Medical Care Costs — Here We Go Again

If you had your eye on a particular car, and the salesman scribbled down a dollar amount and said something like ‘Here’s my estimate of the cost to you, but since you will be billed separately by me, the dealership, the sales department, the manufacturer and the transport company, you won’t know the full tally until some weeks after the sale’, how would you respond? You might inquire, ‘Can you tell me what all those amounts will be?’, and he might spew out a series of numbers and the vague reasons for them, and how you are benefiting from this adjustment to that charge and this offset to one or another fee, or he just might be honest and simply say ‘No, I don’t know them myself, and it depends on who’s buying’.

 
Would you buy that car, or would you instead seek out a purchase—an obligation—that provided all the financial details up-front?

 
I’m pretty sure that you would simply shake your head, maybe mutter something under your breath, and leave, unlikely to ever return. But unfortunately, for all but the most privileged among us, it simply does not work that way with health care. And that really galls me.

 
A few years ago my physician recommended that I get a colonoscopy, for no reason other than my age. It was preventative care, which our insurance supposedly covered. Shortly before the procedure the surgery center telephoned me and told me that they thought my out-of-pocket expenses would be $90, though they could not guarantee that. I blithely said OK, assuming that if it turned out to be more, the increase would not be dramatic.

 
You see where this is going?

 
I arrived, paid my fee and underwent the procedure—which was entirely routine—and my plumbing was pronounced to be in fine working order, thank you very much. And then, over the next days and weeks, the invoices began filtering in; from the physician’s office, from the surgery center, from the anesthesiologist and from the lab. My out-of pocket outlay was over $500. A year later Sue went through the same deal; same insurance and same cast of players, and she was socked for something like $800. This was for a routine service, provided at a facility owned by the hospital system that she worked for as an ICU nurse, and from whom she purchased her and my health insurance.

 
Now I am scheduled for cataract surgery, and at the end of second preparatory appointment I was given a sheet breaking down the costs for the two surgeries. About $750 each, and since my personal deductible of $750 was still untouched, my out-of-pocket would be about $950.

 
Huh? $1500 – $750 = $950?

 
I gulped and said OK, since we’re talking my eyes here, after all, and left. Yesterday I received a call from the surgery center. This is a different hospital system/insurance plan than our prior experience, but still—I’ve learned to distrust the billing department of a surgery center. The woman rattled off a bunch of confusing numbers, saying the fee would be over $4,000 and my personal deductible was $1500, and they had plugged the numbers into the mysterious insurance calculator and determined that my fee would be $750. Per eye.

 

Would I like to offer up my credit card for payment right now, since that would make everything else go so much more smoothly?

 
Uh, no, I’d really rather not. Could the surgery center send me a breakdown of all those charges, so that I might try to make sense of them?

 
No, the surgery center does not mail out such materials.

 
Hmmm. With my razor-sharp mind I calculated that it sounded as though my out-of-pocket numbers were edging, er… make that leaping, up toward $2,500, and I’ve not yet heard from the anesthesiologist, the janitorial staff or the groundskeepers.

 
I hung up the phone and stumbled, in a daze of numbers to the left of the decimal point, to dig out the documentation on our Blue Cross Blue Shield ‘Gold’ policy.

 
Let’s see: Individual Calendar Year Deductible: $250; Out-of-Pocket Maximum: $1500

 
Uh… if my Max is $1500, why am I already up to $2500, not including the cup of coffee?
I think I will telephone my ophthalmologist’s office Monday AM and tell them that I am confused by the billing, and that I will postpone the surgery until I can make sense out of the charges, and perhaps even cancel it and—gasp!—do some price shopping.

 
When I worked in the IT department at a clinic in an impoverished area many years ago, I was once told by one of the psychiatrists that there was no real rationale to the clinic’s billing, they just continued to churn-and-mail invoices, trying to collect as much as they could. I have long suspected that there is something of that pattern in our current system of health care billing.

