Posted by: silverback | 2010/03/03

healthcare is FINE

hey there, sugar

i need to get a wisdom tooth pulled. the United States Navy did me the service of removing two of my four wisdom teeth way back when i was 18 or 19, as a matter of standard procedure for any sailor bound for the submarine service. i guess they didn’t want to have to deal with emergency dental surgery while underway on nuclear power. of course, their extraction of two means that two remain. last February – almost exactly a year ago – i awoke the morning after the 2009 Atlanta Supercross with the right side of my mouth in excruciating pain. at first i thought it might be my inaugural cavity, accelerated by the amount of cotton candy i had consumed the night before, in an attempt to mitigate Lucas’ intake of an astounding amount of sugar.

i went to visit my dentist soon after, where he examined me and took x-rays, et cetera, before declaring my discomfort was a result of me grinding my teeth in my sleep. i’ve spent the last twelve months occasionally wearing a night guard, brushing exclusively with Sensodyne, and avoiding chewing hard things. in that time, i can feel my upper right wisdom tooth beginning to break thru, and my teeth touching in different places than they ever have before. this week, i again called my dentist for another consultation, and within a few seconds on the phone he concurred that it must actually be a wisdom tooth. apparently he actually looked at the x-rays this time.

anyway, he had to refer me because he doesn’t do dental surgery. it must not be profitable, or something. i called the dental surgeon he recommended, and they were more than happy to schedule the extraction of my wisdom tooth this week. during the hashing out of the details, i was trying to ask “how long will that take?” so i said to the nice lady, “so what does that look like as far as…” and she quickly answered, “yes – cost breakdown will be $70 for the consultation and $360-475 for the extraction,” to which i replied, “oh – i’m not worried about that, i have Blue Cross….,” and she then answered,

“we don’t accept that plan, so you will have to pay for this in full on the day of the procedure.”

i was silent for a few seconds, before quipping, “well, what the hell do i have insurance for, then?!?”

in what i could tell was a well-practiced script, she said, “alot of our patients ask the very same question, so i understand your concern.” note that she didn’t answer the question. she did say she would “file for me.” i guess it’s possible that i’ll get a rebate, then?

something is definitely broken, if i’m paying almost $50 a month for dental insurance, which, from what i’ve been told, most dental providers have declined to honor. the reason i was given is because the insurance company’s reimbursement of “reasonable and customary” fees are a fraction of what the doctors actually charge. and what, it seems, the general public is willing to pay out-of-pocket.

so, just what is fucked up? is it that insurance companies can dictate what medical procedures should cost? is it that doctors will charge the very limit of what the market will bear? or that they can, because like it or not, we need medical care? is it that insurance premiums are too high for the services (or lack thereof) provided? that’s probably what pisses me off the most. i’ve been paying my insurance company $600 a year for the past 5 years (just for the dental coverage, mind) – a total of $3000 for those math-handicapped – and now i need $500 worth of credit from those assholes, that i apparently can’t use.

even if the doctor did “accept the plan,” i would still need to pay a deductible, and then 50% of the costs. so in essence, Blue Cross Blue Shield of NC has turned my $3000 of premiums into $6000 for them (or $1500 for me, depending on how you look at it – either way i’m getting bent over). i give you $50, but when it comes time to pay it back, you only have to give me $25, and only after i give you another $75. again, how is that not broken?

i have some amount of sympathy for the doctors. i know their malpractice premiums are ridiculous, because the law allows no limits on monetary damages. it is important to note here, however, that the companies getting money from us for health insurance are also getting money from the doctors just in case they screw up, in essence getting paid twice for every medical procedure ever performed in this country. of course, the one time a huge judgement is levied against the doctor or dentist or hospital and the insurance company has to shell out a hundred million dollars, they’re going to be writing a check using money they made off their investment of my premiums. you just know they’ll raise premiums again in response to the current legal climate, though, and make that back fairly quickly.

i also understand that at some level, a person can never be fully compensated for a loss of health or life from a doctor’s negligence, however rarely that might happen. tort reform will aways be a sticky quagmire to wade through, as no lawmaker or judge wants to be the one to set a precedent regarding limited compensation for the one isolated incident where the doctor shows up drunk and removes the wrong half of the patient’s brain. doctors are, after all, human just like me. they simply make (a minimum of) ten times what i do. i’m cognizant of the fact that eight (or more) years of medical school ain’t cheap.

