Health What?

A couple weeks ago (was it more) I wrote encouraging a filibuster on the cobbled up health care bill(s) that are in the news, in debate, and in flux. As I have repeatedly noted, when it comes to fiscal savvy, I was last in line when the boss passed out gray matters in that area. However, I have read and heard enough to know that any bill plastered together by politicians will be one that helps not their constituents but will help those who put the most in their campaign coffers. I also suspect that whatever either side says about the cost and the paying are both, simultaneously, lies. If an estimate involving a bunch of zeroes comes from politicians, you can bet the three bucks you’ve been sitting on for a Starbucks mocha latte that that number will be off by at least six zeroes. And you can up the beat by wagering a chocolate-java cappuccino that ninety-five percent of the people living here will suffer for it.

We all know we are in harsh times economically, and I do want to share some personal adventures that illustrate partly why we are in such a mess when it comes to health care and our economy. First, a few years ago some local, toothless idiot sailed exactly into the dead center of the rear end of my Taurus station wagon. I ended up in the hospital with a couple of compression fractures and two herniated discs. I was referred to a pretty cool doctor up in Annapolis who regretfully wasn’t so cool to his wife; he sold out, beat it for California, and left my records with another surgeon in Baltimore. The divorced doc and I had decided that before any surgery would be done for the neck thingie, we would try some pain blocking shots if things started hurting really bad. Well, in a couple of years, they did, and I called up the good doctor with whom my records now are parked. His “office” said that I should come on up, that the doc would review my films and records with me and that we would schedule a shot event. I am at this point pretty dang happy as I tend to put off a deals with folks in the hurting businesses, doctors, dentists, and lawyers. I drive a couple hours to Mt. Sinai in Baltimore, find the doctor’s office, wait for forty -five minutes, meet and shake hands with the doctor who tells me that I need a new MRI and other stuff and that he hasn’t looked at the earlier dvd or the other records because they are lost in boxes in his old office. This entire conversation took four minutes and forty-six seconds; I checked. The ride home in a down pour took two hours and thirty-five minutes. On the way home, I am cussing myself for not being proactive and telling the doctor that I would be needing new tests before I came up, but then again I have never had too much luck telling a doctor anything. About six days later, I get a statement from BCBS showing where the good doctor had billed 245 dollars for the consultation and that because he was participating in their plan I had saved 60 bucks. OK, now I am not real good a higher math but can figure that there are 12 five minute sessions an hour and if he works for 5 hours, leaving 5 hours for making some real money in surgery, he can bill about 4500 real dollars a day (I do not know why doctors show a 245 dollar charge when they know they will settle up for 180 anyway; a former pharmacist says it is because the bill is general to fit all the possible health plans out here or lack thereof. But if that is the case why in the world did “the office” ask for my provider card?) Anyways, 180 is a lot for a five minute conversation and the doc sure as hell could have said that I should get tests X, Y, and Z before we met. But then again, I have never met a poor doctor.

Another story: an acquaintance had a bummer of a PSA, but his doc couldn’t see him for a couple of months. So he gets another PSA despite the protests of two doctors and the results are moved on to the urologist. He takes off work and rides about an hour expecting a biopsy and some bad news. He gets into to see his urologist-of-choice who informs the lucky rascal that the last PSA dropped significantly and that no biopsy is necessary (another PSA dropped some more, I am happy to say.) I never did ask what he was billed for that four minute and twenty-five second consultation, but I’ll bet it was a hell of a lot of lattes. A simple phone call would have sufficed and a small bill for that phone call, say 10 bucks would be fine, figuring any competent high school graduate can make at least 20 such phone calls an hour, more than covering the 15 bucks and hour he/she makes.

Finally, my true stories turn to pills,pharmacies, and politics. I did business all my life with local drugstores that were bought out by a succession of growing chains until finally all my prescriptions were in the hands of Rite Aid. Rite Aid got a good deal on some corner property and moved into Maryland. I am not real wild about paying taxes in Maryland, but prescriptions are not yet taxed so I was OK with the move. But Rite Aid forgot who I was, and I didn’t know a damn soul there, and all the new folks were either hiding behind walls of cookies, licorice, and condoms, or they were just plain rude. Consequently, I quit Rite Aid and take my pitiful little business to an Epic pharmacy run by one fellow and one clerk. I am happy that they know my name, will deliver if I get in a pinch, and am liberal enough to like supporting what really is a small business. BUT, my prescription plan is run by Medco, chosen by some mental giants in Delaware to administer the pharmaceutical-plan of all state employees and retired state workers. Good move, we sure don’t want government running the health plan. Yet, Medco while being a manager is also a purveyor of drugs, huge company, selling ninety day supplies delivered right to my doorstep. But I do not want my drugs coming in the mail; the mail is for bills, cigars, and flavored lubricants. So, I stick with the small guy. But he can’t make any money, actually loses money if he supplies my non-generic meds for ninety days. But I stay, not because I am a multi-millionaire, but because what it costs me for a thirty day supply versus ninety days’ is worth it for the personal service. However, Medco comes up with a new plan that if I don’t get ninety supplies, I have to pay an extra 40 dollars every other time I refill for 30 days. Now, I can’t afford to use the guy who knows my name and will probably have to go to humping Happy Harry’s which is really Walgreen’s or to ratsville Rite Aid. Oh yes, nobody so far in Delaware politics can tell me just how we have what appears to be a conflict of interest in pharmaceutical management. If the powers to be wanted a single provider, they should have said so and forced all who worked for and retired in the state to use Medco; at least that would have been up front. To exacerbate this deal, I tried to get a shingles vaccine, but it would cost me 45 dollars copay plus 230 dollars because the Epic man-in-white has to pay that much past what is allowed. I called Medco to find out how come. I talked to two women there who knew not only what Medco was allowing for the drug but also what my pharmacist was paying for it. Both women insisted that my pharmacist was refusing to service my account, but when I asked them why a business man should provide a drug that cost him more than they would reimburse, they just didn’t get it. Finally, when a supervisor told me that she was not concerned about every mom-and-pop drugstore out there, I gave up and hung up, nicely.

For sure Epic has failed my friendly pharmacist; I guess because it is not buying enough or smart enough, and of course, we can’t survive growing health care costs by providing drugs that are more expensive than they should be. Thank goodness for the other guy who went through the PSA deal or I might get to thinking that I am the only guy in the United States that all this stuff happens too and that everything is just dandy with health care like some are saying. Oops, nearly forgot to tell you that Medco stock is up 13 percent in the last month, go figure.