 
I truly have great respect and appreciation for the medical practitioners who offer high quality health care in the U.S. (for those who can afford it), but I find the process of buying and selling such care abominable. While $3,000 is most certainly not chump-change for me, I could (and might yet) bite my tongue and put a serious hit on my savings account. But there are a large number of people in this country who simply could not come up with such a sum. So, even with supposedly good insurance, they would have to fore go the treatment, or if their credit was OK, incur more debt.

 
I supported the President’s push for health care reform, though I believe a much better package could have been created if he had not been forced to cater to the demands of the fringe element of his own party, simply because the opposition party had no interest in compromise. That is especially ironic when you consider that some of the procedures Obama favored had at one time or another been promoted by the GOP. What frightens me the most as I approach retirement age is the prospect of exorbitant medical costs, or the inability to pay. I would not be surprised to learn that many of you reading this know someone who had thought themselves financially secure, only to have that mirage swept to bankruptcy by a serious medical event in the family.

 
I personally would be inclined to model our health care reform on some of the integrated procedures that have been put in place by successful medical groups in this country. Examples of those would be the Mayo Clinic, the Cleveland Clinic, Sloan-Kettering and Duke Integrative. In those instances the physicians and other medical practitioners are not all individual entities, pressed (voluntarily or not) into our current model of dispensing individual treatment and medications and charging for each tiny piece—with the winner being the one who dispenses the most—but rather the staff functions as a team, working for the common goal of best-treatment for the patient, and with no monetary incentive to over-treat and over-bill.

 
A lot of people are making an awful lot of money in health care, without contributing any actual care whatsoever. The purpose of the health insurance industry is not to maximize health care, but rather to maximize profit. That is capitalism, and it’s OK when you’re talking non-critical services like boob-jobs or hair implants, but it is my opinion that it is wrong to put serious health care decisions under the control of those who profit the most when it is denied.

 
Here is a link to a broad but brief discussion of the models of health care that exist in the world today. Have a look if you wish, but I encourage you to leave your own comments here at my blog, describing your own experiences, and agreeing or disagreeing with my post. Opinions matter, and I’ll allow any to post on my blog so long as it’s not mean-spirited.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

 

Blog On!

 

Motorcycle GearHead

Eric on Valkyrie

Thinking Happy Thoughts

OK, full disclosure up front; I’m a bike nut. By saying ‘nut’, I don’t mean to imply that I’m reckless—I teach a couple dozen MSF motorcycle safety classes per year, and I try hard to practice what I preach. But I am compulsive about bikes; I live, and breathe, and dream motorcycles. I tell Sue that so long as it’s other bikes that catch my roving eye, as opposed to other women, then it’s OK.

Right? Well, yeah… so long as I don’t run up the debt.

I will never catch up with Jay Leno’s collection (not even close), but my next bike will make for a lifetime total of fifty (I’m aiming for one hundred, but don’t tell Sue). I suffer from MBS (Multiple Bike Syndrome), and it can be infectious. For those who know bikes, I currently own a Goldwing (Sue’s favorite), a Valkyrie Tourer, a Moto Guzzi 1200 Sport, and a Buell Ulysses.

Envious? You should be. ;-)

So, what is it about bikes? Why do some folk think that motorcyclists are crazy, while others (me, for one) cannot imagine why anyone would deprive themselves of such an exhilarating experience? As an aside, I have a cousin who once voiced the opinion that riding bikes was like riding a ‘murder-cycle’, and the kicker was that he’s a firefighter. That is a very admirable career and I laud him for it, but please—to chastise me for riding a motorcycle, while he voluntarily ventures into burning buildings!

But I digress. Back to the question: Why do some people so deeply love motorcycles? It’s no mystery to me, but when I try to describe the feeling to people who haven’t been there, it can be quite the challenge.

