Real Healthcare NOW!

Hello dear reader(s)!

I hate health insurance companies.  So do my doctors.  So do most of the staff I have dealt with, even though I know that without the for-profit middle-men of the insurance companies interfering in health care, many of that staff would not be employed.

The simple fact of the matter, is that health insurance companies make everyone’s health care more expensive, and less effective.

Here is an example, from this morning.

I have a Medicare Advantage plan.   It usually picks up the other 20% Medicare won’t pay, (minus co-pays, deductibles, etc…) and also sets up yearly out-of-pocket maximums which makes it worth it.  It also has a decent drug plan.  However, that means you are subject to networks, and in my case (because it is HMO style), referrals.

So today, I went to an appointment with a PCP (Primary Care Physician, not the drug), in order to…wait for it…get referrals.

You see, for me, with my history, every damn thing I need requires specialists.  A Primary Care Physician simply can’t grasp all of the different pieces of the puzzle that is me.  There are a lot of people like me.

Yet insurance companies work off of what is good for the average patient they are fleecing and know that most people don’t usually need specialists and that they can save more money just be being seen by Primary Care Doctors.

But not me.  And not a lot of other people.  My Primary Care Doctor really has no business being involved in my care.  Yet here I am, taking up an appointment slot, causing a doctor to get paid asking me questions on why I need the specialists I seek when I know damn-well why and could call them myself for the appointments if my insurance would pay.

It is always a fight too.  Despite being part of the same health group of my most recent hospitalization, the initial hospitalization of my first chemotherapy post-diagnosis, and some follow-up care and other hospitalizations, they still have to waste time asking me questions to justify the need.  They finally pull up a bit of records and then they agree, knowing that they have neither the time nor the expertise to treat me.  They bill my insurance company who spreads the costs out in terms of premiums and my insurance company receives money from Medicare.  It was a completely unnecessary visit, but people must get paid.

In addition, my Primary Care Physician always seems to believe they will uncover some truth the specialists will miss or are unrelated to my vast history and will order labs.  (As if the specialists won’t duplicate the same tests when under their care.)  Now I have to go do labs that will then be billed to my insurance company and the government, increasing costs.

The labs will come out abnormal (because it’s me) and the people at the office of the Primary Care Physician will not understand that is my normal and that only a specialist can really properly interpret the numbers.  They will panic and either have me go the ER or come back in for another appointment rather than give me the numbers over the phone or just send them on to the multiple specialists I am already being referred to.  Everyone will get paid.


It’s fucking bullshit.

These fucking death profiteers need to get their grubby-ass hands out of the game altogether.  They are not legitimately insurance, as insurance indemnifies against loss and they just profit while sticking their nose in your treatment.  Their profit margins are so high, as is their overhead, that costs are ridiculous.

Additionally, every hospital and provider group need to hire additional staff in order to deal with these scum which makes the costs of everyone’s healthcare increase.

Then the GOP turns around and blames the sick for everyone’s high costs, not even mentioning the obscene profits of those with their dirty fingers in the pie.  Real insurance, would be able to cover everyone, with lower costs.  Insurance is a pool, everyone pays into.  The money is available for those who need, on the likely scenario that people paying in will not all need it, but it is there just in case.  When people dip into that pool for insane profits and lavish lifestyles, it makes it seem as though that pool is not big enough even though without the unchecked greed and extra costs, it absolutely would be.

Canada does healthcare great.  Is it perfect?  Nothing is.  But the biggest complaints I hear about Canadian healthcare is the wait for elective procedures.   Our wait is growing here too, and we aren’t covering everyone.

Add to that George W. Bush’s gift to big pharma that Medicare won’t even negotiate for drug prices as a block, and it is no wonder people (not just the poor) are losing everything when a health issue arises.

Despite popular belief, a lot of the catastrophic health issues that arise have nothing to do with lifestyle.


My Medicare Advantage plan is better than Medicare alone.  Am I glad I have it?  No.  Because in most places I wouldn’t need it.  It costs money for the premiums and my income is already severely limited.

A lot of people do not like the politicians in this country.  I am one of them.  Just because vast amounts of money are thrown at someone, doesn’t mean they need to take it and let it influence them.  But a lot of people seem to miss that there are people behind the politicians trying and succeeding at buying their influence.  They claim healthcare is so expensive but throw vast sums of money at people who are supposed to represent you in order to influence policy in a way that brings them the highest possible profits.


