A Call to Action for Your Healthcare

It is time for healthcare consumers (i.e. you) to start advocating for yourselves against the big bossy, expensive healthcare system.

This call to action comes from a recent transaction with Providence Health when I took my daughter to urgent care a few months ago (before graduating) because I was fairly certain she had an upper respiratory infection. It was deemed allergies and we were sent on our way with a prescription for Flonase. With something that was so simple I was surprised at a bill for $368. (Mind you, I hadn’t met my deductible of $3000.) I’m used to getting plenty of medical bills because of my daughter’s health condition, but simple office visits never cost so much so I looked at the itemized list. There was a charge of the visit and an extra charge for the removal of impacted cerumen (earwax).

Not at any point did they irrigate my daughter’s ears or do any procedure to remove “impacted cerumen.” Impacted means that it’s stuck in there, pushed up against the ear drum. So I called and questioned the charge. I was informed that I was correctly billed and would have to cough up $236 for the removal of said earwax. Excuse me.  I called them again and expressed my concern that no such procedure occurred. I was read a part of the provider’s note that said she put a curette into my daughter’s ear to remove earwax.

If that did happen, it was so quick and unimportant that I don’t remember it. And call me crazy, but as a provider myself, I thought that removing a piece of earwax that is blocking the view was just a part of a good ear exam.

So here are my concerns:

1) Why are healthcare consumers being charged extra for what is part of a normal exam for a given complaint? It was not a “procedure.” How often do these types of things just slide by because people aren’t questioning their bill?

2) If there is a charge to the procedure and it does not necessarily need to be done in the office (i.e. I could take my daughter home and put drops in her ears) then shouldn’t the consumer be asked first? I was not asked.

3) How outrageous is it that something so negligible costs $236?! Really? We were in and out of that room in ten minutes. No special tools, medications, assistance, time, etc., was needed.

As a country we are busting at the seams because of high healthcare costs. People cannot afford it and it is becoming less affordable every day. We want to blame politicians but shouldn’t the blame and the outrage go to the businesses, pharmaceuticals and hospital systems pocketing outrageous profits by inflating their costs and slipping in unnecessary charges when we aren’t looking? These entities are also the ones that get tax deductions and write-offs when the consumers are unable to pay. I have been saying for a short-while now that I blame the CEOS and medical directors that make multi-million dollar salaries for keeping profit margins high. My experiences as a new provider makes me feel even stronger about it as I waste time combating insurance companies daily.

It is time to refocus our efforts to fix the healthcare system.  As healthcare consumers, I urge you to question your provider about the interventions being performed and any possible related charges. Is it something you can do without? Is it something you can do at home for less? What would happen if you didn’t do it? Just ask nicely and a good provider will understand your concerns.

You should also start looking at itemized statements from your visits, even if you’ve already met your deductible. Do the charges really fit what happened? If not, make phone calls, insist on seeing the chart note if you have to. If you don’t get results the first time, try again. If you need to, go to the insurance company and let them know that the charges are incorrect and they can investigate for you. You can do these things while being polite and civil.

In the meantime, file complaints to the higher ups. Express your disgust at being duped and over-charged. Let them know you are going to take your business somewhere else (if your insurance allows, of course) if they don’t remedy the situation.

It is an uphill battle to be sure, but it is time to get angry at the real criminals here. It is also time to start fighting back. As for my example/experience, it is still being worked on. Providence is listening to my squawking and they are investigating my complaint still.  The most recent thing I have been told is that they re-coded the charges and have submitted it to my insurance company for review.

Observation of the Affordable Care Act in Rural Oregon

More than an opinion piece, this is an update of how the Affordable Care Act is affecting my practice in a rural Oregon community. With the ACA, many more people now qualify for Medicare. They have swamped our clinic and when I should normally have spare time on my hands as a new provider trying to build my patient-base, my schedule fills up almost daily with new patients trying to establish care.

Many of these new patients are ticking time bombs: they have not had health care in years but yet have serious chronic problems. They come to me with long laundry lists of concerns, many are in what I consider to be crisis mode with off-the-chart blood pressures and spilling sugar into their urine because of uncontrolled diabetes. They have moles, bumps, lumps, growths, pain, asthma, COPD, discharge, limited ability to move and so on. It is impossible to review everything that needs to be reviewed within the cushy 30 minutes allotted to each patient.