i can walk these circles in my head for days, and still not be real clear about anything except that at some level i always end up back at the unpleasant reality that i’m the end user, and i’m getting screwed. and i hate that feeling. moreso, i hate that i’m absolutely powerless over it. my options are seriously limited. i ruptured my spleen one time, and it nearly cost me $30,000. that was for 3 days in the hospital and an angioscopic procedure. luckily, i was uninsured and below the poverty level at the time, so the hospital took a charitable write-off. so yeah, it was free.

taking that into consideration, canceling all my health insurance and taking my chances in the E.R. when i seriously jack myself up is starting to look pretty good. even if the current “healthcare reform” bill somehow does get pushed through our horribly ineffective Legislative Branch and signed into law, the proposed legal penalty for not carrying health insurance ($750, i believe) is roughly 1/6th of what i’m paying in health insurance premiums right now.

and as i understand it, i would be able to purchase insurance any time i needed it, regardless of whether my spleen is already ruptured or not.

thanks a bunch, Blue Cross Blue Shield of NC – you will no longer be getting any money from me for that “dental plan.”

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Responses

  1. Fred,

    I feel your pain. Figuratively, of course. If you want to figure out what is really happening follow the money.

    My wife is an ER doctor, and I can tell you see is working more and keeping less year after year. Her groups malpractice premium went up 300% a year or so ago, cause the company that carried them dropped them. Not because of any claims cause there were none and there had not been any. They were told it was no longer profitable for the insurance company to engage in the major malpractice category. The new company is the only company who will carry MP in NC for the ER. A monopoly? After investigation, since they insurance co is publicly traded, we determined from their financial statement and balance sheet that they work on a 2% profit margin. You’ve owned a business. Can you even imagine what that would be like? When she hit me with the news I recall telling here wow how much are you going to have to increase your rates to cover the increase in expense and how will this affect your patients? Her reply, “We are mandated by law as to what we can charge. We can not do anything to cover the increased expense”

    So no money there. Where is the money? My theory is, Lawyers. Law school costs nearly as much as Med school. Fact the amount of lawyers is growing in the US, while the population of practicing doctors is shrinking. Seems like a simple supply and demand issue to me. Too many Lawyers, not enough cases, lawyers are smart business people, lets create some demand. “Have you been injured? Do you know anyone who knows anyone who’s been injured. Call Schiester Schiester and Doubletalk and together we will win lottery.”
    Fine print;
    Of course we take 1/3 to half plus expenses, which leaves you almost where you began.

    Sound familiar? Legal Terrorists. Don Rumsfeld may not have been everyones favorite Sec Def. but he once made a statement that is applicable here. “We’ve got to be 100% right every day, and the terrorists only have to get lucky once”

    What do the Lawyers do with all this money, besides line their respective pockets? Lobby Congress and the White House to pass laws which protect them and to not pass laws, IE Tort Reform, which would hurt them. I should state here, that like doctors, not all lawyers are created equal. I have used, know and even like several. It’s just, as a group they have more bad apples then any other, except maybe Congress, oh yeah they are all lawyers too.

    Now speaking for myself if it came down to trusting my doctor or my lawyer, with my credit card for a year, the choice is an easy one. I personally do not know if a single doctor who wakes in the morning and thinks which of my patients am I going to screw today. On the other hand…. I’m sure you get my point.

    In conclusion, without TORT REFORM there is no health care reform. Sorry for hijacking your blog.

    A closing thought. Everyday in Africa, a gazelle awakes knowing in order to see another day, he must run faster then the fastest lion, and a lion awakes knowing that he must run faster then the slowest gazelle. Start running.

    Cheers

    RABBOT

  2. Crap. That’s the coverage Ginny and I have. Largely subsidized by the government thanks to her position as a schoolteacher, but I have a nagging feeling we could be dealing with the same crap under a lot of circumstances. I recommend you watch “Sicko” for the more sensationalist side, and “Sick Around The World” for a more balanced perspective. I love the US but detest our health care system even more than our military machine’s profiteering off of a systematic pattern of militaristic economic imperialism masqueraded as “protecting freedom”.


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