Sorta like trying to convince me of the allure of cauliflower.
ugh

I once read a statement by a fellow motorcycle fanatic, errr… aficionado, and he said something along the lines of ‘When you’re driving a car, it’s like sitting and watching a movie, but when you’re riding a bike, you are the movie.’ I think that sums it up pretty well.
Driving a car is not a simple thing (even though the people who text, or shave, or do whatever else while behind the wheel are in effect pretending that it is simple). But even so, riding a motorcycle requires a much higher level of participation.
My dear Mom is ninety and still drives her car. She’ll occasionally ride on the back of my Goldwing (a Barcalounger on wheels, as far as passenger accommodations go), but there is no way she could actually pilot a bike. On a bike the rider is very physically engaged, especially on twisty roads (the best kind), where the rider leans with the bike and shifts his body weight, rotating his focus through the curve while pressing through the corner, all while coordinating throttle, front and rear brakes and perhaps clutch control. And trying to ignore the giggling. Ooops, I guess that’s me…

It’s an invigorating experience; I feel very alive, and absorbed, when I ride. And all I have to do to live the thrill is roll the bike out of the garage and fire it up.

A common bit of advice is to write what you know, but how to incorporate motorcycles into a science fiction/fantasy novel? I compromised by deploying a purpose-built biped in ‘Guild of the Viizar’, where a conventional motorcycle would have been sorely out of place in the minimal-gravity lunar environment. Here’s a blurb.

The handlebar yanked violently in his white-knuckled grip, nearly wrenching itself free, and Airen found himself fighting to stay astride the vehicle as it skewed wildly to the left. He yelped—loud inside a suited helmet—and the front wheel was caught up in a diverging rut in the rocky formation concealed just below the loose, chalk-colored surface. Airen twisted the throttle open to lighten a front wheel that was digging in, and he wrenched the bars to free the wheel from its rutted diversion. Surface matter arced out in a lazily floating plume behind the paddle-treaded tire, lending the illusion of a sedate cruise. The rear end abruptly came back around, whipping nearly 180 degrees the opposite direction, and with little traction the biped slewed from side to side, threatening to suddenly catch and fling him headlong from the saddle.

Sound like fun?

On rare occasion a driver (‘cager’, in bike-speak) who pulls up beside me at a traffic light might scowl in disapproval, but more common is the melancholy smile and nod of the head from someone who is likely thinking something along the lines of ‘What an adventure! I wish that was me…’

If that has ever been you, encased in the boxed-in, sterile environs of your car and casting that wistful smile, I would suggest that you give motorcycling a try. What the heck, you’ve only got one run around the circuit, right? I could dredge up other clichés, like ‘grab the golden ring’, or ‘it’s on the bucket list’, but the truth is that there will come the day for each of us when such adventures are no longer an option.

Two scenarios, as best I can figure: we get old and die, or we die young, and in the meantime we have either taken those adventures we someday thought we might, or we haven’t. My brother (another bike nut, especially over BMW’s) recently sent me this link to a video that makes me think of that person eying my bike with envy. Check it out: Out of the Rut

So if you’re tempted by that vision of personal freedom, sign up for one of the MSF beginner’s courses, often offered at places like Vocational Colleges (google it—you’ll get results). You don’t need to own a bike, the class provides small, un-intimidating machines to learn on. When I started coaching I thought the students would be mostly young males, like when I started out long ago, but in reality the students span a wide spectrum, where it’s not unusual for middle-agers and seniors to outnumber the young, or for female students to outnumber the males.

Maybe the bug will bite, and you’ll get that seriously cool Triumph 1200 Explorer before I  add it to my stable. Or maybe you’ll enjoy the bike class, but decide that it’s not for you, and you’ll try something else adventurous, like piloting a gyrocopter over the cane-fields of south Florida.

Hmmmm—I used to do that, but that’s another blog.

 

An Understanding of the Curious Cat

Teiko

Teiko (Nightfall's camera-shy)

I have recently read a number of pieces about introverted personalities, and about writers, and since many of those articles made reference to cats as pets, I wonder if there is a real connection? After all, I myself am an introvert, a writer, and a lover of cats (and proud of it!), and so is that not all the evidence needed? And since I was relieved to see the introverted personality-type championed rather than pitied (’oh, you poor, poor dear’), I now take up the gauntlet and come to the defense of the often maligned feline.

