Maybe I have a unique perspective on health care compared with some. Maybe not. My wife and I started with an early version of what we have today: in the 70s, the version we have now being; “health care is nothing more than a business.” Now if you count Blue Cross in the 60s: earlier. But I can’t say much bad about that version of health care. I really didn’t have to deal with it since it was part of my father’s work benefits, and the one time I had a claim they paid in full: as far as I know, no questions asked.
I was a kid. Kids usually don’t pay much attention to such things. But I do remember health care was pretty accessible for even the poor back then. I remember doctors making house calls. I remember it all being about care: not money first.
I would remember otherwise. Carmans rarely qualify as “rich,” and we have many poor in the family. I was privy to many bitch sessions about the “way things were…” “Bitch sessions?” Um, “adult” conversations. Sorry.
Believe me, I would have remembered all the moaning and kvetching, which they did about each other, kids these days, pollution, hippies… I even remember them bitching about roast beef being a “horrible” 17 cents a pound. Not a word about health care. If you got sick, or needed preventative care: you got it… even my dirt poor relatives.
Something has changed. And that “something” is the fact that we decided to let for profit corporations: insurance companies, many who wouldn’t know tetracycline from Viagra, decide who gets it, who doesn’t, according to their rather fat bottom lines.
In the late 70s my wife was working at Opryland in Nashville, and we had our first experience with what some dare to call HMOs/health care. I know people bitch about what they call, “Obamacare,” but frankly I don’t think it goes far enough, and certainly would be a damn sight better than fascistic Neo Con care system we have now. As it stands I doubt Obamacare can be much worse than what we have now; especially since it gives some exclusivity to the same companies that already rip us off; exclusivity in exchange for having to cover those they’d normally turn away.
To listen to the teabaggers they think it obscene we don’t have more dying needlessly because they don’t have enough money, or it would be better if all the poor went to emergency rooms at our expense when they have no other options. But no one ever accused such folks of having a heart. The Tinman had nothing on these callous “I’ve got mine so screw you” creeps.
I don’t like that exclusivity, but at least it gives coverage to those who can’t afford our current form of Fascistic-care. Feed the corporate coffers or die, care. But if you listen to all the screamers it’s so unfair that corporations that rake in billions now might have to sacrifice a bit so all get their inferior product. I guess teabaggers answer to health care for their poorer neighbors is a less than Jesus-ly “love them,” but, “Go ahead and die already.”
I’m amazed they haven’t demanded Dickens be burned. To them Scrooge must be a fictional saint.
The first health care organization my wife and I were a part of was Prucare. They had their own hospitals, their own doctors: everything. Run by Prudential. I guess they thought they knew health care better than the professionals and could buy them off to do it in a more profitable way: the wrong way for everyone else. They quickly proved that insurance companies may know a lot about insurance, and the bottom line, but when it comes to saving your ass they know worse than Sargent Schultz, which would be, “Nothing! I know nothing!”
I won’t bore you with all the stories I have of pathetic to nightmarish run ins with Prucare, except one, because Prucare proved just how the insurance companies would do it if they ran everything.
Since Prucare had their own everything, when you went to Prucare you saw a different doctor every time because they shifted doctors so much: looking for those who would work the cheapest, I suppose. And if you actually saw the same doctor twice they might realize there might be something more serious going on here and order up more expensive treatment and tests that damn well might save your life.
Uh, uh. Can’t have that, now can we?
Not only might they miss the pattern to your visits, you might fall asleep, like me once, in their examination room due to a high temp. Wake up three hours later after being led there: no one came in. They forgot you. This was what amounted to their emergency room? And when you gently remind them you’re there, telling them you fell asleep… they’ll yell at you for not telling them sooner.
I was asleep, fools.
Here’s the main story that shows just how bad the system would be if the insurance folks who hassle our nurses, doctors and specialists still ran everything…
I had a urinary infection. They gave me an antibiotic I was allergic to. No one knew that at the time. No one’s fault… at first. I wound up back at Prucare with 106 temp instead of the 103. For two weeks, every day, I came in almost every day because my temp was bouncing all over the place: 104, 106, 100, a low of 95.6 which sometimes qualifies as almost normal for me… then quickly up to 107, briefly. Finally the head of the hospital was passing through the examination room on about my 8th visit in two weeks and said, “Doctor, have you noticed your patient is have a reaction to the medication he was put on?”
