Health Care Nightmare

I sat across the desk from Marlene and she said, “How about next Wednesday?”  That was fine with me and suddenly I had an appointment to do a sleep study all night in the sleep lab.  They will wire me up head to toe and record how I sleep all night in an effort to stop my snoring.  The older I get, apparently the worse my snoring gets, and the solution is something called CPAP which is positive pressure air treatment that is delivered with a mask while you are sleeping.  But before they prescribe that for you, they need to do a sleep study.  Sounds like a real adventure!

I looked at Marlene and she said, “Uh Oh, there seems to be a problem with your insurance…..”  Oh boy, now what? 

It seems that Blue Cross Blue Shield had decided to raise my rates by 100% because I was now 61, and even though there was no change in my health status, I was now one year older than last year and therefore my premium went from $1400/month to $2800/month for the family!  The only way I could keep the same premium as last year was to change the policy from a co-pay policy to a deductible policy where I suddenly was responsible for the first $6000 of expense.

So where I would have originally  paid a $50 co-pay for the sleep study, I was now forced to pay for the whole procedure.  I innocently asked, “How much will this cost me?”  (Are you ready?………)

“The study costs $2400 but the doctor has a negotiated rate with the insurance company for $850, and by the way, after you  have the first study, we prescribe the CPAP and then you have to do a second study, but that only costs $750,” she cooed! 

I looked at her in silence for a moment and since anger at her was pointless, I simply said, “My God, they’re screwing me!”

Marlene suddenly became my confidant and whispered, “This is nothing, you won’t believe what's happening to me!”.  She proceeded to tell me her story which is classic and horrifying at the same time.   Marlene is in her early 70s and her husband is in the later stages of dementia.  She managed to get him accepted for coverage by Medicaid for full time care, and she had only a few days to get him into a ‘rehab’ center now that he was accepted, since she still has to work.  The rehab center costs $330/day which fortunately the Medicaid covers, but she is having a real problem now.  Apparently her husband who has been in the rehab center for 7 days is having a medical problem, and the staff there is warning her that his condition might require them to admit him to the hospital.   Unfortunately, in order for Marlene to keep the space for her husband that is being covered by Medicaid, she is going to have to pay the rehab center $330 a day in cash to ‘hold’ his place there as long as he is in the hospital!  Medicaid will not cover any absentee time from the center and she can't hold the space without paying!


Think about that for a second.  Here is a 72 year old woman working at a doctor’s office as a receptionist/secretary.  How much do you think she earns in salary?……$24000/year??  With her and her husband's Social Security, how much does she have to live on after taxes?…..Maybe $4500 a month?  If she has to pay $330/day for 10 days while he is in the hospital, that is $3300 just to hold a room for him so Medicaid will cover him when he returns!!  What a bargain, huh?!  She started to tear up and said she didn’t know what she was going to do……

These are just two rather benign anecdotal incidents of inequities in the health care system that penalize us all.  Multiply these two stories by millions, and you get some sense of the size of the problem we face as a country with medical care, rising costs, unfair practices, insensitive insurance companies, and unsympathetic politicians.  What about the 40 million people who are uninsured, or the millions who are deathly ill and fighting just to receive the benefits they have been paying for, but being rejected by insurance companies who only are gaming us all to make as much money as possible.  Why are all those feckless legislators in Congress standing in the way of reform when there are so many citizens being literally beaten and abused to death by a system that has evolved into perhaps the most amoral health care system in the developed world?

Oh, by the way, I just got a letter from Blue Cross Blue Shield today that told me they were also not going to cover my daughter for any ADHD medication for the new policy because her taking of the meds since she was in 5th grade was for a ‘pre-existing condition’.  And for this they raised my rates???

The only way to put a face on this crisis is to seek out the stories one by one.  Only then do you get a sense of how desperately reform is needed.



PS: Enough Already

I did get an answer to my letter to the station manager concerning his loudmouthed talk show host.  He told me that "balance" would not be good for his station because his audience has come to expect a certain point of view when they tune in. He drew an analogy between a music format station that would be unsuccessful  playing a mix of classical, country and pop and his talk radio station that should not be a place for anything progressive or liberal mixed with the station's conservative viewpoints.  

He also reminded me that talk show hosts have first amendment rights as well, and isn't it grand that we can express our views without recriminations here in the USA.  He missed the point that character assassination doesn't really happen with music formats, but why am I not surprised that someone sanctioning that kind of broadcasting would try to equate the two.  I guess folks like that will try to rationalize any argument to support their own warped sense of fairness and civility.  He did, however, acknowledge that after he listened to a recording of the talk show host's language and behavior, he agreed that it was inappropriate and that the management did speak to her about it......and I am sure they had a good laugh!