For these reasons, my schedule is further filling up with follow-up appointments. In an effort to keep these patients out of the hospital, I am seeing a few of them on a weekly basis trying to get them to an acceptable baseline. It is a lot of work. It is also very expensive as many of them need to be referred to specialists at this point. I can't help but to think if they had been treated sooner things would not have progressed to such a demanding state.

It does my heart good, however, that the majority of my patients are very cooperative. I prescribe the medications, make the referrals and provide lots of education and they are listening to me. Maybe I have been in healthcare long enough that I forgot that there are people who do not understand what exercise is, who don't understand the basic food groups, who can't understand the labels on the medication bottle. When I explain these little things to them, they have incorporated them into their daily routine. I love it when my patients beam because they dropped a couple pounds or their blood pressure is "within range"--they are proud that they are doing the right thing. And when they say they feel better--well, my day is made. It is my opinion that people as a whole want to take care of themselves but they do not know how.

That said, I think it is a shame that we have large parts of our population that have been in the dark for so long. It is a huge disparity that should never exist in a civilized, progressed society. Yet we keep insisting that healthcare should only belong to the people that can afford it. We insist that insurance companies with their medical directors making multi-million dollar bonuses for cutting costs and reporting profits to shareholders is the better option.

The people I treat work in jobs like construction, farming, milling and other very hard labor jobs. Very few of my patients are actually unemployed but they could not previously afford health insurance. And these jobs that I listed, these are jobs that the rest of us need to have filled so we can perform our jobs, too. I need someone to build the roads I commute on, to make the paper I put my signatures to, to harvest the vegetables I put on my table.

Such it is: we live in a world where things cycle around. We need a healthy working class and to have that, we all need access to healthcare. I don't think the ACA is a perfect solution as there is still a large sect of working class that is still caught in the middle--not able to afford private insurance but still too "rich" for Medicaid--but many people have benefited. I hope that watching this change will drive us closer to a single-payer system when we can all assume that basic healthcare is part of any decent society.

Reclining Society Podcast

Maria and I used to podcast under a different name before; these days we are podcasting under our blog name, Reclining Society.

This first podcast is a little unbalanced, but stick with us and offer constructive suggestions if you like what you hear so we can continue to improve our discussions!

You can listen to it here:

http://awscdn.podcasts.com/Reclining-Society-1-b434.mp3

Here is a list to the articles referenced during our discussion:

http://www.slate.com/articles/technology/data_mine_1/2013/09/facebook_privacy_and_kids_don_t_post_photos_of_your_kids_online.html

http://www.cbc.ca/news/canada/british-columbia/sexting-teen-guilty-of-distributing-child-porn-1.2491605

http://www.theatlantic.com/politics/archive/2013/11/the-nsas-porn-surveillance-program-not-safe-for-democracy/281914/

http://www.bbc.co.uk/news/world-europe-25939737

And because I mentioned a few amendments from the Bill of Rights:

http://www.archives.gov/exhibits/charters/bill_of_rights_transcript.html

Irresponsible Fundraising by Public Education

My daughter attends a high-performing Title 1 elementary school--basically a school with a high level of low-income families. As for my little family, we fair well but we have no relation to Richie Rich and need to plan our budget. Each year I become disgruntled because of what I consider to be irresponsible and excessive fundraising. This year is no exception and a flier attached to my daughter's fundraising packet informing me that we need "to do our part" tipped me enough to talk about it. Here are the problems that I have with school fundraisers:

1) The fundraising projects continue school-year round. From walk-a-thons, to gift-wrapping, to candy sales, it's at least 3 to 4 times a year. Some of these fundraisers involve school assemblies to give the children a motivational rally to sell, Sell, SELL! When the school year is already so limited, spending time motivating children to sell things to earn "cool prizes" is irresponsible. Children should spend as much time in the classroom as possible.

Things I DO NOT want my daughter to have.

2) We are already a Nation of Stuff in a time when I firmly believe we need to start downsizing. These fundraisers are selling overpriced goods that nobody really wants. The companies behind the fundraisers pocket large profits and only give a small portion to the schools. They are bribing our children with prizes that are basically junk and cause clutter. (Part of me wonders how materialistic the schools are seeing as parents have to provide the bulk of supplies to begin with. Do they need all the stuff they claim to need? I am not in the school often enough to know, but I am interested in hearing what those in "the know" think.)

