Gold-Plated Health Care

Recently I was diagnosed as having sciatica, a.k.a. a “slipped disc” in the spine, a common ailment that (they tell me) ought to be fixable. The orthopedic guy who diagnosed me prescribed physical therapy, three times a week for a month. Yesterday I got a letter from Empire Blue Cross saying they were overruling the doctor. I need only two weeks of physical therapy, they said.

I’ve had one week of therapy already, and I am doubtful just one more week is going to fix me, but I guess I can continue to do most of the exercises by myself. As medical aggravations go, this is hardly a tragedy. But this is the way life is for most of us. If you aren’t wealthy, the medical treatment you receive is what your insurance provider, not your doctor, decides you should have.

And that’s if you are lucky enough to have insurance. At least I could go to a doctor and get a diagnosis, and now I have some idea of what I need to do to take care of myself.

One of the most persistent myths on the Right is that health care is too expensive because we are indulging ourselves with too much of it. The persistently stupid Jeff Jacoby writes in today’s Boston Globe,

With health benefits tax-free if they were employer-supplied, tens of millions of Americans were soon signing up for medical insurance through work. As tax rates rose, so did the incentive to keep expanding health benefits. No longer was medical insurance reserved for major expenditures like surgery or hospitalization. Americans who would never think of using auto insurance to cover tune-ups and oil changes grew accustomed to having their medical insurer pay for yearly physicals, prescriptions, and other routine expenses.

We thus ended up with a healthcare system in which the vast majority of bills are covered by a third party. With someone else picking up the tab, Americans got used to consuming medical care without regard to price or value. After all, if it was covered by insurance, why not go to the emergency room for a simple sore throat? Why not get the name-brand drug instead of a generic?

I think righties must be blessed with unusually good health, since clearly they’ve never had to deal with health insurance.

First off, although it may be different in Massachusetts, many years ago insurance companies stopped paying for emergency room visits if they decide after the diagnosis that the medical problem wasn’t an emergency. Although exactly why anyone with insurance would choose to an emergency room for a non-emergency eludes me.

But what happens if you think it’s really an emergency? Is the sudden chest pain a heart attack, or heartburn? If you pick A and go to the emergency room, it turns out to be B, you just ran up a several thousand dollar medical bill that the insurer won’t pay. If you pick B and it turns out to be A, you could die. Coin flip?

Same thing with generic versus name-brand drugs. Most insurers simply will not pay for the name brand if a generic is available. The consumer has no choice.

Also, in New York a “routine” office visit is somewhere in the $100-200 range, and even “generic” prescriptions can cost over $100 a month. Lots of people on limited and fixed incomes will not spend that kind of money just because. They’ll wait until they are really sick. But a lack of preventive care is one of the factors driving up health care costs.

When patients think someone else is paying most of their healthcare costs, they feel little pressure to learn what those costs actually are – and providers feel little pressure to compete on price.

Jacoby has no clue how the system works. Health providers aren’t pressured by consumers to compete on price. They are pressured by the insurance companies to compete on price. Then insurance companies compete with each other to provide the lowest costs to employers. So the company that puts together a network of cheap doctors can offer a better price to the employer, but in my experience the employer doesn’t give a bleep whether the doctors know a spine from a sock. Quality is optional.

De-linking medical insurance from employment is the key to reforming healthcare in the United States. McCain proposes to accomplish that by taking the tax deduction away from employers and giving it to employees. With a $5,000 refundable healthcare tax credit, Americans would have a strong inducement to buy their own, more affordable, insurance, rather than relying on their employer’s plan.

Unfortunately, since the actual cost of a year’s worth of health insurance is a hell of a lot more than $5,000, only very well-paid employees will be able to use the credit. And, of course, if you have a pre-existing condition, in most states you can kiss off buying insurance at any price.

BTW, after the elections I may be asking for donations so I can pay for accupuncture. I figure it’s worth a try. I’d like to be able to take walks again.

Update: Jacoby’s email address (published in the Boston Globe) is [email protected]

35 thoughts on “Gold-Plated Health Care

  1. I’m reminded that when the Brits went to their single payer health care plan – I think it was called National something or other – hordes of people showed up at clinics, hospitals and doctor’s offices for everything from sniffles to a flea bite. It took a while, but eventually people got bored with the whole thing, relaxed into normalcy and the numbers of ‘illnesses’ dropped accordingly.

    I have read that if people were presented with medical bills rather than insurance companies presented with them, we’d have in this country what Europeans have had for years – universal health care.

