You're Fat. Let's Cut Your Pay

Here's a real WTF. Apparently the Senate Finance Committee passed an amendment to the healthcare bill that will penalize workers not following a "healthy lifestyle". A blog post on the issue can be found here with links for more information.

Apparently it's unhealthy lifestyles that are entirely to blame for skyrocketing healthcare costs. At least, according to the idiots in government that is what is causing the problems. It's like the lack of standardized tests are the root of our education problems, not the fact that our culture denigrates intelligent people and glorifies people who are more into chugging beer and achieving touchdowns...our current President was actually losing some votes because he wasn't someone that voters would "want to have a beer with". That says something about our population.

I'll make it clear that I think our unhealthy lifestyle in this country is certainly not helping anything with the cost of healthcare. What I also see:

preventative care: poor people who wait until they are literally unable to function before being dragged to the ER are in a far worse spot than people who can go in to find out why that weird mole is changing shape on their chest or why the rash is getting painful.

Bureacracy eating time and resources. The bariatric office I have been working with has a person whose only job is to work with insurance companies. I've heard other doctors complain about having to fight with insurance companies, and read about doctors that have had to choose between diagnostics for people or letting them go without certain treatments because insurance companies say they wouldn't need it. Taiwan managed to increase health coverage to its citizens while having the lowest administrative overhead; they did it using smart cards that keep patient records and information, thus lowering insurance fraud, duplication of services and tests.

The cost of healthy living. These arseheads in government are the same monkeys that have a subsidy to corn farmers and tax sugar imports, meaning that the controversial additive High Fructose Corn Syrup...a possible contributor to weight gain...is very cheap and found in just about every @#% thing in the supermarket while sugar, natural sugar, is too expensive and thus harder to find. Gym memberships are out of the budget for many households, especially with today's economy. Eating fresh fruits and vegetables isn't very cheap either. There was just a study released showing how the healthy mediterranean style diet was more expensive than the more calories-for-your-buck Western diet.

Now these arsehats are saying that if you're overweight or smoking or anything else deemed "unhealthy" and not willing to follow some corporate shill's idea of a wellness program, you could get dinged with an increase in your premiums. In a time when people are struggling to keep a roof over their heads and are barely able to even get a job, somehow this is going to give incentive to become healthy. Here's a bit of news: making people miserable in the workplace isn't considered healthy living.

Do you think stress will help with health costs?

Do you think misery and stress don't contribute to being overweight? Or strokes? Heart attacks?

Don't you have a responsibility to be consistent in the first place...i.e., stop giving tobacco companies a free pass while at the same time penalizing the tobacco consumers?

What about lifting the taxes on natural food sources like sugar, and instead shifting some of that corn into alternative fuel uses instead of using them as a primary ingredient in McNuggets?

What about taking action to make it cheaper to eat fresh vegetables and fruits instead of salami and Twinkies? The government has no problem artificially manipulating the cost of things like milk and corn. Why not make it so I can buy fresh vegetables and lowfat ham and bread for my meals for less than the cost of a cheeseburger and McD's, all things considered?

No, no. These mustn't be considered. The real problem is that in a time when we're struggling to pay our bills, we need to add one more reason for employers to hate their employees and give another justification to cut costs by trimming headcount when employees, miserable and stressed by yet another pressure at work, aren't trimming their waistlines. All under the guise of "personal responsibility."

I didn't see it mentioned that people who are living a "healthy lifestyle", whatever definition they come up with for that will be, being rewarded. I only see punishment in the material mentioned at the original article. You're fat? Well...that goes into your record. Don't shape up and you might just happen to get let go at the next round of pink slips.

This sounds more like a federally legal way to discriminate. I really hope this gets slammed into the courts and the first person hit with this discrimination wins big. Maybe one day those arseheads on the hill in local, state, and federal governments will learn to get their heads out of their collective rectums and actually focus on something more important than whether or not Bob in accounting is twenty pounds overweight, or at least stop propagating the myth that there's one overarching cause to the healthcare costs.

Hmm...why is it that when discussing health costs, it's never at all the fault of the insurance companies that are making billions of dollars a year? It's never paperwork, it's never bureacracy, it's never making preventative care affordable, it's never our culture glorifying the lifePstyle of gluttany and excess, it's never linked to stresses and poverty? It always seems to be that it's because Bob is eating too many Twinkies. And it's conveniently Bob's fault. So now they're going to penalize Bob.

