Wednesday, September 16, 2020

A Brief Journey through the American Healthcare System...via Medicare (Copyright 2020 Virginia Zurflieh)

 


Author’s note: I’ve published this account on my Boxer Underground Blog, but be forewarned, its only relation to Boxers is the fact that my son and daughter moved in and cared for my three Boxers (and me) while I was in the hospital, and later, while I was recovering at home. Thanks, Linda and Rob! (Photos of Uno, Emma and Remy by Robert Zurflieh)

 

A Brief Journey through the American Healthcare System

…via Medicare

Copyright 2020 Virginia Zurflieh

 

What was I thinking? Apparently, that I was going to glide serenely through life from my 77th birthday to my 100th (thereby topping my mother’s record by 57 days) and arrive at a painless oblivion sometime thereafter…in my sleep.

I didn’t purchase a Medicare supplement and I hadn’t updated my six-year-old “homemade” will. I intended to have plenty of time to take care of things like that later.  I did sign up for the prescription coverage part of Medicare (Part D) – which is basically private, for-profit insurance – when I retired 12 years ago, but dropped it shortly thereafter. The insurance provider had steadily increased their rates, despite that from that date in 2008 to the Saturday morning in 2019 on which I went to the hospital, I was filling only one $10 prescription a month, plus the odd antibiotic for a dental procedure or sore throat now and then.

Then…WHAM…a trip to an urgent care clinic early one Saturday morning, a CT scan, a trip by ambulance to the hospital, more CT scans, exploratory surgery and a 28-day stay in the hospital followed by a 20-day stay at a “rehab center” – really a nursing home and a truly awful place. Also, three subsequent week-long stays at the same hospital and three months of home healthcare.

In addition to learning how totally unprepared I was for a major medical emergency, I also gained some insight into several facets of the American healthcare system that I would never have been aware of if I hadn’t been personally confronted by them.

1.    Immigration (yes, immigration): Judging by the hospital I stayed in, immigrants are utterly essential to the for-profit American healthcare industry, especially in Florida. My first stay was 28 days on an ICU floor. A large percentage of both the professional and support staff were immigrants. Many, but by no means all, were Hispanic. My surgeon was Croatian; the cardiologist was Indian as is my primary care physician (PCP); the GI specialist was Middle Eastern. Everyone that I encountered was competent and courteous. Most spoke fluent English. The same was true in other areas of the hospital in which I stayed during subsequent admissions. I can’t imagine how this hospital could have functioned without its immigrant staff.

 

The staff at the “rehab center” at which I spent 20 miserable days was also largely comprised of immigrants, but although most of them were helpful and kind, some spoke almost no English and were clearly several rungs down the status ladder from their hospital counterparts.

 

2.    Pain Management (as opposed to pain relief): Because of the current opioid addiction crisis, doctors these days live in fear that their patients are going to become addicted to the pain medication they prescribe. So, they prescribe as little as possible for as short a time as possible.  For me, it was simply a matter of trying to time one of my steadily decreasing number of pain pills per day to a half hour before the wound-care nurse came to change the wound vac three times a week. For people with unbearable, long-term pain – cancer, a broken hip, a condition that cries out for heavy-duty opiates on a regular basis – the prospect of their physician’s new pain management protocol must be terrifying.**

 

3.   Physical Therapy: PT joke: “I’m a Personal Torture Instructor…I Mean Physical Therapist.”  I’m sure many people benefit from physical therapy – people who’ve had orthopedic surgery to repair or replace a knee or hip, for example.  But I wasn’t in the hospital for a hip replacement and attached as I was to IVs and other medical paraphernalia, wasn’t even up for a walk to the bathroom. Nevertheless, because physical therapy providers contract with hospitals, rehab centers, etc., for so many hours of PT per patient whose PCP has prescribed it (mine was a PT believer), and because they only get paid if they perform the stipulated number of hours of PT, I was confronted several times a day by a pair of chirpy, gung-ho twenty-somethings who were determined that I was going to get out of the bed where I had been trying to catch up on sleep (ironically, the hospital was not a very restful place) and do anything that counted as PT, even just sitting up in the chair beside the bed for 30 minutes; or when I finally got to a bathroom sink, helping my daughter help me wash my hair. Torture – no; constant annoyance – yes.