  2. If I could find a yoga instructor who knows something about anatomy I’d try it. some of these poses look like they’d make me worse.

  3. Anybody catch Fareed Zakaria on CNN today?

    Fareed Zakaria endorsed Obama at the end of his Sunday international news discussion show. I was surprised! I didn’t think Television news celebrities did that. I certainly wouldn’t expect Wolf Blitzer to openly endorse anyone.

    Maybe I’m wrong.
    Under The LobsterScope

  4. Jacoby’s also conveniently overlooking the fact that solo policies cost a hell of a lot more than group plans you get from your employer–even if you factor in the amount the employer chips in. And pre-existing conditions generally don’t apply to employer-provided plans. Insurance always costs less when you spread the cost across a larger number of people, which is why a single-payer system is the least expensive plan of all–unless you’re the insurance industry, but after decades of profiting from others’ illnesses, I’m really not too worried for them. Nor do I have much sympathy.

  5. I am pleased with the care I get from Medicare through Kaiser in Northern California.
    I think the country would benefit from expanding Medicare coverage to all.

  6. Maha,

    Your post on the health care system is interesting and I could respond to it by giving my take on how things are in Canada (I`m generally EXTREMELY satisfied), but I need to respond to your back issues since I have lived half my life with disc problems.

    Maha, get your aching body over to the computer and type in http://www.iayt.org It’s the “International Association of Yoga Therapists” website. The site has a function enabling you to find one of their members in your area.

    After my 3rd ruptured disc, a friend and colleague of mine recommended I go to her yoga teacher, who was also a yoga therapist. After two years of working with her once a week, 11 months a year (I’m usually on vacation for about a month), and several sessions per week practising on my own, I feel that yoga therapy has been a god-send for me.

    You are right in seeking out someone who knows about anatomy and physiology. That’s why you need a yoga therapist, as opposed to an ordinary yoga teacher.

    Please tell us if you find someone in your area through the website. I highly recommend yoga therapy. I have also gone for acupuncture, but I think yoga therapy is more of a long-term solution when it comes to back issues.

    Best of luck. Get well soon!

  7. Jacoby probably never has had to go through denial of coverage, and he probably has excellent coverage through the Globe. There are many of us who could not obtain private coverage at any price because we have preexisting conditions, no private insurer would touch us. Some of us are fortunate to get group health coverage through work, but it is dependent upon our continued employment, and COBRA coverage is damned well unaffordable. Jacoby doesn’t even ask the most obvious question-where are individual policy holders going to find a policy that is even affordable in this age of rising costs?

    Even professed conservatives have had their bad experiences with insurance coverage. The late Catherine Seipp, a writer with National Review, wrote about her experiences in trying to get her insurance carrier to cover a prescription for her lung cancer, which her insurer declined to cover. Catherine Seipp eventually died of lung cancer.

  8. Yesterday I got a letter from Empire Blue Cross saying they were overruling the doctor,

    That didn’t happen. I have it on good authority (every rightwing gasbag and GOP candidate, including John McCain in the last debate — and he wouldn’t lie, would he) that only when you have government-paid healthcare do you have bureaucrats determining your healthcare. With insurance companies this doesn’t happen, so it could not have happened to you. Who’re you going to believe?…

  9. Maha: I have mentioned here before that I am an acupuncturist and I have treated many people with sciatica with a success rate of at least 95%. Yes, it does cost money but you will be better in no time. I don’t have a clue what it costs it New York but sometimes insurance will pay for it. At least here on the west coast that is the case. Hope you give it a try.

  10. Reagan broke all the promises of the New Deal. Employer paid pensions and now employer paid health care really are obsolete concepts.

    Letting the insurance co.s sop it all up in the individual market is the worst possible solution. But we all knew that.

    I’ve always been in favor of expanding Medicare by taking 10 years off from both ends every few years. (Pre-Bush Medicare, of course.)

  11. Ah, that $5,000 figure from McCain is for couples/families. A single person would get $2,500.

  12. Canadian Reader — thank you for the recommendation. I did find a couple of yoga therapists nearby. Right now I can’t afford them, either, but I’ll keep it in mind for the future.

    Donations, folks? I don’t ask for much.

  13. Actually, using the emergency room for technically-non-emergency reasons was somewhat common in California when Kaiser when to the “personal doctor” policy. It was supposed to give every patient their own doctor, who could keep an eye on your file. What it meant was you couldn’t get an appointment for non-emergency services. I had been puking for a few days and called to schedule an appointment to be looked at (maybe food poisoning, maybe touch of the flu, wasn’t sure). They said the nearest appointment was two months later. Crap, I’d either be cured or dead. So I was forced to go to the emergency room to get looked at.

