In this essay, above average is bad. Out of range is bad. It is there on black and white, on a piece of paper: you need drugs. And more frequent doctor visits. And frequent diagnostics, mostly involving sucking your blood out, to make sure there are no side effects to the pharmaceuticals and to monitor just exactly where you are in the range.
It is a scam worthy of such greats as Ponzi, Madoff, and Joseph Kennedy. Going to a doctor in the U.S. is like walking into a casino: the odds are against you, the house always wins. When every last penny has been drained from your pocket, they toss you out, to go an earn some more money or to die impoverished in the streets.
Look at the nature of averages. Or more precisely, in this case, what the statistics boys call "median." Half of the population will be above the median, and half below it. The median is defined that way.
Now take some blood tests. Typically blood pressure, triglycerides, glucose, white blood cell count, and a couple of different kinds of cholesterol.
What are the chances, per the statistics boys, that you will have nothing above average, and therefore need no medication (if the average or below is the standard of health)?
Keep in mind this is not about sickness in the ordinary sense of people who feel sick or have obvious symptoms. This is a test that includes healthy people.
Each test is independent, so to get the answer, you just keep multiplying by 1/2. The order does not matter, but let's say it goes like this:
You have a 50% chance of having high blood pressure. 1 times 1/2 is 0.50.
You have a 50% chance of having high triglycerides. 0.50 times 1/2 is 0.25.
You have a 50% chance of having high glucose. 0.25 times 1/2 is 0.125.
And so forth: white blood cells, 0.0625. Cholesterol 1, 0.03125. Cholesterol 2, 0.015625. That is about 1.6%.
In other words, of 1000 people getting this set of tests from a doctor, only 15, maybe 16 will be fully healthy. Everyone else will need some help from the pharmaceutical industry to get "at the lower end of the risk factors."
Just to be sure to pick your pocket, they don't test you against your age class. Most people see a gradual increase in blood pressure as they age. The doctors don't say to you, "for a 60 year-old male, you are below average! See me again in five years." No, you get compared to the healthy 30 year olds. If you are 60 or older, the chances that you have average or better blood pressure are thin. In fact, there may be something wrong with you, like a weak heart.
The human body has been evolving for some 3 billion years. Modern medical science has been around for about a century. Who are you going to trust, Mother Nature or some gal or guy who went to medical school dreaming of making big money?
We don't need everyone to be below average for all health risks. We need to look at what is normal, and only treat conditions that are at least two standard deviations outside of normal. Which means only the roughly 2% of people who get extremely high results, and 2% of people who get extremely low results. May 4% at each end, just to be safe. [This would not apply to actual diseases like diabetes. Everyone with diabetes should get treatment. Almost everyone in the U.S. needs to eat less and exercise more.]
There is likely a good reason that blood pressure increases as we get older. Lowering the blood pressure to a pre-defined standard probably just insures that blood is not getting to where it is needed in our bodies. [This is my hunch, and if someone will grant me a few tens of millions of dollars, I would be happy to hire professionals to test it.] Someday some enterprising scientist will find that "normal" blood pressure causes senior dementia, or some other result worse than the slight increased risk of dying of a heart attack before your kidneys or liver or brain fails.
They never give you unbiased statistics. When have you ever seen a chart of how many people have heart attacks and strokes who don't have high blood pressure? In fact lowering blood pressure, unless you have really, really high blood pressure, is not likely to change your cause of death.
Scientists — real scientists, not the ones funded by industry — will tell you that even when you are trying to do totally honest, accurate science, there is a danger called selection bias. This amounts to rejected data that would prove your bet hypothesis is wrong.
Selection bias can happen even in an academic context. The reason is that certain results, interesting results, are publishable, but the negative results are not. Scientists like to publish. Their careers usually depend on it.
The pharmaceutical companies themselves have found that out when buying potential drugs that academic scientists claimed would be cures. One study by a major pharmaceutical company found that, for almost all of the drug candidates in a batch they bought, they could not replicate the "good" results.
I believe that doctors can help some people some of the time, and in good medical science. But you can't always believe the medical consensus.
