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.