    I live in an area that’s largely rural, and borderline conservative. A good number of people out here don’t have insurance, and the injuries I see coming into my school are frightful. I’ve see students with broken toes and fingers, some of them swollen and purple, that have been taped together with masking tape. The child with the swollen and purple finger had a popsicle stick-and-masking-tape splint applied so the broken finger would heal straight. One of my students had an eye infection for five days: his eye was nearly swollen shut.

    I think that’s why I got so mad when the SCHIP bill got vetoed. I know those kids are hurting and I can’t even give them aspirin. Even if we can’t get Americans to agree to provide healthcare for everyone, how could anyone agree to deny health care to a child? You might as well stomp on puppies: it’s just as heartless.

  14. A friend of mine was just diagnosed with MS. One of her first–and biggest–concerns was whether or not her insurance would cover the treatment/medication she needs. I find it appalling that such a question ever should be asked in America, this country that prides itself on its wealth and power. What has happened to our priorities as a nation? Not only do we need to elect Obama, we need to put pressure on our representatives in Congress to make sure that health care changes happen, and happen soon.

  15. My mother likewise had her physical therapy cut short before she was fully healed. I would bet that all the righties who make such stupid claims about health care are young, and don’t need it. They simply cannot see beyond the end of their own noses. It will be fun to see how their tune changes when they experience the travails of old age.

    And I wish Obama – rather than voicing the other objections to McCain’s plan – nuances really – had focused on how limited McCain’s $5000 credit really is, and what it would mean. I think health care should be uncoupled from employment – there are tons of us who are self-employed, and a lot of people seek/stay in jobs they hate for the medical benefit – but it needs to be done right, such as a single payer system run by the government.

    I often send out this link to Sara Robinson’s article on the Canadian system, as experienced by someone who grew up in California, and is able to compare the two systems. Especially interesting is the Canadian attitude toward taking care of yourself as a duty you have to the rest of the country. I suspect if America ever moves to a system like Canada’s, we would eventually adopt the same attitude, growing through or bypassing the selfish,fear-based objections raised by righties.

    Finally, I have some yoga videos from this woman who greatly benefited from a gifted IAYT teacher after a car accident left her with years of pain in her neck and upper back. She’s now a yoga teacher. I hope you can get some permanent relief from your sciatica.

  16. Hey Barbara,
    I ruptured a disc in my neck about 14 years ago while at work, loading up some equipment..
    I was a commercial diver at that time, and the time I felt best was when I was in the water, zero gravity or close to it. If you can, get into a pool and do some simple but gentle aqua exercises.
    BTW, I’ll be happy to throw you a couple of bucks in a couple of weeks when I get paid for this special assignment I’m on.
    It’s the least I can do for about 4 years of Mahatainment!
    ‘Hope you’re feeling better, dear lady….

  17. Mrs. W — I’ve known people with insurance who went to emergency rooms and had their claims rejected because the insurance company decided their problem wasn’t an emergency. And that can be very costly.

    Last year I tripped and fell on a sidewalk and injured my knees. Very painful. I was practically across the street from a hospital emergency room but didn’t dare go into it, because I didn’t know if the hospital was in my network, and even if it was I didn’t have pre-approval! I was more afraid of getting stuck with a bill than of what might be wrong with my knees.

    So I hobbled to my car, drove home, and saw my doctor the next day. By then one knee was the size of a volleyball and dark purple. But it was all soft tissue injury, so I’m still certain I would have been stuck with the bill.

    This is insane.

  18. BTW, on a more serious note than my previous comment, get some ideas about exercises you can do — stretches and such — on your own after your therapy ends. My late wife had a bad back — previously broken — which was always a problem, twice laying her up in traction for a couple days, until she was in The Netherlands and had it flare up again. There the physical therapist they sent out (they went to her, not her to them!) taught her a series of stretches which she did regularly after that. Never had another problem with it in 20 plus years.

  19. When I had a separated placenta my son was born dead. They jump started him and then a couple of months later said he had cerebral palsy (brain damage to the motor skill area of the brain that may or may not involve mental retardation). Off to therapy we went. We went 6 weeks and then the insurance co. said that’s all they pay. We had people appeal to the insurance company and they started up again. A couple years later there was a job change and for the cobra policy to cover previously existing condition (therapy) we had to pay $1,000. a month ($700. for the cobra and $300. for the new policy). After the cobra time was up, the company supplying the insurance changed providers and there was another fight. This time the union stepped in (thank goodness).
    That is just one small battle. Just think of all of the people who were told their houses were washed away, not blown away by Katrina.