When I think of it like that I can't help but picture someone handing someone a chocolate bar then giving them an electric shock whenever they take a bite of it, or those oddball countries that managed to get laws that make selling sex legal but purchasing it illegal. Huh?

There are times I'm so fed up with dealing with the intricacies of human interactions that I want to just separate myself from everyone and live in an earth-bermed home in the woods all off the grid. I couldn't possibly be the only person that finds all of this to be ridiculous, am I?

Health Care Reform Proposal

The Junkfood Science blog has an entry regarding the Democrat's proposed healthcare plan, and if the 10,000 foot overview looks like spaghetti from this diagram then it's probably too complex to actually manage in any practical sense.

You might be able to find the blog article from either the link I embedded above or the blogroll on the right side of this page to find Junkfood Science and check it out.

It's so disheartening what a complex mess healthcare is. I enjoy the Junkfood Science blog; the posts are thought provoking and packed with good information. But I do think there's a bias towards strong opposition to the Obama health care proposal; which is fine. Everyone is entitled to an opinion on their own information site...you won't find much praise for Windows on this blog, for example (is there any? I don't think so...I know I have some good things for it though, just not good enough to have posted about it yet).

What I haven't really seen on the Junkfood Science site is a counterproposal or explanation as to why nothing proposed could work. Maybe she has posted the information and I've just missed it (like I said, I enjoy the site or I wouldn't waste my time there). There's something I learned relatively recently (meaning in the last couple years) and that is that if you have a complaint, fine, voice it. It's good in a team or group to have someone that can see the flaws in an idea and point them out. But try to have a counterproposal or solution as well. Just whining about the problems accomplishes nothing but makes you a poisonous element to any team or group.

Now that Obama is in the hot seat everyone is focusing on how we're hoping the healthcare reforms he'll start...and it's important to say it'll only start, not complete, since changes with government occur at a glacial pace...but that it'll probably fail. Every lobbyist and company with a stake in it is making sure they can yell, "I TOLD YOU SO!" when it doesn't work for everyone.

On the other hand, what is the alternative? I'm in my thirties and I don't recall any time aside from Hillary Clinton's efforts hearing about a concentrated effort to help American citizens get healthcare that didn't leave them thinking it would just be better to crawl into the corner and die rather than sort through the bureacracy to get better.

Republicans and insurance companies are saying that the government will stifle competition (yet I keep getting packages from UPS and FedEx...didn't we have a government-run group that delivered packages at one point? I think it was called the postal service...).

After three decades we're still in a mess and not the Democrats or the Republicans have done squat to help their constituents. The Democrats have been and are trying now to find a remedy. Politics as usual between our defacto two-party system is trying to hamper even that effort. Meanwhile we have 46 million Americans (as of 2007) without insurance and with the economy tanking the last couple years there's little doubt that number has risen significantly.

I'm begging. Stop bitching about the planned reform and find a solution. If you think you know better, then propose it. The last time the country actually set it's collective sight on a goal we managed to land an astronaut on the moon in surprisingly short time. Now why can't we get vaccines and medical care to our neighbors without putting them in debt for the rest of their lives?

Bueller?....Bueller?....

Insurance Politics Are A Racket

I toyed with the idea of putting this in the feed several days from now, but you know, this story is so outrageous that I decided to just plop it into the present time in the list.

Here's the story about one woman for whom a trip to the hairdresser was the first step on a road to ruination, financially and emotionally. I couldn't imagine going through what she went through and coming out on the other side a sane person.

It highlights so much of what is wrong with healthcare in the U.S.; the politics, the playing of the system, the bureaucracy, and the black mark that you end up having tattooed to your name for having the audacity to get sick.

What's really sick is the system.

Read the story. It's truly a terrible state that we're in when this is what can happen to any American and underscores the need for medical reform more than ever.

Do Insurance Companies Have Any Sense?

I love this.

The insurance company sent another of those "This Is Not a Bill" forms that are basically a warning of what benefits are or aren't being properly paid for. This one says the hospital will be charging me five thousand dollars.

Huh?