Recently a panel of medical experts recommended against a test that has always been supposed to be indicative of prostate cancer, PSA. The knew that PSA results only correlate loosely with prostate cancer. Yet doctors turned high PSA results into a lucrative business of "cures." Looking at a broad range of statistics, the panel found that the negative results from all that expensive "curing," including death during surgery, more than washed away the occasional live saved. Cancer sounds scary, but most prostate cancers evolve slowly. Most men with prostate cancer die of something else, something unrelated. So the panel suggested stopping PSA tests unless there was a good, obvious reason for them. [New Data on Harms of Prostate Cancer Screening, New York Times, May 21, 2012]
Oh, the howls of the financially wounded. The oncologists and urologists, the main beneficiaries of the PSA scam, attacked the panel with vigor. They only care about Science when it is in their financial favor.
The average person is not in a position to argue knowledgeably with their physician about whether they really need a blood pressure or cholesterol pill. Half the American population does not believe in evolution. They don't believe the human body has evolved to optimize its own health and longevity. Sadly, the other half tends to believe in anything presented as science uncritically. In theory they know there is good science and bad science, but in reality they have to rely on their doctors.
We need to rethink medicine from the ground up. We need to ask ourselves how it fits into our other values. Do we let children live in poverty, or underfund our public schools or other important public while paying vast sums for cancer therapies for the over-80 set that, at best, extend miserable lives for a few weeks?
We have evolved a culture that has made us a nation of pill-popping hypochondriacs. Part of this is because costs are masked: for most people, someone else is paying the bill.
I am not against wonder drugs. I am not against necessary surgeries, or preventative medicine that really prevents disease. I want a science-based health system that takes into account economic realities. That is what we need, not what we have.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
Friday, June 15, 2012
Saturday, March 10, 2012
Predators, Doctors and Wage Slavery
Society is probably too strong of a term for living among fellow human beings in these mostly United States.
I was thinking about writing a science fiction novel in which (on another planet, in a different time) doctors are predators, a sort of subspecies of the regular denizens of my imaginary civilization. Where could I get such an outrageous idea? Well, there is the opening section of B. Traven's The Rebellion of the Hanged, in which Marcelina, a Mexican peasant, falls deathly sick. Her husband Candido takes her to town to see the doctor. Candido's life savings consist of 18 pesos, but the doctor wants 200 pesos to operate. The town's leading citizen offers to loan money to pay for the operation, with the Candido to work off the loan at a timber camp, cutting old-growth mahogany. Candido accepts the loan, the Doctor operates, Marcelina dies anyway, and Candido becomes an enslaved timber worker. Thus setting the novel in motion. It is a great novel, which is why you probably never heard of it before.
Yes, I recently had a walletectomy performed. Walletectomies are the most common medical operation in the United States, and most are 100% successful. Fortunately for me they only did local anesthesia. I jumped out in the middle of the operation, so I have half a wallet left. I am hoping the rest of the wallet will grow back eventually, or that half will keep me going until I die of some other cause.
According to the American Bankruptcy Institute, 1,362,847 people filed for bankruptcy in the United States of America in 2011. According to Medical Bankruptcy in the United States, 2007, published in The American Journal of Medicine, in 2007 "using a conservative definition," 62.1% of all bankruptcies were medical. Do the math and you have about 850,000 people who went bankrupt due to medical bills or health issues in 2011. And probably more this year. It adds up.
Note too, that the habitually poor don't go bankrupt, and have their medical bills paid by Medicaid. The rich go bankrupt on occasion, but usually from bad investment decisions or cocaine habits. Bankruptcy from medical bills is a working and middle class phenomena. It typically involves losing home ownership. After you are totally impoverished, you too can qualify for Medicaid, food stamps, and Section 8 housing (warning: there is a very long waiting list for section 8 housing).
Some say maybe people should buy better insurance, then they could survive an expensive illness. The problem with that theory is that most people don't make enough money to buy the best insurance policies. Given the level of prices and wages now existing in the U.S., most people would have to live in a tent and eat grass so that all their wages could go to medical insurance. So we take our chances with less than wonderful policies.
The problem is not entirely caused by a predatory medical profession. The bigger problem is low wages. While low wages is also a complex problem, it mainly comes from decisions made internally within corporations. The people who divide up the pie take the biggest pieces, leaving crumbs for the workers. Also, some sectors of the economy are just less profitable than others, and yet someone has to do that work.
Workers today are too busy fighting each other for crumbs to organize themselves to fight for a fair share of the pie.
