Tuesday, May 6, 2008

My Medical Last Straw

For the usual reasons, for a long time I have figured that if we are going to have a national government we might as well had national health care for all. It could be in the guise of a single-payer medical insurance plan (only one health insurer for all Americans) with independent health providers (doctors and hospitals) that could be privately run. Or it could be one big government run health system. Either would be fine by me.

However, health care has not been an important issue in my life, and since there seemed to be plenty of people working on passing single-payer health care, I have not been active in that area. Nor have I written about that much.

Last week that changed.

About 15 years ago my wife Jan and I got a catastrophic health insurance policy from Blue Cross of California, which was then a not-for-profit organization. We were both healthy, but Jan's dad bugged us about it, and the premiums were only a couple of hundred bucks a month. We both work freelance, so we don't have an employer and can't get the better insurance rates that big corporations negotiate with health insurers.

About 8 years ago Jan started treatment for high blood pressure. That locked us into our Blue Cross policies because, as you know, when you change policies even if you have something as common and innocuous as high blood pressure, then won't insure you for anything related to the pre-existing condition. And almost everything but cancer and broken bones are in the cardiovascular category.

Jan bought a home blood pressure monitor and I checked my blood pressure with it. For years I was in the high end of normal, then it crept up into the definitely high range and I sought treatment at the only local medical provider, Redwood Coast Medical Services, known as RCMS. My doctor is Thomas Bertolli, who is also the RCMS medical director.

It seemed to me that in settling on a blood-pressure medicine for me I was being involved in a number of expenses talks with Mr. Bertolli at $75 a pop (remember my medical insurance covers absolutely nothing but hospital care, and then has a high deductible). The only relevant information was my blood pressure readings. But I started taking medication and we upped the dose until I was getting good readings. After resisting his trying to get me to come in for unnecessary lectures, I found that RCMS did give free blood pressure readings. So I got those and my prescription was renewed without seeing Mr. Bertolli and paying $75 each time.

I knew from my wife and other patients that if you let them, they would schedule a doctor visit every time you needed a prescription renewal.

My time was running out, however, and I knew it. But my wife actually found a loophole in our favor. Our insurance, which now runs $350 a month, would pay for an annual physical. Would pay $131 for that. So I figured here was a win-win situation. I would schedule an annual physical instead of a mere office visit with Mr. Bertolli. RCMS would get more money and I would not be out of pocket.

When I called for the appointment, however, they said I would have to have a blood draw a week before hand. That means paying for the blood draw and lab tests. Well okay, I would pay for that. Who knows, maybe something would show up in the blood test. However, my wife warned me that her nurse-practitioner had popped her head in during the blood draw, chatted for a minute, and then charged us for a doctor's visit! So I was prepared to head off that scam.

I go for my blood draw. The nurse started telling me what would happen, and she said I would see Mr. Bertolli for a couple of minutes before the actual blood draw. I said I did not want to pay for a doctor visit when I would be seeing him for as long as he wanted a week later. She sent me back to the waiting area while she waited to tell Bertolli of this possible peasant rebellion.

The nurse came back with the news that to get a blood draw I would have to see Bertolli and pay for it. I said no. Then she took me back to the blood draw room anyway.

Bertolli came in and said it was medically necessary for me to see him before a blood draw. I asked him what the medical necessity was and he could not give an answer. He said he was not trying to just run up the charges. He told me medicine costs money like everything else and I would have to pay for it or leave. The fact that I have paid for it, to RCMS and my medical insurer, did not matter. I told him I elected to not see him, not have a blood draw, and not have a physical. He said fine and I walked out.

But of course, the AMA (American Medical Association) has made sure that they control the dispensation of all pharmaceuticals. I thought I could go to Tijuana, Mexico (I live in northern California, but visit San Diego once in a while), and buy my medicine without a prescription. But apparently that was old information. Now customs is seizing medications bought in Mexico unless you have a prescription from a doctor in the United States.

It is simply blackmail. Bertolli thinks he has control of my life because I would have to do hours of driving to get to a non-RCMS doctor. And his AMA gangsta friends are probably all doing this, if RCMS made it policy.

And our elected officials specialize in doing nothing, because doing nothing keeps things profitable for the AMD and the private insurers.

And despite this extortion of people who have no insurance or inadequate insurance, RCMS is widely reputed to be going under financially. The reason for this is twofold. When insurers have to pay, they bargain RCMS down to an unprofitable level. And moreso, when Medicare and Medicaid patients come in, RCMS is reimbursed by the government for less than the cost of treatment. Our area is now heavily populated with retirees, so RCMS sees a disproportionate number of Medicare patients.

And that tells you my probable health trajectory. I am 53 years old. At the age of 65 I will be able to go on Medicare and get my blood pressure treated. In the meantime, I will have high blood pressure, which increases the risk I will have a heart attack or a stroke. It isn't that I don't have $75 to donate to RCMS. It is because I don't trust someone who would blackmail me to tell me what is good for my health.

It is notable that my untreated blood pressure readings are not atypical for a man of my age. The blood pressure medicine was really preventative medicine. Unless it is provided for a reasonable cost, I have to consider it optional.

And cholesterol medicine, I suspect, is one of the biggest scams ever put over on the human race. The only people who seem to benefit from it are people who have already had a stroke or heart attack. I believe tens of millions of Americans are taking it just to enrich doctors and pharmaceutical companies.

Am I over my head here? Am I just talking nonsense? See my What I Know About Healthcare for my qualifications for analysing the health industry.

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