A lot of people who have this surgery are self-funded. Many others...no chance Hades can they afford it. I wouldn't be surprised if a lot of people who self-fund the surgery can't really afford it but do it anyway, hoping they will survive long enough to pay the hospitals and doctors back. More insurance companies are starting to cover the surgery because apparently the people that can understand their own complicated paperwork system and stackloads of billing procedures somehow figured out that the money spent on paying for complications from obesity is less than paying for weight loss surgery among their insured clients, on average.

Did I say they understand their own complicated paperwork system? Ha!

Where was I? Oh, yeah. Insurance covers the surgery more often now. I belong to an insurance company group that now covers, with pre-approval and a checklist of hoops to jump through, bariatric surgery.

But what I save in money is killing me in aggravations. They've screwed up paying for pscyhotherapy, which they mandated I undergo. They nearly turned down approval for the therapy because I wasn't getting psychotherapy...days after they sent a "this is not a bill" telling me they just paid the therapist. That's just two screwups along the way...

...Now they're telling me I owe five grand.

My copay is two thousand dollars. I tried paying that to the hospital...a month later I got a check in the mail for two grand. Huh?

I called the hospital, they said the insurance company paid them. I called the insurance company, they told me they paid the hospital. But they didn't pay the surgeon yet. They're separate? I always assumed doctors kind of work in the hospital, but...um...no?

They told me to wait until the surgeon's billing goes through. This was about a month after the operation...isn't getting paid the kind of thing people put their paperwork in relatively soon after making sure their patient survived the procedure(s)?

So another month later...I get billed for five grand. I think there's a discrepancy.

And because it happened to arrive on a Saturday, I have to wait until Monday to get any of it sorted out. Again.

How is it that we have technology that allows the police to track your whereabouts, including an approximate speed you're traveling, if you have a cellphone...police can track down where you last used your credit cards...the military has satellites that can take photos that can identify, roughly, make and models of cars...but your insurance company to whom you give so much information can't seem to figure out that they paid for XYZ prerequisites, okayed a procedure that will require ABC bills, but then forget that they even okayed the procedure in the first place?

Isn't that a sign that, as a business, you are kind of screwed up?

Hospitals are trying to cut back on some of their redundant paperwork through computerization. Poorly implemented, this can be a nightmare, and I don't know what it's like "on the inside" for doctors in the hospitals I have to work with. But from the patient point of view, the customer point of view, it makes a little more sense now when I'm ordered to have labs performed that instead of getting a piece of paper and walking down the hall to hand it off to a tech I simply walk to the lab and give my name and doctor who ordered the tests and they punch it up on the computer system. Handy, huh?

Insurance companies have the power to bankrupt us, as do hospitals. It's funny that when they want to get paid you better pay up or it's implied that a large man named Guido will be paying you a visit sporting a large baseball bat and shiny sunglasses. But when THEY screw up, what recourse do you have but to hope they don't order a colonoscopy as punishment?

Thanks to various government rules corporations are treated as if they were people. I have to wonder...because of the view, would insurance companies ever have to have colonoscopies?

Health-Related Debt and Bankruptcy

Here's a disturbing story. It states that medical bills contribute to 60% of declared bankruptcies in 2007. It's a scary trend.

Wanna know what's even scarier?

Of those bankruptcies, 75% had health insurance, but the bills still overwhelmed them.

This isn't saying that the medical bills alone were the cause of the bankruptcy but they significantly contributed to the problem.

There are other scary findings in the study; things like the number of insurance companies that drop clients right after one disabling health problem because they're too expensive (one quarter of insurers), and even more within a year (another quarter).

It's sad...I'll never be able to think of those $10 Tylenol pills I received during my stay in the hospital and not think about how overpriced medical care is. I always sit and wonder about what kind of braintrust came up with the game where hospitals charge three times more for various services knowing that your insurance company will only pay a fraction of the bill, giving hospitals more reason to exaggerate their bills even more in some kind of brainless monetary arms race. It's ridiculous and absurd and frankly I'd like to think if it weren't for the powerful lobbies people would be angry enough to have done something about such a situation.

Maybe we should contact our representatives who are supposedly in Washington working for us to let them know how absurd this is...

Copay Confusion (Or: I Hate Insurance Bureaucracy)

I got a call from my wife. "I picked up the mail and there was a check from the hospital for two thousand dollars."

