Sunday, August 20, 2017

Twenty-One Days Until TEOTWAWKI - Day 11: Health Care

I have never been a fan of the ACA.  The ACA is the Affordable Health Care Act, aka Obamacare.  I just hate the nickname, too.  Maybe former President Obama likes that name, as it's his legacy.  I think it's a disrespectful term.  Indeed, it's meant to be disrespectful, because the people who were most against it want to be sure that he is appropriately blamed for it. 

I think blame is a useless pursuit.  It's a pointless distraction that keeps us from making positive change, because we're so focused on faulting someone rather than fixing what went wrong.  Fine.  It's my fault.  Now, what are YOU going to do to fix it?

What I don't like about the ACA has nothing to do with the hope that everyone could have low-cost health care.  I'm all for low-cost health care, but I disagree that the ACA achieved that goal.  First the cost of health care did not change.  All that changed was who paid for it.

At the core, what really bothers me about it is the law that now requires me to purchase insurance from a private company.  It's the Corporatocracy at its worst.  That the government feels it has the authority to force me to purchase anything from a private vendor is the part that is most grating. 

The health insurance we have had for the past many years has been employer provided through Deus Ex Machina's employer, that is, his employer paid a portion of the premium, and we were responsible for paying the remainder in weekly installments that were automatically deducted from his pay check.  I think we could have opted out of the company-sponsored insurance, but we had no choice as to who the insurance provider was.  The company chose the insurance provider and if we wanted to take advantage of their insurance plan, we paid for it.  If we didn't want to use their insurance company we were on our own. 

It wasn't great insurance.  I mean, I guess it paid for stuff that would have been pretty expensive otherwise (like x-rays), and if we ever went to the doctor, probably it would have been good, but let me share some personal stuff with you.

First, I actually do think that good dental hygiene is more important than seeing a doctor, and science actually backs me up ... somewhat.  Studies show that bacteria in our mouths can affect our heart health.  As such, good dental insurance is much more important to me than health insurance. 

Second, the whole orthodontia thing.  Our insurance didn't pay for any of it. 

Third, we were limited in our choice of physician to a very finite number of doctors, most of whom belong to major practices in the area.  I guess, for most people, a big doctor practice is a good thing, because if their own doctor is busy or on vacation, there's someone they can see, but I've had some issues with those big practices.

The first issue is the wait time.  If I have an appointment at 3:45, and I'm on time (that is, I get there by 3:45, I should not have to wait.  If I'm late, they have the right to refuse to see me and to bill me for the appointment.  I agree with all of that.

What I don't agree with is that I arrive on time.  I have to wait five to fifteen minutes in the waiting room.  Then, I'm shuttled back to an exam room, where I wait an additional ten to twenty minutes.  The doctor comes in and checks on me, spending, maybe, ten minutes - all total -, and then, he/she will give me some recommendation or scribble all over my "chart." 

Five minutes to take my vitals and ten minutes to see the doctor, for a total of fifteen minutes of time spent being seen. 

But how many of us only ever spend fifteen minutes in a doctor's office? 

Which is my point:  just because one is a medical professional does not make one's time more valuable than mine.  If I make an appointment for 3:45, and the doctor allots 15 minutes to see me (which is the usual amount of time), I shouldn't spend more than a half hour in that office, including any tests of paperwork. 

The second issue was a pretty serious HIPPA violation, which I won't share, but suffice it to say that there is a medical practice here in Maine that I would NEVER go see.  I don't have any super secret or embarrassing medical issues, but I don't trust them with my records, because it's still personal. 

Unfortunately, half of the doctors on the approved list were with that practice.

So, we put off selecting a new physician, and for the last five or so, we didn't have a PCP (personal care physician), which means we were paying higher prices for substandard care at a walk-in clinic, because when an injury (like Deus Ex Machina's poison ivy a few years ago) happens, we don't have a doctor.

