I reported last week about my disappointing visit to the pain doctor last week, a ten-minute interview that led to no change in treatment despite the fact that I told the doctor I am desperately hoping to change my treatment.
Yesterday another sharp pain arrived: A letter from the insurance company. That tiny appointment, where no exam and no test was done (not even weight and blood pressure), cost $400, $187 of which I have to pay.
This is insane.
"Tell me, doctor, will he live?" "As long as his money holds out, yes."
I understand that when you go to the doctor, you're not just paying for his time and expertise, but for all the expenses connected with running the practice. Same if you hire a plumber; his vehicle and tools are all part of what he has to charge. But $400 seems pretty excessive, more so since it was a very unsatisfactory visit.
My wife suggests that I get in touch with the original doctor who saw me, the one who runs the practice, and explain that I am dissatisfied. I think it's a good idea, although I doubt I will get any joy from it. This is all part of the mess that is the state of modern medicine -- overworked practitioners; patients who abuse services paid for by others; free marijuana; astronomical costs for malpractice insurance; pressure from snake-oil salesmen to cover Reiki and supplements and dance therapy and Chinese traditional medicine and crystals and all manner of woo-woo stuff; practices consolidated into pill mills and poorly run clinics; insurance companies putting the squeeze on customers while colluding with government to get richer; patients who expect to be fixed after a lifetime of bad choices; and medical education that is sure to teach students carefully how to address patients by preferred pronouns but not to actually listen to their concerns. If I could stay away from it all and take my chances I would, but this stenosis is more than I can handle on my own.
As I sit here, I am typing mostly with my left hand, as my right arm is pressed against my side, an ice pack jammed in between. I feel as if a red-hot knitting needle has been stuck by Captain Ahab into the softest part of the upper arm. Nature sucks.
I was talking with a neighbor as the dogs peed, and suddenly felt this horrid shot of minuscule agony zing through me. It was centered in that tender part of the arm. I have only ever tested positive for yellow jacket sensitivity, but this seemed to have been a bee, since a stinger was left in me. One way or another, I got the sensitivity reaction. I had to excuse myself from the chatty neighbor so I could get the dog inside to howl. Me, not the dog.
No trip to the emergency department, though. Just little continuing spikes of pain at random intervals all night. Next day, the upper arm will turn into a large, hot welt, not generating enough heat to fry an egg, but enough to feel like a hard-boiled egg to the touch. The pain becomes dull, accompanied by itching. For the next three to five days, mostly itching, fading as slowly as an old actor who won't let go of the limelight. Basically, a week of discomfort, all because some little freak of nature got caught in my shirt and blamed me for it, when I didn't even see the aerial son of a bitch until it zapped me.
I know this is Mother Nature's doing. She is pissed at the piece I wrote about her stupid, stupid bugs. It's been what, three years, I think, since the last time one of these striped bastards got me, but Nature, who is a mother, suddenly decided it was time. Coincidence?
She reads my blog. I mean, I guess that's nice, but still.
I guess I ought to shut up while I'm still alive and not broke. Experience has taught me that the EpiPen doesn't really do anything to allay my reaction. I have one anyway, more as a security blanket in case my reaction has gotten worse since the last time.
Like everyone else I've been hearing about Mylan becoming the Worst Company in the World for jacking up the price of the EpiPen. Almost no one seems to have factored in the tax on medical devices that is part of Obamacare (no one but Kevin Williams), or that the FDA has all sorts of barriers preventing the sale of competing devices (no one but Megan McArdle), and no one seems to understand why Mylan and other healthcare companies have seen fit to do this---because the Supreme Court said insurance can be mandatory, that's why.
If you're covered, and we all have to be, the cost of the EpiPen will be covered to large extent and so the price hike is not so obvious when you go get one. So when your premiums skyrocket to cover these kinds of costs, you'll blame the insurance company, unless you read the paperwork (and even then you kinda blame the insurance company). So I'm surprised Mylan got caught on this gouging scheme, because it's going on all over the place and for the same reason---because government started screwing around with health insurance.
The old saw about subsidizing something meaning you get more of it doesn't apply to health as much as to health costs. Subsidize the cost of health care and amazingly, everything suddenly costs more. It is very much like the government giving money to colleges and students, and seeing a stratospheric rise in tuition.
So I hate everyone involved in this, but until the pain and itching go away, most of my hatred is directed toward the insect world. Some say Monsanto, a frequent winner of the Worst Company in the World sweepstakes, is killing honey bees and stuff with their chemicals. I urge them to focus on the wasps, but for the most part, kill all the bugs you want. I hate them. Momma Nature seems to always find a way to make more of the little creeps anyway.
So I heard on the news that UnitedHealthcare has lost so much money on Obamacare patients that it is aiming to leave the health exchanges by next year. As it turns out, UHC is not even one of the biggest players in the field. Humana, Aetna, Anthem, and Blue Cross are more heavily invested and are suffering more and greater losses.
"My Heart Bleeds for You"
I hope all the insurance companies wind up begging for money, begging to be released from their commitments, because they could have stopped this thing. They may eventually realize that the plan was always for them to become wards of the state, eventually incorporated into the Department of Health & Human Services as part of US National Healthcare, but by then it may be too late. The greedy suckers only saw millions of people being forced by government's lethal power to buy their products, and they fell in line. Well, that bayonet points at everyone eventually, smart guys.
