Studio Ruthe

Another healthcare rant

It's been three weeks since I got out of the hospital. I have received two different survey forms to fill out, one telephone survey and two cards, one get-well, one thank you, from my healthcare "concierge." What I want to see is my EOB--Explanation of Benefits--the paperwork you get from Medicare letting you know what the "provider" is charging, what they are actually allowed to charge and what my co-pay will be. Until now I've never come close to my "out of pocket" maximum. I suspect this year will be the first time.

When people, usually Republican people, write about Medicare, or Medicare-like healthcare, the complaint is always made that we don't pay attention to those bills or how much we spend on medical care. I pay close attention to those bills, when I get them. It would be helpful if they came promptly and also if they clearly identified what service was provided. My hospital stay was OK. I am grateful they were able to make a diagnosis quickly and do what needed to be done. Now I'd like to know what all of this costs.

BTW, how do you like the way I've deal with all that jargon?

One more thing: those EOB's do not come from the government. Mine come from one of those private medicare advantage insurance companies.

More about things we don't want to talk about

Monday the New York Times had an excellent article titled, "For the Elderly, Being Heard About Life’s End", that subject we don't want to acknowledge. You can read it here. They say all the things I want to say.

I'm in San Francisco this week; my internet access is only so-so. I'll tell you all about it when I return home on Saturday.

An interesting afternoon

Steve teaches a class about public health and aging for people getting a certificate in public health. Most of the students are healthcare professionals, but unfortunately, not doctors. They should be taking the class.  Today's class was a discussion based on an article about limiting medical interventions for older patients (late 70's and up). Steve invited me to come to the class and sent me the reading. While the argument generates lots of controversy it presupposes so many things that won't come to pass in my lifetime, it becomes meaningless.

Simplifying the argument: In a more perfect world, where elders are respected and not the subject of so much prejudice, it should be possible to make a rule based on age, limiting what medicare would pay for in the way of technological interventions. When the class began I was the only one in favor of the argument. After a spirited discussion we concluded it would be best if medical decisions were made based on the individual and on science, whatever that means. Since I haven't met too many doctors who look at the whole person and who don't base their decisions on things like worry about malpractice suits, pharmaceutical company propaganda and the need to avoid death regardless of the patient's wishes, I rather like the idea of a rule or concensus based on age. I don't want to die hooked up to machines, like my mother. Nor do I want round the clock caretakers and being treated like a child. These seem to be today's inevitabilities.

One of the biggest problems is no one wants to talk about death. We seem to think it will go away if we ignore it, or maybe, if we can just keep breathing, they'll find some way to keep us alive forever. Instead, it creeps up on us and takes us in the most terrible, painful, undignified ways. It would help if we had a good, rational discussion about how we want doctors to treat us and how we want to die. We aren't going to live forever; wishful thinking won't make it so.

Family, Art and More Family

My days here in NYC are going very quickly. On Thursday, Renee and I took the train out to Long Island to visit her other son and family. It's a 60 mile trip and took 2 hours, each way. The Japanese must laugh hysterically every time they hear something like this. We had a lovely, too short visit. Train schedule was not very accommodating for us.

Yesterday I met Phyllis at the Rubin Museum. I really love that place, at the same time it makes me very angry. It's a beautiful space, so wonderfully designed you feel like you are entering a temple of peace and beauty. Here is a story about the museum and how it was built. If you read it carefully, you will note one line, "...Donald and Shelly built their managed-health-care network, Multiplan..." I am angry about anyone who makes enough money on healthcare to build a huge art collection and then build a museum to use as a tax write-off, thereby screwing us, the public, all over again.

Even with my anger, I managed to enjoy the museum and the art. My all-time favorite piece is a huge applique you can see here. Phyllis, who has been a photographer most of her life, took me there to see photographs of Bhutan by Kenro Izu. Most of the photos were platinum/palladium contact prints made from huge negatives, taken with a custom made camera that weighs 300 pounds. Story about the exhibit here.

After this soulful sojourn at the Rubin I met up with Renee and we went to dinner with her brother and sister-in-law, so more family and lots of laughs. Renee and her family treat me like I belong to them. Having moved to the east coast with no family here except Robin, I have always been very moved by their efforts to include me in all of their events. I am truly grateful to be so accepted and loved by my daughter's in-laws.

Healthcare, not insurance care

I went to see Sicko this week, and also went to a meeting about single payer healthcare. I wasn't going to go to Sicko; I figured it was preaching to the choir. I was amazed at how much he told me that I didn't know before, and how it held my attention. As my movie rating system goes, this one gets top billing. I never thought about looking at my watch.

I've been fairly pessimistic about the possibility of getting single payer healthcare in my lifetime. Sure, I don't need it: I have Medicare! But so much of our healthcare system is awful: wasteful, aggravating, totally irrational. Only the insurance and pharmaceutical companies benefit from our system. Even after seeing the movie, I wasn't too hopeful. But the meeting I attended was overflowing with people, and most were committed to changing the system.