For many years, we visited an independent group.  They were a bunch of medical care providers who shared office space and administrative space, but they weren't a "medical practice."  In their shared space they also had several different types of practitioners, including an acupuncturist, a naturopath, Shamanic healers, a couple of Physician's Assistants and Nurse Practitioners, and at least one actual MD.  They didn't take insurance.  When the ACA passed, they closed the clinic, and we were forced to find new doctors.

When we lost our employer-sponsored health insurance this year, we were given the opportunity (ha!!) to sign up for COBRA.  Anyone who has been given this opportunity knows what a (expletive) joke it is.  The cost of maintaining one's coverage through COBRA is prohibitive, especially for someone who is not employed.  Unemployment would barely cover the cost of our mortgage.  If we had to pay for COBRA out of that income, too ....  Well, there would be no paying anything else, including buying food, paying the electric bill, or compensating the water company.  We'd, basically, be paying for health insurance ... so that we would have the privilege of seeing a doctor, which we couldn't afford, because after paying insurance premiums, we damn-sure couldn't afford the co-pays.

I had been wanting, for a very long time, to explore other options, which seemed out of reach for us.  In particular, there is a local doctor who does not accept insurance.  I read about him several years before the ACA was a thing.  He was offering an alternative to high-cost insurance premiums by providing basic medical care on a subscription basis.  Basically, his patients pay a monthly rate and all office visits are covered. 

Deus Ex Machina and I discussed opting out of his employer sponsored health insurance and joining this doctor's practice.  But then, the law changed, and we were suddenly required to have insurance or pay a penalty.  It wasn't in the budget to pay for insurance AND pay the medical subscription fee.

When we no longer had insurance, it seemed like a good time to explore that option, and so we did.  For much less than the cost of an insurance premium (and one-tenth of the cost of COBRA), we have a primary care physician. 

And I like him.  I like him a LOT.  He's open to my crazy ideas.  I discussed why, at my age, that I'm not running down to the imaging center for my recommended mammogram.  He didn't agree with me, but he was willing to listen.  Then, because I had discussed all of this reading I'd done, he looked, too.  It was nice that he didn't act like he had all of the answers, even though he's a doctor, and he actually does know a lot more about those things than I do. 

And he said that one thing that I've always known - when it comes to medical research, always look at who the sponsor of the study is.  That will say a lot more about the outcome than the actual outcome.

He still believes that a mammogram is a good diagnostic tool for early cancer detection, and he will probably continue to recommend the tool for women in the risk age group, but at least he respects my decision to not have one, as I feel it is not medically necessary.  The last doctor I had who was like him moved, and I never, quite, got over that loss ... until I found this new doctor.

There's a part two to the savings.

My daughter injured herself a while back.  We kept hoping it would clear up, and she had multiple x-rays and evaluations, but the recommendation was always, "Rest.  Heat/cold.  Ibuprofen."  She did all of that.  For many months.  With no improvement.

Our new doctor recommended she see a chiropractor.  We're paying out-of-pocket for the visits.  Did you know that doctors charge their self-pay clients less than those who have the physician bill the insurance company?

So, basically, health care is so expensive, BECAUSE of insurance companies.  If all providers offered self-pay on a sliding scale, perhaps health care wouldn't cost so much. 

Now that we don't have health insurance, I'm actually happier with our care than I have been in many years.  Isn't that funny?

2 comments:

  1. is there a searchable list for doctors that don't take insurance? I'd love to find someone in my area.

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    Replies
    1. I don't know of a searchable database for doctors who don't insurance.

      What you might do, though, is to contact local doctors who are in a private practice (not a group) and talk to them about a subscription-based service - i.e. you pay a monthly fee (whether you see him or not) - OR see if they have a sliding scale or reduced fees for patients who pay out-of-pocket. Our chiropractor charges us less because we pay cash each visit, and he doesn't have to pay someone to file the insurance paperwork. It's beneficial for both of us for me to pay out-of-pocket and we both, actually, save money.

      Anyway, call around. There might be someone who will work with you on the cost.

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