    Everyone also needs to check their life insurance policies. My sister has terminal cancer. She has paid into a life insurance policy for 18 years. Now that she is very sick she read the policy and it says the day she retires or the day she leaves the company with disability, the large policy she has been paying on is reduced to $10,000. She doesn’t even know if she can be buried with that much. She said by reading the policy, she did find out that she can apply for half of the money before she stops working if she has a doctor fill out the papers saying she has less than 6 months to live. The only reason I can think of no one EVER mentioning this to anyone is that people with money will have lawyers keeping up on that and the poorer person trying to do it themselves will just think it is all straight since they have been paying so long. Her hr department said it was illegal for them to mention it.

    I can understand why insurance companies might be nervous about a national health care plan, and they can rest assured that they are bringing it on themselves.

  20. It’s clear that people who write articles like that have never actually dealt with medical billing offices. They cling to the idea that medical services have actual “prices” that I, a consumer, could determine. They obviously haven’t seen the blank look on the face behind the counter when asked what a procedure, or an appointment costs. These days, the “price” of anything is an abstract concept, representing one of an assortment of numbers negotiated separately for each insurance provider, modified by some other percentage agreed to, and further modified by a fraction representing what portion of unpaid bills needs to be offset. It is literally impossible to “shop around”.

    Not that “shopping around” is really what we should expect of someone coping with a diagnosis of cancer, a heart attack, or even a traumatic injury.

    Health care and free-market economics are a ridiculous pairing.

  21. Actually, between doctors and insurance companies there is quite the complicated dance. Doctors either charge more to the insurance company because they know the payment will get reduced to what the company will actually pay or they agree on some set fee schedule for most things and go with that. But both my wife and I have had to pay out of pocket for medical procedures and the difference is astounding.

    Doctor shopping allows you to pick the best qualified doctor and we found that most doctors will severely discount their prices for people who self-pay because they know they will get paid, and much sooner than from an insurance company without all the crappy paperwork. I just had my semi-annual skin check (at my age and location it is a necessity) and I pay cash to a very good dermatologist who charges me just over $100 a visit, even if he has to do a minor procedure, which he did this time. Otherwise it would cost at least twice that.

    This is pretty common.

    We don’t need health insurance in this country, we need health care and health insurance is not health care. Health insurance ought to be supplementary to health care to cover things that truly are ought of the range of normal procedures for a problem or purely elective for reasons other than health.

    Good luck with your back.

  22. Ow! I have sciatica and it hurts. Horribly. When I was pregnant it got so bad I could only sit on a yoga ball.. so that is what I would recommend instead of a desk chair.
    And really! Stop indulging yourself with all this medical treatment nonsense. [/sarcasm]

  23. I am always appalled when I read about the hoops of fire that you have to jump through in the States to get proper health care.

    A significant percentage of the American public must be suffering from extreme brainwashing to be able to refuse universal health care (go see our “friends” over at Moms4SarahPalin for an example of this).

  24. Jacoby wrote, “After all, if it was covered by insurance, why not go to the emergency room for a simple sore throat?”

    I recall an article some weeks ago where one of the McCain advisers said that there WAS no health insurance problem in the US, because anybody could go to the emergency room “for free” (as we know, paid for by an increase in costs to those who can pay). Ergo, problem solved. I guess Jacoby didn’t see that piece.

  25. Not that I wanna add to your worries Maha…

    But the Hillbilly’s downward spiral began with a diagnosis of “Sciatica”…She went through the PT, did the exercises, took the drugs, etc…All to no avail…

    When, after several months in agony, they told her she needed surgery on her herniated disc, she quickly went for it…

    The surgery seemed to work, but she developed breathing problems which she assumed had to do with her allergies…Turned out it was pacreatic cancer that was causing her troubles and, by the time that was diagnosed, it was too late to do anything but watch her die…Almost exactly a year after the surgery on her back…

    IMO, surgery after the age of menopause, should only be considered as a last resort…Male or female…I think it was her surgery that triggereds the growth on her pancreas…

  26. That’s so sad, D.R.

    Fortunately I’m not in extreme pain, so even if I don’t get any better than I am now I wouldn’t get surgery. I’m mostly sad that I had to stop exercise walking and hope I can get back to it in a few weeks. Not exercising definitely is not good for me.