We switched meds, temp started to drop and so did I; passing out on my way out of Prucare. They knew it. They seemed to have no interest in finding out why, and after many more visits on my part to find out why I passed out, oh, like driving somewhere, they diagnosed hypoglycemia, handed me a diet plan.
“Aren’t you going to test me?”
“No need. Just follow the diet.”
Yeah, “no need.” Might cost money, right?
Well, we moved on to Cigna and Blue Cross, but not the Blue Cross of the 60s, and Prucare is no longer. Now the folks that thought they knew better just do so from a distance. I’m guessing, if my case is a good example, they were afraid of being sued. In fact, when I left, I was told I couldn’t have my records because there had been too many lawsuits. I offered up my lawyer’s number and mentioned the Freedom of Information Act.
They gave in.
“Well we’d really rather you didn’t see them.”
My response: “Now I know I damn well want to see them.”
I never sued. I probably should have, but I’ve never been a big one for lawsuits unless absolutely necessary. I’ve only done it once: an employer who refused to pay all his employees.
The only thing in there was their obvious poor attempts at caring for me, the comment during the temp jumping weeks that I may be too obsessed about that… (Wouldn’t you be with that kind of day by day temp jumps going on?) …and that I was a “delightfully eccentric young man.”
Nah, never mind.
These days the progeny of Prucare specialize in providing mostly a serious, constant, barrage of pot shots from a distance at doctors, and lording over the lives of other medical professionals. At least Prucare was in your face about providing as little as they could. Now Prucare’s progeny tell Docs if they want to have patients they must play ball, like adapting to shifting “formulai” that decides if the meds you know you’re patient needs is something they want to pay for. I’m told docs have to hire nurses just to handle complicated business affairs with all the different companies. You think single payer might mean a lot of red tape? Try handling the shifting sands “Cig-No,” as my various specialists and doctors call them. My wife broke her leg last January and had to spent extra months/extra visits on, and in, several plaster casts because the real nice walking kind might take a bigger bite out profits.
Diabetes runs in the family: brother and father. I begin to notice sores on my feet that weren’t healing. Uh oh. So I went in and the nice, cute, vampire-ess they sent me to at the lab drew blood. She even looked a bit like Monica Lewinsky so, thankfully, she chose an arm. I don’t need any wife-made dents in my frying pans, or marks on my head.
(Has any wife actually ever done that cliche’ inspiring act? Did they get charged with murder? I would think, in many cases back when the cliche’ was fresh, “Yes.” I would think a frying pan to the head just might be lethal. Those weren’t aluminum, or even stainless steel. We’re talking cast iron, folks!)
I told them I was going on tour and needed to know the results ASAP. I had to go on the road: work. I mentioned I’d be away for several months. I’d need to know, again: ASAP.
“One to three days and we’ll give you a call, either way. If you have it we’ll work you though it.”
I gave up calling them. I didn’t have time to go in and ask. You can’t E them. And phone calls? Let’s just say they have a phone tree from Hell. I’ve heard one worse, but that’s another story for another edition of Inspection.
Meanwhile I’ve cut back on carbs, started eating on a more regular basis in small portions… nutritive sweeteners I practically eliminated long ago. I’m trying to be proactive about this, having seen what it did to my father.
Four weeks later I sit thousands away from Nashville, having given them many numbers, and they could also call my wife, and no calls. I left message after message. No calls. They’ve eliminated the “check results” on their phone tree option. Finally my wife got a response two days ago, “Have him give us a call at…” their regular number.
But you can’t call them there. They won’t let you through. You can leave a message, but I rarely get a response.
(Note: they finally did respond after being harassed many, many times. “You have a mild form of diabetes.” Joy. Now they want to give me meds that give me diarrhea: not while I’m driving on a daily basis to shows all over New England! Wait until I have a few weeks by myself at camp. Should enhance the experience, right? And how long did I tell them I’d be gone? Three months. So they gave me a 30 day, no refill, supply. Jolly. Now I wait, and I wait to take what they claim I must have. “Health care?” Ha!)
