Saturday, December 13, 2008


I haven't written in this blog for nearly a week but it sure doesn't mean I'm not thinking abut things.

I am seriously concerned about the messiah's plans for health care and the claim that employer-based health care isn't working. Listen, I know that employers offer health care not because they really care about their employees, but rather it's a way to attract decent employees to the job. Nowadays few people care about other people because "it's the right thing to do." If the messiah wants to expand employer-provided health coverage he needs to speak the language employers understand—tax breaks.

I have a dear friend who is the political 180 of me. We do agree on a few things—leave the gays alone, allow a woman to make a choice about carrying a baby, and stem cell research is something that needs to be fast-tracked. But she feels business and its greed is evil and the only way to fix it is to have government regulate business practices and encourage unionization to ensure employees are treated humanely.

I hate unions. The two I was forced to belong to as an RN did nothing for me when I suffered my career-ending injury. At the first job, the union did nothing for me as far as assisting with modifying my job (in other words, it wasn't a good idea to have me to janitorial work or direct patient care. I was fine for treatments, assessments, teaching and documentation. Nope. Not even when a pair of utilization revue jobs came open did the union step forward and insist I get the job over someone who was not having on-the-job-injury problems.

I also hate unions because of the United Farm Workers, simply because those farm workers who marched alongside Cesar Chavez are still in the gutter while Chavez' family all live in palatial homes and live off of their dues. But I digress.

My friend also has multiple orthopedic problems that require frequent epidural steriod injections. We were commiserating one day and she told me that one of her spinal injections earlier this year was billed at $19,000. Yes, let me spell that out for you, nineteen thousand dollars. It was not a diagnostic procedure, the doctor knew exactly where he was going, and the procedure took 15 minutes. It was performed in a fluroscopy suite (real-time x-ray to guide the needles), and the doctor also had a couple of nurses and the x-ray tech in the room. She put $400 down as her co-pay and anticipated remaining balance.

When she saw the bill she went postal, but she went postal on the insurance company. Wrong organization to go postal on—the question is WHY did the doctor and facility bill that much? Anyway, four months later she needed a repeat of the injection and this time the bill was $6,000. Identical procedure, same place, same doctor.

She can't find out why the rates changed, so she likes to think it's because she negotiated. She's about to have another injection so we will see what this one costs.

I don't see my bills, I guess that is the advantage of worker's comp. At the time I was declared permanent and stationary (worker's comp term for "you are as good as you are going to be"), my attorney told me that my three surgeries had cost the State of California $250,000 (California Department of Corrections). I don't even want to think what that is in 2008 dollars (my last surgery was in 1994).

When I was still working as an RN in the small community hospital, there were several billing scales—MediCal/Medicare, private insurance and self-pay. At that time, self-pays were billed the highest amount (which I always thought was kind of strange; if you are in the position to have to self-pay, either you are Bill Gates rich or so poor you don't have a decent-paying job and make too much for MediCal/Medicare.). I'd imagine that now it's the insured who pay the highest rates ...

So who has the real answer as to why medical care is so expensive? Does the cost of working as a physician justify the rates? Is malpractice insurance eating up doctor's income? My friend tells me it's hard to get a case of malpractice into court. Is that true? Are the insurance companies misleading doctors and holding them hostages by scare tactics (you better pay or else you are going to be sued big time)? I do know that support staff have to be paid for out of the fees we pay our doctors. That charge of $300 for am uncomplicated 15-minute office visit isn't all going into the doctor's pockets. So just where do our health care dollars go and is this really a place for government intervention butting in?


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