$16 for a bowl of pretzels? It can be purchased for $2 at the Quikie Market!

3) They involuntarily draft the parent to become an active participant. Even if my child does the leg work and solicits the goods, collects the money and then delivers them, I am ultimately responsible for her work. I will be the one to carpool her across town, to take the deliveries to my place of employment, to double-check the money she collects. These are not necessarily hard things, but if you are in a Title One school often both parents are working, there are single-parent families with the parent working, the hours worked by parents are often the "odd shifts," transportation may be limited, some parents are not fluent in the English language. Having said all that, I think it is unfair of the flier to read "We ask that every student do their fair share and sell." 

4) It is uncomfortable to circle through your family and friends multiple times in a school year to ask them to open their wallets yet again. It's an imposition at the least. Often these people want to be supportive but again, being in a Title One school, selling things that aren't necessary, and doing this multiple times a year is excessive and inconsiderate.

Please note that this is not a blog about why schools need to resort to fundraising because of government cuts or misappropriation of tax funds or under-funding schools while funding national defense; that is its own topic that is too overwhelming for me to adequately address on this forum. (But if someone else wants to take a stab at it, we welcome guest bloggers!)

Recognizing it is unrealistic to do away with fundraising in schools all together (a noble goal), more effort should be directed to responsible fundraising. Here are some suggestions to make this happen:

1) Before the school year begins, have the various groups (PTA, after school programs, etc) meet to discuss a single fundraising project if it involves selling something and bribing children. Determine the goals of the fundraising projects--new supplies, new computers, the after school activities--and divide the funds appropriately.

2) The above mentioned project should be an event to sell something responsible such as first aid kits, emergency preparedness kits, other needed home items. They are out there and can make a huge impact. To encourage children to sell, work with local businesses to obtain gift certificates for a free ice cream cone or a movie ticket--things that can be enjoyed but do not cause clutter and waste!

3) There should be year-long standing fundraisers that do not cause such imposition to the family. I give the school credit on this one as they are very active with collecting BoxTops throughout the year. They also are involved in Scrip Fundraising, a program where local or online businesses provide gift cards ordered by the school and the businesses donate a portion of the gift card profits to the school while the purchaser of the gift card gets everything they paid for. I feel this is a win-win for everyone as the school gets the profit, the consumer can purchase gift cards for things that they already need (oil changes, groceries, clothing, etc.) and the businesses receive business and have a potential tax write-off. I would like to see these types of programs more heavily promoted by sending home fliers and emails to parents to increase awareness.

Does anyone else experience these same thoughts? Have you had any fundraisers that made you think twice? How do you think we should approach this topic? Any solutions I did not consider?

The Unintended Student Loan Scandal, written by C. Patrick

Enter C. Patrick., guest writer to Reclining Society and his take on the abuse of taxpayer supported education funding under the pretense of enhancing the collective society. He is a science professor to a major state college.

Today I was notified that I will receive a 3% salary raise owing to increasing income from tuition my college is receiving. Unlike many universities that are generating funds through tuition increase, my college has chosen to open the academic floodgates and increase total enrollment, nearly doubling the number of students in the past ten years. Although a boon to my place of employment and, more recently, my wallet, I have mixed feelings about this policy. While making higher education available to all is a noble idea, the underlying motivations for increasing enrollment and the effects on society are potentially less than ideal. Masked underneath the mantra of providing education for the masses is a more greed-driven agenda on the part of universities and colleges.

Grabbing a piece of the federal education loan pie has become the major priority among most academic institutions which results in increased personal debt for students. Even further, it creates increased pressure to prevent students from failing so the college may maintain its income. Students that probably should not have been admitted, and subsequently, should not have been allowed to continue, are instead bestowed degrees and pushed out the door to make room for the next customer. This has led to a commoditization of college education, and it is now not uncommon to see minimum wage jobs held by college graduates.

Overall we are sliding into a situation where taxpayer dollars in the form of loans and grants are used to saturate the market with college-educated job hunters whose degree has been devalued. I suppose one could argue that increasing the general education of a population is a good thing; however that’s essentially backing the use of taxpayer money on a very expensive social engineering experiment. While there certainly are methods of addressing this problem, including placing restrictions on the college majors eligible for federal loans, none are politically palatable, and most would probably be perceived as attacks on the ability of everyone to receive equal opportunities at higher education.