Will it be worth it to completely wreck what's left of our healthcare just to see the unindicted co-conspirators go down with the ship? No, but it will be a bit of consolation. Like enjoying the band as the Titanic takes us under.
I still have some hope that good, streamlined law could replace the bad, unwieldy law, something that perhaps doesn't require a million bureaucrats, arbitrary rulemaking, or brutal punishment for people who work for a living. I tried to do my bit toward that this morning, at the polls, but it's a long shot regardless of the outcome. We shall have to see.
In the meantime -- young and healthy people, keep sticking it to the Man by not buying health insurance, even if they make you pay a penalty. It's not a tax, no matter what the cursed and wicked Supreme Court says, so you do what you have to do to avoid it. That will bring the phony baloney structure down around their ears.
Meanwhile, my ears will be busy listening to the violin above playing for our friends in the insurance game.
The whole town is lighting up in that festive way that says, "We have lots of lightbulbs!" And "It's Christmas!" And, "If you're at our tiny downtown, do your Christmas shopping at the barbershop! Or the pizza place! Or the cell phone place! Or one of 15 beauty salons!"
I say, bring it on. The more the merrier. I love Christmas, and I especially love Christmas lighting, coming as it does at a time of year when we get so little sun that adults are starting to get rickets. I'm definitely one to prefer lighting a single candle to cursing the darkness, although some do disagree.
Of course, there are challenges to dealing with Christmas lights, and I'm not even mentioning the horrible wiring problems or carelessness that causes house fires, injuries, or worse. (If you are decorating, do yourself a favor and check the Consumer Product Safety Commission's holiday decoration safety tips.) No, I'm just dealing with the impossibility of reusing lights from year to year. Fresh out of the box: Lovely, uniform, exciting.
Wrap them up as carefully as you like---come the day after Thanksgiving, they're the snarl from hell. (Pro tip for mad bombers: Using tangled Christmas lights for bomb wiring will completely prevent the hero from stopping the bomb with 007 seconds left; he'll never find the right cord to cut.)
Mrs. Key is of the opinion that the smart thing to do is throw out the old strings of lights after Christmas and buy new next year---or better yet, pick up some new ones immediately at post-Christmas sales. I missed the sales last year, though, so I saved the old ones. This year they were as snarled and tangled and mangled as the Affordable Care Act. But unlike the ACA, they did eventually get untangled and they actually worked.
And I do hate to throw out lights that still work. I come from a time where Christmas meant big, fat, hot bulbs with meaty wires that got used year in, year out, until they burned down the house. And we liked it that way!
I was thinking about the rising costs of medical care and the largely urine-sample-poor job of bringing down costs that insurance companies and---God help us---the government has done.
One problem is that medical advances are always expensive, and while we want everyone to have access to everything, no power on earth can afford to give everybody access to everything. Ultrasounds are still costlier than most of us would want to pay for out of pocket; CT scans even more so. There's an economy of scale and a cheapening effect over time on new technologies, but they can only go so far. It's going to be a long while before the local CVS has a tube where you can pop in and have yourself scanned for free while waiting for your bottle of oxycodone.
Another great example comes from the 1966 science fiction classic Fantastic Voyage, wherein a team of scientists is shrunk down in a submarine and injected into a VIP to break up a blood clot in his brain.
How much do you think it will cost to send a molecule-size Raquel Welch into your bloodstream? The HMO ain't gonna touch it. How would you like to be one of the people on the Independent Payment Advisory Board death panel who has to turn down access to the "shrinkerizer treatment" because no way can we pay for everyone to get this thing?
In the case of the movie, the guy they have to save has technical knowledge that's key to the shrinking process and so is the focal point of the Cold War battle over shrinkerizing. Not ones to shrink from danger, our teeny weeny scientists risk their lives to save his. This inspired me to come up with...
The Fantastic Voyage Scale of Importance
Under the assumption that if you're going to have five human beings with advanced degrees injected into you (at taxpayer expense) you have to be very, very, very, very important, we can extrapolate that the kind of care you're going to get is directly related to your personal importance. Here's the scale; where do you fall?
Title: Top Dog
Importance: Your life may win the Cold War for the forces of freedom.
IPAB says: Will shrink down Raquel Welch and inject her into your bloodstream.
Title: Second Banana
Importance: President of the U.S. or wealthy founder and head of a company that gives a lot of dough to the president.
IPAB says: Will shrink down some people and inject them into your bloodstream, but no one good-looking.
Title: BFD
Importance: Beloved celebrity; speaker of the house; Veep.
IPAB says: Robot version---the Raquoomba---shrunk down and sent in; at least we can say we tried.
Title: Well-known for Being Well-known
Importance: Celebrity on an old TV show; sales quota achiever; governor with good poll ratings; mayor of a big city with a strong political machine.
IPAB says: Balloon angioplasty or something. Tell the doctor not to go nuts. Show poster of young Raquel Welch in office.
Title: Local Hero
Importance: Local mayor; business leader; cute little kid; veteran (honorable discharge).
IPAB says: Nothing outside of the PDR please; we're not made of money here. Poster of Donald Pleasence.
Title: Schmoe Six-pack
Importance: Someone's dad, maybe.
IPAB says: Inject something. Whatever's lying around the doctor's office. The PA can handle it. Tell 'em Raquel says hi.
Title: Who?
Importance: Family pet; homeless bum; writer.
IPAB says: Don't waste a needle.
