My Health Insurance Epiphany

I saw the light last week, though some of you may think I'm in total darkness by the time you finish reading this.

So I was sitting in a hospital waiting room for Mrs. B's doctor to come and tell me she was out of surgery - outpatient procedure from which she's recovered fine - and in the recovery room, and it struck me that I'm finally falling off the fence. I don't like the idea of universal healthcare.

Now, before anyone on the right of the political spectrum jumps for joy, let me explain: It' s not a political or partisan thing with me. If it was, I'd point out that the first close-to-universal healthcare system ever proposed in this country came from the late Richard Nixon, 37th president of the United States.

I believe many - maybe most - doctors do what they do because they care and want to contribute to healing folks. But human nature being what it is, I'm sure plenty of them also enter the medical field 'cause there are potential big bucks to be made. And when the average person thinks his enterprising spirit is going to be taken for granted or ignored he loses some incentive and some motive to try to outdo his peers. Trust me, if my bosses said tomorrow that the market size-plus experience-plus merit pay scale was being dropped, and that my salary would become the same as that of some guy who writes his condo association newsletter for $15 per week, I'd lose the fire in my belly. Sure, I'm in this business because I believe in what I do. But I'm human. I also want a good salary for good work. And I promise you a part of me would ask "what's the point" if that distinction in pay was dropped. The last group of people we want to stop trying to be the best is doctors. I like the idea of fixed rates being set for certain services, but we have to factor in quality. Better doctors with better skills and better facilities should be able to charge more than their weaker colleagues, I think. But the scale for medical services needs to be lowered all around, in order to make things more accessible.

So my problem is not so much with the costs of health insurance as it is with all costs associated with healthcare. I have a problem with medical suppliers and equipment suppliers overcharging hospitals and clinics and private doctor's offices, because those hospitals and clinics and private doctor's offices pass those costs on to the few patients who can pay for everything. And for those of us who can pay a portion, those hospitals and clinics and private doctor's offices, simply pass the high costs on to our insurance companies. So yes, I have a problem with $3 hospital bandaids, when they take five seconds to apply, and you can buy them 20 to a box for less than $5. I have a problem with $200 charges for a saline solution drip in an IV. I have a problem with $1,000 injections of anesthesia, $20 3-foot-long strips of ace bandage, $500 a night for "room and board" when you have to stay overnight in a hospital, $10,000 for 20-minute-long, barely invasive, non-life-threatening surgery.

Simply put, "things" like bandages and "relatively" minor services in hospitals and clinics just shouldn't cost so much. If I can buy those "things" in the civilian world for pennies their cost in a hospital, something is wrong, 'cause you know the hospital is buying those "things" in bulk. The cost of a strip of ace bandage in a hospital should be less than a buck. The cost of that salt water drip should be a few bucks. The cost of that bandaid should be a quarter.

What should be left to the free market is the actual cost of a specialist doctor's services. Doctors who are the best at what they do should get paid more than Dr. Nick from The Simpsons and other colleagues who graduated last in their class at the Tijuana Mail Order Medical College. That's only fair. Mrs. B's doctor? I've done my homework. He's been described by colleagues as a star among his peers. His work on Mrs. B has not led us to think otherwise. So I have no problem with him getting the big bucks. He's earned it.

Here's the rub: Everything associated with Mrs. B's procedure last week was covered. One hundred percent of the tab was picked up by our insurance company. Good, right? Maybe, unless you consider we pay the equivalent to a Volvo payment - a Volvo for which you put zero down - for our health coverage each month.

No, the way to make healthcare affordable for everyone is not to nix traditional insurance and give health coverage away. Let people continue to pay. But have them pay what's reasonable. And the truly poor among us? Well, what they can't pay in $$$ can be supplemented. Why not? That's essentially what Medicaid and Medicare do. Let's just expand those platforms to make sure that folks who can't pay for all their care get access to doctors.

That's my generic plan. And if you think I'm all wet, consider this: If those "things" and those simple services about which I wrote were actually more reasonably priced, then the health insurance companies MIGHT quit passing on to consumers the screwing they're receiving from hospitals and clinics and private doctor's offices, who are in turn being screwed by medical equipment suppliers and suppliers. And if that happened, my and Mrs. B's health insurance would probably only cost about as much as a bicycle payment each month.

Adventures in health care and other random crap

Sorry for the lack of posts the past couple of days. I started my Monday at about 5:30 a.m. by tripping over my dog as I went to let him outside to handle his business.

What I got for my trouble was a severely wrenched ankle - that I was already nursing, a set of X-rays that showed my ankle bits a bit out of order, and the inability to walk. I could not take a step without excruciating pain. Luckily, I remembered that when Mrs. B and I bought our house two years ago we found an old hand-carved cane in the shed. She wanted to toss it. I thought it was cool, in spite of the paint chipping off. So I kept it. Don't you know I was beyond thrilled to find that cane on Monday. So, funny as it looked I found myself a couple hours later hobbling at a snail's pace with this cane into an urgent care clinic a few miles from my house. I figured it would be as fast, maybe faster than a traditional emergency room. Mrs. B walked next to me, though I'm not sure what she would have done if I'd fallen, since I'm nearly twice her weight, I think.