I claim to be especially well suited to that task, because while I cannot say that I know the how or the why of it, I’m quite certain that in some prior life I was a cat. There is simply too much of a connection for there to be any other possibility.

Some people just don’t get it—they do not understand the curious mind of a cat. They wonder why anyone would bother with the effort required to build a relationship with such an aloof, persnickety creature. Such folk clearly do not appreciate the cat, and I might venture that they are in fact often inclined to favor a dog of one stripe or another. Not that I mean to disparage the dog, mind you—dogs are fine by me. I was in fact once owned by a fine Chesapeake Bay Retriever, many years ago.

But still, to favor a dog over a cat!? That I cannot understand. To begin with, there’s typically no need to earn the affection of a dog—the only requirement is that the human is breathing, offers food, and does not threaten with a stick. And that’s OK, but a relationship with a cat is something that you must truly earn, and so is of greater value, by my reckoning.

A dog is like a teenage boy; loud and boisterous, forever attempting to maneuver himself into the center of attention. Here I am! Me! Me!  The closest a cat will ever come to such demonstrative action is to rub against your leg and purr, or simply plant himself in the way and defy you to pass by without recognition.

Admittedly a cat will sometimes come off a bit on the arrogant side, with her air of superiority and I-can’t-be-bothered-to-notice posture. If everything is not just as she would have it she’ll likely express disdain by issuing a great yawn when attention is directed her way. Moreover, many folk facing the blank stare of a cat simply do not understand that it is the responsibility of the person to come up to standard, because the cat is just too cool…

Upon presenting herself to new company a cat immediately recognizes if the person is of a cat-sympathetic temperament. It’s an aura thing. Only after being recognized as a potential ally may that person begin his or her campaign to win over the cat’s affection. Such a campaign is, by the way, much more likely to succeed if all standard dog-approach techniques are abandoned forthwith. Such is to say one should not caper about, hopping from foot to foot while excitedly calling out “Here Boy! Here Boy!”

A cat would regard such foolish and unseemly behavior with suspicious reserve, as well she should.

I am pleased to advise that I harbor no such inadequacies—I understand all too well the mood, and the motivation, behind the enigmatic behavior of my furry friends.

I understand, for example, that when we walk through the house, Teiko is not walking with me, he is leading me. He must assert his position of authority and diligently direct me in the proper direction; that being either toward the woefully neglected food bowl (it’s never full enough), or to the door. In the latter case once the door has been reached the course of action is somewhat arbitrary. To go in, or to go out? That depends solely upon which side of the door it is that he is currently located. A closed door is meant to be opened and the threshold crossed—that is a fundamental tenet of the cat. If the door was standing open, then the entire issue becomes moot—not worthy of consideration.

You see? I do understand.

I further understand that when Nightfall arrives at the back door, his yowls muffled by the small rodent clenched between his teeth, he has no intention of eating it, nor does he think that I’ll do anything with it other than gingerly bag-and-trash it. The entire purpose here is that I recognize his prowess as a hunter. Once he sees that I have observed, he is finished with it. Dismissed.

Both our friends Teiko and Nightfall are long-haired Turkish Angoras, who were so gracious as to adopt Sue and myself as their own. We are honored. Teiko (pure white coat, incredibly soft) is perhaps the most outgoing cat that I have ever known. He looks you straight in the eye, watches TV, and has an endearing habit of doing forward somersaults when he gets excited. Nightfall (pure black coat, also plush) is more reserved, and his is the name given the understudy in my short story ‘Edgar’, which tracks the competition between a Master Wizard (feline) and his mentee.

And so you see, I hold the advantage in our household. Like I mentioned at the outset, I was a cat once, and so all this comes naturally to me. My grasp of the thought patterns of the cat, my native intuition of his likely actions—these tools help me to maintain control of our interactions. By understanding the psychology of a cat, I can outfox him. Teiko and Nightfall may believe otherwise, but it is not they who exert control.

No, my furry fellows, it is I who calls the shots here, I’m the one—

Ahh…What’s that??? Nightfall, meowing at the door?

Sorry, gotta go!!!