expensive system of getting health care to those of us who need it. Unfortunately, it’s going to continue to be cockeyed, convoluted and expensive.

During the presidential campaign, Obama said that if he could start from scratch - if there wasn’t already an entrenched system - he would opt for a single payer, national health system. Well we’re not starting from scratch and from what I’ve heard so far, we’re going to continue to play fine tune games with the system we have - and I don’t think it’s going to help. We keep hearing that there are 37 million uninsured in the country as though that was the problem or a good part of the problem - but it’s not. The problem is that health care is just too damned expensive and too big a profitable business for insurance companies, drug and equipment manufacturers - and most doctors and hospitals.

My wife an I are probably among the millions of "middle Americans" who won’t be helped one damned bit by anything that Congress devises to "reform" healthcare in the United States. We have health insurance, including increasingly expensive drug coverage from her job from which she’ll be retiring shortly and we’ll be switching over to Medicare parts A and B and maybe the part D drug coverage - if we can ever find a linguist to translate it for us. Our health coverage costs will be increased after my wife retires and there’s not a snowball’s chance in Hades of them going down through anything being proposed by the president or his health care reform team.

Let’s consider drug costs for example - a huge portion of medical costs. Over in England, where they have that hated national health plan, my brother and his wife - both seniors like us - take their drug prescriptions down to Boot’s the Chemist - hand ‘em over - and in return, get whatever medications were prescribed. That’s the entire transaction. No money changes hands. There is no co-pay for seniors - and for the rest of the people who use the national plan - the co-pay amount is what those of us used to American style drug plans might call "incidental." But it wasn’t that many years ago when our co-pays were comparable. Our insurance plan covered a 90 day supply of any medication for $2!! No kidding. Two dollars. Then it began to climb. It went to six then twelve and it kept climbing until it reached today’s levels of $20 for generics and $50 or $60 for brand names. Still not a bad deal compared to the cost of those drugs without insurance - and there’s the first cockeyed aspect of our healthcare system that Obama isn’t going to be able to change.

We live in a free market society and the reigning motto on what anyone can charge for anything is - whatever the market will bear. But when it comes to the medications that cure us or help to keep us alive - what the pharmaceutical companies are charging us comes close to being criminal. They will claim of course that they have to charge what they charge because they have to plow so many gazillions into research to produce new generations of life saving drugs. Except that we know that they spend more money on promotion than research and that many new drugs come from other countries or are "me too" drugs. It is absolutely unconscionable that a medication used by millions can cost the end user hundreds of dollars a month. The VA has been able to bargain with the pharmaceutical industry to get a better price on some drugs - but don’t look for any reductions in what the rest of us have to pay.

The same is true of what doctors and hospitals charge, Maybe the biggest screwing of patients comes from billing codes - first devised by the AMA more than 40 years ago and since grown like Topsy to the point where medical billing has become a full time profession - with the awarding of a DEGREE in Medical Billing and Coding.

In the good old days, you went to see your doctor and he sent you a bill for a reasonable amount - presumably based on the amount of time he spent with you and any supplies that might have been used. Not today. Today we have medical practice by billing codes. A few weeks ago my wife had an epidural injection to try to relieve some of her back pain. It was done under fluoroscopy so that the doctor could guide the needle to exactly the right spot. He gave her a small amount of lidocaine and then injected a steroid solution. The bill that was submitted to Blue Cross was what I call medical costs on steroids. Here’s a verbatim reproduction - codes and all

97535 Self Care Train $ 74.00
62311 Lumbar Epidural $ 1056.00
98925 Manipulation $ 98.00
77003 Fluoroscopy $ 440.00
J2001 Lidocaine Inj. $ 200.00
J1030 Deep Medrol $ 150.00
97010 Ice Pack $ 15.00

Total: $2030.00
To Blue Cross’s credit, they denied any payment for "self care train" which is also called home care training. The only home care training that might have been involved in my wife’s treatment would perhaps have been the doctor saying "maybe you should take it easy for the rest of the day." But Blue Cross didn’t think that was worth $74 and neither did we, so it won’t be paid. And Blue Cross cut $1477 from the rest of the bill - which is the arrangement between Doctors and Blue Cross. The doctor submits a padded bill and Blue Cross pays what it thinks is an appropriate amount. Should we be grateful for Blue Cross? I think not.

Why? Beacuse another huge portion of medical costs is the billions of profits raked in by insurance companies. President Obama says if we’re satisfied or comfortable with the coverage that we already have - he thinks it’s O.K. for us to keep it. Which is a way of telling people like me and my wife and probably most of the people who read these words - that "reform" isn’t going to help us one damned bit.

It will probably take more years than Obama will stay in office to produce real reform - meaning single payer coverage for all and taking a huge bite out of what makes up a large portion of health care costs - profits!! Frankly, I would settle for just one smidgen of reform - a little less convolution.

As I said, my wife is getting ready to retire from her job - and somehow the insurance world knows this, knows that she’s eligible for Medicare, parts A and B - and she has been deluged with offers of "medigap" insurance that picks up costs not covered by Medicare. She’s also being solicited to buy Medicare part D, the wonderful government program designed by Rube Goldberg. That is to say, it’s not quite as straightforward as my brother’s prescription drug program referenced above - but it can all be explained by searching on line - starting, say here - and then just click away to guide you through the maze.

If you can figure out what it all means and how it works, please send me an e-mail and explain it to me. No rush. Any time in the next four years will do. Of course by the end of four years, it won’t matter. Everything will be reformed by then. And I will have given up driving my gas guzzler in favor of riding my pet winged pig.