Um...okay.

Ordinarily I wouldn't question it. I'd cash it and we'd have a fun weekend away, especially with a three-day weekend coming up for us.

But seeing as this came from the hospital that a little over a month ago had cut me open and knowing that my copay for the operation was two grand, I thought this was a little too good to be true.

I called the hospital. "The insurance company paid your bill from us in full, so we mailed you the difference."

"They paid in full?"

"Yes. All paid."

Oooh...what was that feeling? Hope? I didn't eat yet...so it can't be an overeating pain, or a pain from something too dry trying to fit through the food hole of the stomach...must be hope. Much needed money!!

But still I've been alive long enough to know that these things don't happen to my family.

I called the insurance company and explained what happened. The nice service rep checked my benefits and information on the procedure, and came back and confirmed that yes, they paid the facility bill in full.

"In full?"

"Yes. But we're processing the provider's bill. It can take up to two weeks..."

"You paid the facility bill, but not the provider bill?"

"Not yet. We're processing the claim. So your copay may go to the provider, the surgeon. You should hold on to the check for two weeks until you get the explanation of benefits..."

Ow, ow...ow...oh, that feeling just drained away. Now I don't know if it was hope or gas.

This is a wonderful example of user-friendliness. To me, the end user, I owe money to some monolithic entity, the hospital. We give them money, they disperse it as necessary...I assume they employ the doctors and whatnot.

Apparently this implies that doctors are like consultants working for the hospital and as such there's two or three times more paperwork that snakes through insurance companies and the hospital, making it much harder to keep track of anything. This also means that two or three months later I'm still getting papers trickling in saying what is owed and what's paid and not paid.

I had paid my copay ahead of time so avoid hassles. Instead I've created another hassle for myself. @#$%#

Ideally the insurance would pay what's needed and the process would be streamlined to the point where I wouldn't need to track all these various places money is owed and who got what. I'd have a form or website for "medical" that would state where to send money, authorize the transfer on a certain date, and fwoom, done. I could get an instant update on where the money is and the status of bills, and maybe even have a link that I could click to send queries to service reps about questions.

It would be a wonderful idea but because of the bureaucracy involved in trying to get insurance companies and hospitals and doctors to work together it would be a monumental undertaking. I'd have better luck finding a way to get a live webcam broadcasting from the moon.

Anyway I'm now going to cash the check, set the money aside again, and wait until the bill comes so I know who to pay and my dreams of having a brief, relaxing vacation has been dashed as quickly as the hope rose in my chest. Or the gas. I'm still not sure which it was.

The Cost of a Tinier Stomach

Some may wonder how much surgery like this costs. My employer happens to carry insurance for me that took care of a huge amount of the surgery bills, but I did have a significant copay.

I recently had the insurance statements come in. If I totalled everything correctly...and no doubt this is rounded a little and doesn't include the consults and psychiatric evals and appointments and whatnot...the surgery and recovery in the hospital came to about $15,000.

Ouch.

Again, not out of pocket entirely except for my copay, but it amazes me how much hospitals charge to insurance companies and what small fraction is actually paid.

Is this average? Anyone else know what theirs cost, approximately, and is willing to share?

EDIT: another bill statement came from the insurance company. Adding this anesthesiologist's bill, the total is closer to $17,500...so far...

Doctors and Email

The nutritionist I had been seeing just before my surgery left abruptly.

I don't know the details, I just sort of heard about it when I was recovering in the hospital. Apparently she and her husband had an opportunity to move back south, something they always wanted to do, so they took it.

I met the new nutritionist last Monday. She seemed nice, maybe a little frazzled; we had been told before that she's hard at work filling the void left when the previous nutritionist vacated the position. They had a lot of backlog with new patients as well as taking care of the post-ops. So a little frazzled can be forgiven.

The thing that I was impressed with was that she gave us her email address!

I rarely encounter that. I don't know if doctors...medical staff in general...are technophobes or just think that such information would be abused (which wouldn't surprise me). I very much appreciated it, though.

Two days later my daughter tells me there was a call from "a " with a number local to a city an hour away. It was late when I got home, so I didn't return the call...the next day I emailed her to see if it was her. She replied, I gave more information and she replied right back. Two quick emails. Quick and convenient!