 

4.    Big Pharma, Big Medical Bills and the rest of the story:

Here again, my ignorance of the American healthcare industry showed. When I signed up for Medicare Part D again in November 2019 after I got home, I learned that although the cost would have been $87 a month for the Part D insurance had I signed up when I first enrolled in Medicare and kept paying the premiums, it was now going to be $87 plus a $40 a month penalty…for the rest of my life. In other words, the insurance company was going to get theirs one way or another. Nevertheless, because Part D lowered the cost of one of my prescriptions from over $500 for a 90 days’ supply to $135, and because I had (due to dumb luck/reasonably good health) avoided the cost of that insurance for over 12 years, I didn’t say a word.

 

Another thing I learned was that neither my family doctor nor the cardiologist who prescribed the expensive medication seemed to have any idea what prescription medicines cost these days. Because my new Part D prescription coverage didn’t go into effect till January 2020 and I couldn’t afford $500+ for the medicine the specialist insisted I take, my doctor persuaded him to provide me with free samples. Then my daughter spoke to his office manager and she gave me a coupon for a free 30 days’ supply, which tided me over till January. (Who knew there were coupons? Not the cardiologist, apparently.) The last time I tried to order a 90 days’ supply, the pharmacy clerk told me I’d reached a “coverage gap,” and 90 days’ worth was going to be well over $300 (the dread donut hole?). I was able to order 30 days’ of the medication for only $45, however, so I took it and will worry about the coverage gap when I run out again at the end of the month. 

 

That was just one example of the outrageous cost of many prescription drugs for which there are apparently no cheap generic equivalents…but which miraculously become affordable once one purchases the Part D insurance.

 

As for big medical bills, Medicare came to the rescue again. The hospital bill was nearly $34,000. Medicare paid over $32,000; my copay was $1364. Certainly not a small amount, but compared to $34,000, a pittance.

 

The bill for my surgery was $89,700. And keep in mind, the anesthesiologist, radiologist, and other medical groups involved with the surgery and hospitalization billed me separately. The surgical group sent an itemized bill, but looking back over it, I can’t figure out what Medicare paid and what Medicare disallowed, or “adjusted,” (a term used numerous times in the surgeons’ bill). In the end, however, if my copay – less than $500 – was 20% of the amount Medicare approved, Medicare staff obviously adjusted the charges down to a tiny fraction of the original amount billed. No wonder some doctors don’t want to accept Medicare patients. 

 

The Rest of the Story: When I began this account, I intended it as a paean to Medicare. Even after I put $10,000 in copays and related expenses on credit cards and ended up with a $240 monthly premium for Medicare Parts A, B and D (deducted every month from my Social Security check); and even after I realized that I would not be off the hook for private, for-profit insurance if I wanted to avoid bankruptcy on a government healthcare insurance program that I had paid into for 55 years, I’m still profoundly thankful that I was covered by Medicare. But every time I feel a little twinge in my side, I wonder how I’ll manage financially if I have to be hospitalized again (I won’t qualify for a supplement for two years, if then, and if I can afford it then); and I also wonder – considering the Covid-19 Pandemic – what is happening to the millions and millions of Americans who aren’t covered by Medicare.

** https://beta.washingtonpost.com/health/opioid-crackdown-forces-pain-patients-to-taper-off-drugs-they-say-they-need/2019/09/10/3920f220-c8da-11e9-a4f3-c081a126de70_story.html

  






4 comments:

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  2. And just think ... 1) Trump is still fighting in court to totally dismantle the ACA which would leave millions without any medical insurance at all in the middle of a pandemic, and 2) Trump has said several times in past weeks that he intends to do away with the payroll tax ... you know, the money that funds Social Security and Medicare. I, for one, will fight that. Medicare is a life-saver for many seniors. Doing away with it (as Trump's plan will do) will be a death sentence.

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