Anyway, after checking in, handing over my insurance card, and a $20 co-pay, I found a seat just a couple of feet from the check-in window, and over the next eight-plus hours I waited for my turn to see a doctor. Clearly, I was wrong in my assumptions about the speed of these places and the definition of "urgent." So while I sat, I people-watched. And I observed and overheard about 40 people check-in during that period. About two dozen of them did not have have insurance. I know this, because the nurse's aide doing the check-in asked each person, like she'd asked me. Then she'd tell those who said no that there was a $70 clinic fee for the uninsured. Interestingly, there were two categories of non-insured. I heard a few answer that they were flat-out poor and could not afford the $70 fee. Most of this category counter-offered with $10 or $20 or whatever they had on them. The nurse's aide gratefully accepted. The other category of uninsured folks chose their words carefully when presented with the $70 fee. BTW, the folks in the second category were pretty much all very well dressed, verrrrry well dressed. As much as I make fun of the looks-obsessed among us, I can tell you that my working knowledge of fashion is good enough to know that these folks were all dressed in things I couldn't afford on average. So when told of the fee the folks in this second category answered cautiously to the effect of "The sign at the door says you have to treat me even if I 'don't' pay, right?" The nurse's aide nodded wearily each time. Category two would then respond to the effect of "Well, um, then no I'm not going to pay anything."

It wasn't necessarily that they couldn't pay. They said they weren't going to.

Suddenly, I had an epiphany about why health insurance costs so much. I'm not mad at the genuinely poor folks who just couldn't pay and had a legitimate urgent medical need. But those folks who by their own indirect admission could pay but wouldn’t are screwing the rest of us who at least try to pay for medical care.

Don’t get me wrong. I believe hospital corporations are almost cruel in what/how they charge for certain types of care and accessories. Hundreds of dollars for minor injections, $1,000-plus per night if you have to be admitted, $30 or $40 for use of an assless hospital gown that you don’t get to keep, and so on and so forth. But what medical facilities charge isn’t all the fault of corporate greed. Hospitals pass some of the costs on to the federal government, which in turn finds a way to stick health insurance companies for some of those costs. And the health insurance companies then raise the rates of the people already paying for their medical care, in order to compensate for folks like those at the urgent care clinic who refused to pay for even a portion of their care.

Oh, and even though it’s gonna make me seem calloused, if I paid for my visit, and you could have but didn’t, and we both arrive at about the same time and have ailments that are similar in seriousness, I’m seeing the doctor first. And I’ll trip you and drop a chair on your head if I have to, to make sure you don’t see him before me. It’s the principle, dammit!

So I finally made it out of the “urgent” care clinic at about 6 p.m. Monday, hopping on a pair of shiny new crutches. Mrs. B was kind enough to carry my cane for me.

Have you ever seen a news report about a person “accidentally” walking through airport security and forgetting that he had a loaded pistol or a Bowie knife in his carry-on? I have, and about 50% of the time I’m skeptical. I think “that dude is a nut job who was planning on taking hostages.” Well, my handy-dandy cane? The one I was so grateful to find on Monday, considering it had been a cast off by my house’s previous owner? It’s a weapon. Seriously, I don’t mean it can be used as a weapon. It is a weapon. As I was lounging and waiting Monday, feeling sorry for myself over my ankle, I started fiddling with the cane. It loosened up near the top, right below the handle. So I gave it a tug, and it came apart. Turns out it’s one of those secret-sword canes. The sword part is rusty. So who knows how old the thing is or if it was ever “used.” But can you imagine how I would have stammered and blustered if there had been a metal detector at the clinic? Not sure I could have explained myself to security. I guess those “I didn’t know it was in my bag, officer” excuses are legit sometimes.

Here's my rusty sword cane. I took a break working from home today to try to figure out how to restore the thing. It'll make for a great conversation starter some day.

Finally, where health is concerned, I’m glad to hear that Nick Bollea, teenage son of legendary wrestler Terry “Hulk Hogan” Bollea, is OK following his jaw-dropping car wreck from a few days ago. I say a prayer for his friend and passenger though, who remains in the hospital in critical condition.

Not sure how to say this delicately, so I won’t: This kid should not be driving. In fact, if he wants to make a career out of something involving forward motion, he should be a mail man. They do lots of walking, and on a good day they walk fast. In the 10 months or so the Bollea family lived in Miami Beach, young Nick decided he wanted to pursue a career as a race car driver. He crashed a car at a race track during a practice/time trial. He was behind the wheel of the family Lamborghini, when it inexplicably burst into flames and burnt to a crisp. And he was pulled over and ticketed at least once for speeding.

OK, I'm done. I'm gonna pop another Motrin and go to sleep. One more thing: Up late, trying to find a comfortable position to sleep in, and watching bad movies I stumbled onto 1990's Dark Man. And I finally figured out what about that film has been bugging me all these years. The bottom half of Liam Neeson's title character's face gets burned off. He has no lips. And yet he still manages to perfectly pronounce "Ms," "Ps," and "Bs." How is that possible?

I know. I'm going to sleep right now.