I don't want to abuse the access to mail but I did let her know that I really appreciated being able to get quick access for a minor question without having to interrupt her (or myself) with a phone call.

I remember having one medical staff member tell me that they don't do that sort of thing because it wouldn't be billable. My thought is that if you can answer the question in two minutes with an email, it would be a far better use of your time than having to inconvenience the patient by scheduling an appointment for a quick question or having to waste the medical professional's time with the paperwork and hullabaloo of an in-person assessment for a five-minute problem.

How about you? Have you any experiences with doctors giving out their email addresses for questions, or have you found my experiences to be the norm?

Your Medical Care and How IT May Kill You

I just finished reading a very interesting article on how electronic records...mandated for hospitals by the federal government in coming years...nearly killed the author of the article.

I added this blurb for a couple reasons. First, I just spent about four days in the hospital having RNY surgery and I spent nearly a month in a hospital suffering from pancreatitis and gallstones. In both cases, at two different hospitals, I had a consistent experience; I typically saw doctors once or twice a day, and nurses (and their assistants) were on a rotating schedule to check on me and in both cases it was the nurses that made me feel the most comfortable and seemed to be working, from my point of view, as advocates for my care. The author attributed his saving grace to be a nurse who worked on his behalf to correct errors and try getting medication to help him (and his wife sneaking his medications to him).

Second, while his article is a scathing review of the current generation of IT technologies for turning patient healthcare into electronic records, even he acknowledged that the shortcoming isn't necessarily with the IT as much as it is IT vendors not creating systems that fulfill the needs of the doctors. He lays the blame at the feet of the IT departments, vendors, and ISV's who make the varioius software packages.

I would argue that it is not just the vendors, but the users. I don't think they know what they really need or want. Most people, asked to specify what they want in a car, will not know truly all the things they want in the car. I can barely remember all the things I need to take with me on a trip for the weekend. How can most people remember or know all the things they'd need with a system as complex and encompassing as medical software that is supposed to meed the needs of everyone working in the hospital?

Third, in reading his account of what happened to him it seemed as if the doctors "fighting the system"...the poor data model...were still kind of stupid in their actions, computerized list or not. He had several alarms go off that no one replied to. That's not a computer problem. He had people ignoring what he already knew...such as the effectiveness of the Albuterol in alleviating pain...and doctors that simply were not listening. The people "fighting the system" to help the guy were nuts for not listening to the patient in the first place and not exercising good common sense!

Read the article. What do you think?

Insurance Companies and Hospitals

I got a bill from the hospital today. This was interesting primarily because I shouldn't owe anything. I already paid the hospital the copay on the operation...a couple grand we've been saving up specifically for the procedure. So you can imagine my surprise when I got a mailing telling me that I owed nearly one thousand dollars that I don't have for "outpatient services".

I called them up and the lady on the other end of the line didn't hesitate one moment before saying, "Yeah, there's a problem with your ID number for insurance." I dug out my ID card, gave them the number, and she typed quickly on a keyboard and asked for my employer and name of insured. Gave that information as well, and she just thanked me.

"So...I shouldn't owe anything?"
"We won't know until insurance gets back to us."
"Okay...I won't have this bill then?"
"I don't know. We'll know when insurance gets back to us."
"Well, do you have an idea how long that will be?"
"No, we don't know when another party will get around to processing the information"

Am I the only one so fed up with bullshit from these companies? I mean, there are people that can get information on my current purchases listed on my credit card, my employment history, what cars I drive...all of this can get pulled up from databases. Yet these gooftards can't seem to keep my insurance information straight, and when trying to get things sorted out, the insurance company takes weeks to figure out how to pull their craniums from their rectums.

Worse I have to wait a few weeks to figure out if I have some kind of thousand-dollar bill outstanding despite the fact I'm not supposed to have any more out-of-pocket. That gives the hospital time to screw up the bill that I didn't pay because I called in the day I got it to be told I have to wait and find out what's legitimate or not for billing, then I'll get a notice saying that I owe the bill plus interest when really I shouldn't have owed anything in the first place!

The whole system is screwed up and the most frustrating part is there's just not much we can do about it. Makes one want to scream. But that still hurts my incision...