The internet is filled with information about single payer and universal healthcare. Jane Bryant Quinn has a wonderful article in this week's Newsweek, dealing with the economics of a new system. Western PA has a website urging single payer for the state of Pennsylvania, and Healthcare-NOW is working on the national level. Take a look at this site for a comparison of the costs of the war in Iraq and what it would cost to cover everyone in the country. And for my friends who ask, "Do you want the government in charge of your health? Think of the post office," I can only reply, Do you want the insurance companies making billions of dollars from your healthcare? That money can only come from denying your needs.

That prescription again

I should have it by now, right? Wrong! It took me two days to reach the doctor's office; the first day I kept getting busy signals or no one answered. Weird. Then I heard nothing for three days. Last night I went over to the pharmacy. Yes, they had filled the prescription: 10 pills out of the 90 I was supposed to receive. They would get the remainder today, maybe. And they apologized for not notifying me. I left the ten pills and told them I would come back when they had the entire order. I don't want to start taking this stuff and find out I can't keep going. I hate to think how I would feel if this was urgent.

Random questions for a Wednesday

I got a phone call early this morning from the doctor's office; my prescription was approved, provided I will accept a generic. That's OK. But I had to give the dr's office the phone number of my pharmacy. Never having called them before I didn't have it and didn't have time to look it up when they called. I tried to call them back when I got back from my classes. Of course, they were already gone. Why didn't they keep the phone number when the pharmacy first called them after the prescription was denied? Am I being too rational?

I've been reading about Philip Pearlstein in a magazine called Art Press. Published in France it's articles are in both French and English. I had no idea that Pearlstein is from Pittsburgh, even went to school at Carnegie Institute of Technology and was Andy Warhol's friend. The two of them went to New York together. My question is: how come we have an Andy Warhol Museum, but no Philip Pearlstein Museum? I think he is a much more interesting artist than Warhol. Is it because Warhol was a better promoter? He was certainly a master. Or is it because Pearlstein paints nudes? Or what?

I am in school most of the day on Wednesday. At some point when I went to the ladies room I found this stuck to the door of the stall. I know what's worse than an abortion, but I can't think of an easy answer about what is better. I presume this is some kind of anti-abortion statement, but it made me wonder what might be better, mostly things that most of the anti-abortion zealots never mention. Instead of picketing in front of Planned Parenthood, how about teaching young women about the responsibility involved in raising a child? How about giving women enough self-esteem to enable them to say no to unprotected sex? How about making men equally responsible for raising those children?

Still thinking about healthcare

It is now seven (7) full days since I brought in the prescription and I still haven't heard from them. Just wanted to keep you updated.

More healthcare nonsense

Last week I went to the dermatologist for one of those full body scans for skin cancer. I was given a clean bill of health and a prescription for something to clear up a condition I've had for years but only bothers me occasionally. This also required a blood test that I took and passed. Wanting to be a good, knowledgeable patient I looked up the drug in the formulary my insurance company sent me and it said I needed pre-approval. I called them; they gave me an 800 number to give to the doctor to call. I called the Dr's office this morning and was told I should go ahead and submit the prescription to the pharmacy where it would be denied, and then the doctor could go ahead and fight the insurance company. This could take two or three days and I should call the office again if I don't hear from them in that time. I'm glad this isn't an emergency, but what if it was?

This is the kind of thing that makes me wonder how our healthcare system functions, at all. My time making all those calls doesn't count, after all, I'm retired. But what about the pharmacist, the doctor's office, and the insurance company? Surely this cannot be cost effective. This is why doctors need such large support staffs. They aren't there for you; they are there to deal with the nonsensical rules set up by the insurance companies.

This is a nasty game that puts your life in the control of an insurance clerk following rules set up by a high priced accountant.

I began working on this post on July 10, inspired by a post on Wintersong, written more beautifully and  coherently than anything I produce. Today is July 16 and I haven't heard from either the doctor or the pharmacy. I'm certainly glad my life doesn't depend on this medication.

Critics of single-payer universal healthcare call it socialism and say it is not compatible with the capitalist system. I think the system we have in place now is a form of totalitarianism. I have no control over my healthcare, and worse yet, my doctor seems to have little or no control over my healthcare. Someone is certainly making money out of all of this, but I'm sure it's not my doctor or any other health provider.

Listening

I usually take the bus to class, but yesterday I drove because I had to go somewhere else first. I suppose I could have taken buses to both places but it seemed too tedious. My love of public transit only goes so far. Of course, if it was run more intelligently, I might feel differently. (That's another subject.) Anyhow, I recently discovered Democratic, as in Democratic Party, talk radio here in Pittsburgh, so I listened as I drove home. I came to the conclusion that I shouldn't listen to them. They are telling me what I want to hear; for instance, Cheney should be impeached, and then Bush, but I know it's not going to happen and I don't want to be so optimistic. Maybe that's why Air America was not a resounding success: it's too hard to come to terms with reality after you listen to someone telling you what you want to hear.

They also spoke about healthcare, my favorite subject. According to a CNN poll 64% of the people polled answered yes to this question: "Do you think the government should provide a national health insurance program for all Americans, even if this would require higher taxes?

Have you heard this from anyone in the media, or politics? Rep. Dennis Kucinich is the only presidential wannabe who is willing to talk about this. Everyone else, Clinton, Obama, et al, treat it like it's impossible that any red-blooded American would want to stop the insurance companies from bleeding us to death. Kucinich has no money and will never win because he's the only one the insurance companies don't own.