Yet this really isn’t about the doctors or the physician’s assistants, though in one way it is. Many times I’ve gone there I feel rushed through, almost as if it’s an assembly line. In fact, sometimes, I think that’s exactly what it is. If the problem I came in for turns out to be nothing I have been treated as if, “Why did you waste our time?” more times than I can count. But if it turns out to be a problem it’s, “Why didn’t you come in sooner?”
Can the patient win here? Not really.
I have tried not to waste their time by simply going back and asking a quick question. It was working: sometimes, “Oh, that’s just that,” and I’d go about my day… sometimes, “We’d better look at that,” and I’d go back out and wait my turn, or make an appointment. Now there’s a security door: coded, and the staff up front won’t pass on messages. Apparently, neither will the phone tree. And, occasionally, they do their best, if I do get in, to avoid tests.
I’ve also been told, by them, they often don’t get messages. The staff who would do that, of course, insist they always pass it on. Pretty good indicator there’s an independent variable here between patients and their health care concerns.
And who would have an interest finding a way to create this black hole messages fall into if it might save them a few bucks? Do the insurance companies have reps within the facility, or stress out those who have to deal with them with demands to create such black holes? Who, or what, decides when to clear the phone of such messages?
“Oops! Golly, gee. There go a whole wad of time wasting messages.”
As I typed: for the most part I don’t blame the doctors or the physician assistants. I’m damn sure what this is. To make it all more profitable they have to see “X” number of patients, spend “X” amount of time, not “waste” time (=money) on “frivolous” adventures like taking messages, passing on messages, listening to/returning calls and, of course, helping the companies to avoid spending “X” amount of money on any single patient. And I’m guessing this whole house of rules and barriers is built on a shifting foundation of quicksand. Plant your feet on “firm” ground and soon you’re sucked in; off to some worse, and less health-oriented, destination. All the better to make sure staff plays by the “make the companies richer” rules.
Of course they can’t always respond to us: their patients, as much as they want to or need to, I understand that. But you can be damn sure they have to spend hours on the phones to companies being told what they can, mostly can’t, do… or how many hoops they must jump through, how high they must jump, how loud they must bark, how much they must roll over, to be an approved provider and get Cigna-type money.
In short: we pay the insurance companies and they make damn sure we don’t get our money’s worth. The less they treat, the more money they make. They are businesses after all. That’s what business is about: making money. I know. I’ve owned my own biz for over 30 years.
I’m guessing medical professionals like all this no more than patients do.
Am I even close. folks? I’ll bet I’m so close that if this were a highway we’d collide, and it’s not me who would be on the wrong damn side of the road, going the wrong way, ethically and morally.
My neurologist has one of the most perfect pictures I have ever seen in an examination room. He told me that specialists are getting rare in some cities because they tire of the hoops they have to jump through. The picture is of a Geppetto-like man trying to desperately put back together a never ending stack of Pinocchios. In the background there are fat, smiling, laughing, rich men holding their money in tight fists, or tossing an occasional buck or two at him.
That’s the non-health care related: corporate managed, pure profit driven, medical system we have today. Yes, we do have death panels. They are manned and woman-ed by people who work for companies like Cigna: the progeny of of the old Prucare-like systems. They’ve just learned to cut corners by getting rid of the troublesome hospitals, staff and equipment. Get rich by means of harassing doctors, nurses and pharmacies. Red tape out the wazoo from a multitude of insurance companies whose only interest is the bottom line. They know, and care, little about patients and their needs. And if they have to hurt their bottom line to make sure you stay healthy, well, never guess who comes first: them and their stockholders. Not your life.
I can’t imagine single payer being worse. But if it is we at least have an advantage we will never have, ever, if we stick with Neo Con care.
We can vote the bastards who set it up out and vote in those who might do better.
Now that’s choice.
That’s a chance at having real heath care.
Inspection is a column that has been written by Ken Carman for over 30 years. Inspection is dedicated to looking at odd angles, under all the rocks and into the unseen cracks and crevasses that constitute the issues and philosophical constructs of our day: places few think, or even dare, to venture.
Ken Carman and Cartenual Productions
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