We need single-payer healthcare.  Genuine healthcare that isn’t tied to a company’s stock price.  Until we have it, do not expect anything to get better.


If the people ever rise up, I would hope they remember that it is not just the government who is the threat.

 

 

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Author: Josh Wrenn

Cancer survivor, wanna-be artist, musician, author, and all around good guy.

9 thoughts on “Real Healthcare NOW!”

  1. I remember having such problems with pre-authorozation and referrals for everything when I was fortunate (or greedy) enough to have children. My human also seemed to have health problems he did not choose. (I chose pregnancy). Today’s Dr visit needed no referral which made the woman behind the counter happy. It made me happy too. I don’t miss the cruddy insurance.
    The doctor ordered bloodwork, I just had bloodwork two weeks ago and I am going to see if it’s the same because I don’t think my blood has changed.
    Good luck to you.

    Liked by 1 person

  2. Hey welcome back Josh, glad to see ur on top of the medical game. Hope it doesn’t get too bad under Trumpcare.
    I gotta look into single- payer healthcare, not familiar with this coverage. Best wishes and continued health!

    Liked by 1 person

      1. As long as you have a Republican in the White House, regrettably Universal single-payer health care coverage will never see the light of day. The rich will never stand for higher taxes on capital gains and dividends. Under Trump, tax breaks for the rich, corporate welfare, and tax deductions will only INCREASE!

        Of course Bernie’s plan would work, and work beautifully like other socialized countries in Europe, but only if corporate America and the rich 1% agree to make these concessions. In other words, we are asking wealthy ppl to subsidize the poor by agreeing to take home less after tax pay.

        Honestly, I don’t see this happening under either party b/c that’s capitalism. It would take a socialist like Bernie Sanders to pull it off, and Congress would have to sign off on it. Chances of that happening would be zero.

        Sadly, the Republicans will half-ass their plan through, Dems would rant and rave bloody murder but ultimately concede. Business as usual in ‘Murica, reality bites, so yeah, I am worried for you. Take care Josh.

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  3. As always, there are two sides to every coin, and, by no means, do I want you to think I am defending health insurance. I speak from both the medical and entitled patient side.
    For the past three years, I have been privy to a population of people I only heard about in stories. I worked in a community health center where the majority of the patient sentiment is, “because I can”. They have treatments done, take medications, see specialists, have surgeries….without batting an eye because it’s covered by insurance.
    There is a huge portion of the American population that would go see a specialist, any specialist, “because I can”. “My back has been bothering me lately. I’m going to see that neurosurgeon I see in all the papers.” “My chest is congested and I’m coughing. I’m going to see a pulmonologist.” The process of having to see your PCP to get a referral for a specialist actually dissuades many people from continuing to seek treatment for their medical issue and saves insurance companies money. “I have to see my doctor before I can go to see the neurosurgeon? Forget it. My back probably hurts because I was helping my friend move out of his apartment. I’m sure it will feel better tomorrow.” You are the patient exception to the referral rule. Someone I would also think should be able to bypass having to see their PCP to get a referral. Until they have a way of determining which patient is which, they will continue to make you go through the rigor moral.

    May I also shed some light on why you are asked the same questions about the same medical issue by members of the same health group? Every time you see a medical professional, they are responsible to do their own, independent assessment. There are a couple of reasons why. First, your symptoms may have worsened or gotten better since you were last evaluated. Two, your doctor can’t just copy and paste what another doctor wrote or assessed. It would be the equivalent of cheating on a test, but, when you are caught, you are fired. Third, the provider would not be reimbursed by insurance for their time with you if they didn’t do a full assessment which means asking all the same questions, like:
    When did the symptoms begin?
    What medications are you on?
    Do you have any allergies?
    Who is your PCP?
    Finally, there is never enough time to fully review a patient record from another provider beforehand. They usually read your history (if they read it at all) while asking you the same questions then quickly realize (hopefully) that everything they need to know is right in front of them.
    Your frustration in your writing is tangible. I hope my comment helps to shed a little light on the nonsense that is our healthcare system there by reducing some of that angst you feel. I

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      1. So, instead of having to go to your PCP to get a referral to see a specialist, you would call your insurance company? You tell the insurance rep that you need to see an oncologist then they review your claims to see that you had chemotherapy in the past and approve your request based on that?

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      2. Actually, I shouldn’t need to call. They should already have the records that indicate that specialists need to handle my care. They do have claims history.

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