Feeling Powerless?

Don’t worry, there are hard-working, brilliant idealists at work standing up for you.

A few years ago the commonly cited number was 45,000 Americans a year dying deaths that could have been prevented had their illnesses been detected before the fatal stage that brought them to an Emergency Room.   My father, though he retired with excellent medical insurance and was on Medicare, though he saw an endocrinologist, hematologist and cardiologist regularly the last two years of his life, as his energy and life force deteriorated, was first diagnosed with liver cancer by an ER doctor, six days before he died.  

My father’s case was, hopefully, unusual in a nation with the most advanced medical technology in the world.  Most of the 45,000 annual American deaths that could have been prevented by earlier intervention (a few seconds of diligent google research shows this recalled number is a fraction of annual preventable American deaths) were died by poor people, people without health insurance, people too frightened, by disease and the specters of unaffordable expense, bankruptcy and pre-existing conditions, to see doctors.  Many who died needlessly probably had serious warning signs they should have heeded.    

In part to address this intolerable death toll in our extremely wealthy nation, in part to rein in the runaway cost increases of the most expensive medical care in the world, President Obama passed the landmark compromise medical insurance bill that bears his name.   I haven’t seen the statistics since Obamacare went into effect, but I’ll guess that the number of annual preventable American deaths has come way down, maybe by as much as a third.  

Progress on an institutional level is at best incremental and the perfect must not become the enemy of the good the president, a man with millions of determined enemies, reminds us.   Malcolm X, in his posthumous autobiography, remarked that sticking a knife ten inches into someone and pulling it out six inches is also considered progress.  But tell that to the guy with the knife stuck into his body.    

The unregulated inflation of the world’s most lucrative medical insurance and pharmaceutical industries, and obscene loopholes like ineligibility for insurance coverage at any price for people with “pre-existing” medical conditions, screamed for regulation.  Obama’s team, headed by medical industry insider Liz Fowler, working for industry financed former Senator Max Baucus (now Ambassador to China), struck a compromise — price increases for medical insurance would be regulated, American health care would become more outcome and prevention-based, there would be no more exclusions for ‘pre-existing conditions’, industry-wide cost saving measures would be introduced over time.  

The private insurance industry got something in return for giving up all this power and potentially some of its profit.  Americans of sufficient means would be mandated to buy private insurance or pay penalties for not buying it.  

Medicaid eligibility would be extended under Obamacare.  Although millions of Americans would remain uninsured, millions who’d been previously unable to afford health insurance could now purchase and even, in most cases, afford it, under the Patient Protection and Affordable Care Act.  

Somehow, along with the industry consenting to be regulated, forced to justify regular, generous increases in insurance premiums, paying out for sick people whose conditions pre-existed their purchase of medical insurance, the law provides that patients have no right to be informed of actual costs prior to any medical visits or treatments.  I kid you not.  

You make an appointment to see a physician’s assistant about a stomach ailment.  Nobody anywhere, not at the company you pay your premium to, not at the doctor’s office, can tell you in advance what that twenty minute visit will cost.  

“We have to wait until the doctor’s office bills us, there’s no way to tell you in advance,” the insurance company will say.  

“We have to be told by the insurance company what the price will be,” the doctor’s office will tell you, “the insurance company sets the price, then we are allowed to bill you.”  

Then, since all plans in your income range might be high deductible plans, you will have to pay the entire cost, whatever it might be, “out of pocket”.   That’s the law.  There is what’s fair and there is law, and the two are, regrettably, not always the same.  

If you went to a store where there were no prices on the items, where no sales person could tell you a price until after you signed a blank credit card statement to buy something, with no chance for return or refund, you would not shop in that store.   Picture a restaurant with no prices on the menu, smiling waiters assuring you that everything was delicious and not to worry, the prices were as low as possible for such amazing food.  

Assume the dinner was fine, or even if it wasn’t, here comes the friendly waiter with your check.  Dinner for two without wine: $507, coincidentally the same as my bill for seeing that physician’s assistant who was so clueless and unhelpful.  The manager is not able to hear an appeal or make any changes to the price.  The owner will not speak to customers under any circumstances, and he’s not in, anyway.  If you try not to pay there is a policeman at the door to inform you lawyers will be called to garnish your wages, and make the collection.   Don’t believe it?  Wait a few weeks, the lawyer’s letter will be in your mailbox informing you of your obligation to pay a legal debt.  

In fairness, and it’s always important to be fair, the $507 total for my visit with the physician’s assistant turned out to have been billed in error.  My next set of bills, which I confirmed the accuracy of with my insurance company, informed me I should have only been charged $457.   And much of that was my own fault.  I’d agreed with the nurse that it was reasonable to do a blood test, to rule out something serious our internet research hadn’t suggested.   The price of the blood test I had to pay was $327, discounted by my insurance company from the sticker price of $642.  Instead of being grateful for the almost 50% discount, here I am bitching and moaning.   Just goes to show, some people are never fucking happy. 

But, if you will excuse me, I have to figure out who else to call to find out how to avoid a similar expense to have a dermatological body scan done by a physician’s assistant I was misinformed yesterday is a doctor.  My concern is not only the cost of the visit and exam, but if anything has to be sent to the lab, that can add from $179 ( to sky’s the limit)  to my out-of-pocket expense, in a addition to $131 for the required pre-procedure office visit, as in the case of my 100% covered preventive care colonoscopy a year back.


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