  27. #26 Dave, wasn’t it a few weeks ago that the repugs said the way to reduce the number of uninsured was to re-label them as otherwise covered or some junk like that because they could just go to the emergency room?

  28. I recommend Pain Free by Pete Egoscue. The exercises are indexed to conditions. At worst, you’ll be the same, at best, the exercises will resolve the condition. It is a great book for self-treatment. I have self-treated a ruptured disc with these treatments and resolved the condition. [I am a massage therapist and yoga instructor as well] The Egoscue Method is very self-explanatory and the pictures and instructions for the exercises are clear. They charge a fortune for one-on-one , but you will not harm yourself by following the book.

  29. Opposition to universal health care in the states I think has always primarily about not wanting to turn the USA into a “socialist state”. This is the meme but I believe the true reason is to ensure that big corporations can continue to rape the public purse. Benefits for citizens bad. Benefits for big insurance companies good. It’s funny how it’s socialism when the government collects taxes to provide health care for it’s citizens including the poor and middle class but trillion dollar bailouts for the wall street is AOK. In this regard (and many others lately) I think that the USA has truly jumped the shark. The Canadian health care system has been demonized in the states for years for providing universal coverage to it’s citizens. This is a typical right wing tactic. Demonize your opponent as extremist in order to maintain the stats quo so that all of the benefits continue to flow to insurance companies who in turn reward the political class with big campaign donations. While our system is not perfect and can be improved further I am extremely happy with the health care that I receive and don’t mind been called a socialist even if I’m not. By the way you may have noticed that our country is also battling a right wing government of our own (actually a wolf in sheep’s clothing) who would just love to kill our system and “introduce best practices” from the states. Harper times his election gambit to be over before the US election. Canadians rewarded this moron with another albeit stronger minority government. It just goes to show that there are many Canadians that are concerned that we could loose what we have and so have opted to keep a short leash on these extremists until our opposition parties gets their act together.

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  31. Ms. Anne Thrope — I used to be a believer in “conventional western medicine or nothing” as you are, but I’ve learned a few things. Open your mind.

    Believe me, I go to regular doctors and get conventional treatments first. I am in conventional physical therapy, notice, and will stick with that as long as the insurance pays for it. But even the medical establishment is beginning (reluctantly) to suggest that maybe acupuncture and other alternative therapies can help in situations in which conventional treatments aren’t all that effective. Just because we don’t understand how something works doesn’t mean it doesn’t work.

  32. “waste the money on acupuncture”?! just because it didn’t work for her. geez. acupuncture for my piriformis syndrome has been and continues to be the best money i’ve ever spent. sciatica is a pretty broad catch-all ‘diagnosis.’ until you have an idea of what’s causing it, treatment is guesswork. will you be able to get an mri to rule out a herniated disk? i’ll just concur with a couple of the above commenters, it is pretty common, usually musculoskeletal and therefore easily treated with acupuncture, chiro, and stretching. i’m a massage therapist and i get several clients a week coming in and telling me they have sciatica, or else describing the symptoms, and it’s usually tight muscles. I still tell them “if this doesn’t work, get yourself to an acupuncturist.” i know it’s expensive, but what’s the value of being able to walk? mine started when i was 23 and i’m 32 now. after 11 years, i’ve accepted that i may have to cope with this the rest of my life. i’ve never had a defeatist attitude towards my condition, rather: i’m too young to be this debilitated. i should clarify. it’s not all the time. a couple -to several times per year, depending on stress levels / self-care / exercise – different things will trigger flare ups. flare up could last one day (if i go straight to the acu. one treatment. all gone. !! ) to weee-eeks if i don’t.
    in the 13 years since i’ve been off my parents insurance, there was one year i had kaiser through my job. i scheduled an appt hoping to get a referral to a specialist D.O. so that i could get some answers from western medicine as to the nature of my agony. not to mention shifting the financial burden from out of my pocket to the insurance i was paying into. no-go. they told me “if chiro works for you, you should just keep doing that.” (and paying for it myself).
    i’m curious as to what your physical therapy entails? more exercises than stretches i gather? some massage i hope? while you still have sessions left, ask your therapist, who has extensive knowledge of anatomy (hopefully) for specific feedback on some yoga poses. i’m not a yoga instructor, i just practice myself, but i do have a detailed understanding of anatomy and i can personally recommend some to you. also, don’t give up on walking. even though it hurts, you must keep moving. sitting only makes it worse.

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