Modern science has provided some nearly-miraculous healthcare technology, including a few wonder drugs and amazing surgical techniques. It has also created a bunch of drugs that have little benefit to patients and yet cost tens of thousands of dollars a year to take.
Society has to be built on trust. We can't each of us be jacks-of-all-trades. We must each have our place. We also can't all be millionaires. But it seems like everyone who enters medical school thinks they are getting a ticket to be a millionaire, if they can just stick out the hazing. Because that is the way the American Medical Association set up the system over a century ago, by limiting the number of doctors allowed to graduate from American medical schools each year.
If I ran things one of the first things I would do is open a bunch of competing medical schools, maybe doubling the number of seats there are now. Then I would choose students not strictly by their grades, or ability to pay tuition, but largely by their desire to alleviate the suffering of the sick. I would guarantee them a decent, above-average salary once they were trained. And I would nationalize the health insurance industry.
Then we could trust doctors to do what is good for us, instead of what is good for their own wallets.
But that would be socialism.
I was thinking about writing a science fiction novel in which (on another planet, in a different time) doctors are predators, a sort of subspecies of the regular denizens of my imaginary civilization. Where could I get such an outrageous idea? Well, there is the opening section of B. Traven's The Rebellion of the Hanged, in which Marcelina, a Mexican peasant, falls deathly sick. Her husband Candido takes her to town to see the doctor. Candido's life savings consist of 18 pesos, but the doctor wants 200 pesos to operate. The town's leading citizen offers to loan money to pay for the operation, with the Candido to work off the loan at a timber camp, cutting old-growth mahogany. Candido accepts the loan, the Doctor operates, Marcelina dies anyway, and Candido becomes an enslaved timber worker. Thus setting the novel in motion. It is a great novel, which is why you probably never heard of it before.
Yes, I recently had a walletectomy performed. Walletectomies are the most common medical operation in the United States, and most are 100% successful. Fortunately for me they only did local anesthesia. I jumped out in the middle of the operation, so I have half a wallet left. I am hoping the rest of the wallet will grow back eventually, or that half will keep me going until I die of some other cause.
According to the American Bankruptcy Institute, 1,362,847 people filed for bankruptcy in the United States of America in 2011. According to Medical Bankruptcy in the United States, 2007, published in The American Journal of Medicine, in 2007 "using a conservative definition," 62.1% of all bankruptcies were medical. Do the math and you have about 850,000 people who went bankrupt due to medical bills or health issues in 2011. And probably more this year. It adds up.
Note too, that the habitually poor don't go bankrupt, and have their medical bills paid by Medicaid. The rich go bankrupt on occasion, but usually from bad investment decisions or cocaine habits. Bankruptcy from medical bills is a working and middle class phenomena. It typically involves losing home ownership. After you are totally impoverished, you too can qualify for Medicaid, food stamps, and Section 8 housing (warning: there is a very long waiting list for section 8 housing).
Some say maybe people should buy better insurance, then they could survive an expensive illness. The problem with that theory is that most people don't make enough money to buy the best insurance policies. Given the level of prices and wages now existing in the U.S., most people would have to live in a tent and eat grass so that all their wages could go to medical insurance. So we take our chances with less than wonderful policies.
The problem is not entirely caused by a predatory medical profession. The bigger problem is low wages. While low wages is also a complex problem, it mainly comes from decisions made internally within corporations. The people who divide up the pie take the biggest pieces, leaving crumbs for the workers. Also, some sectors of the economy are just less profitable than others, and yet someone has to do that work.
Workers today are too busy fighting each other for crumbs to organize themselves to fight for a fair share of the pie.
Modern science has provided some nearly-miraculous healthcare technology, including a few wonder drugs and amazing surgical techniques. It has also created a bunch of drugs that have little benefit to patients and yet cost tens of thousands of dollars a year to take.
Society has to be built on trust. We can't each of us be jacks-of-all-trades. We must each have our place. We also can't all be millionaires. But it seems like everyone who enters medical school thinks they are getting a ticket to be a millionaire, if they can just stick out the hazing. Because that is the way the American Medical Association set up the system over a century ago, by limiting the number of doctors allowed to graduate from American medical schools each year.
If I ran things one of the first things I would do is open a bunch of competing medical schools, maybe doubling the number of seats there are now. Then I would choose students not strictly by their grades, or ability to pay tuition, but largely by their desire to alleviate the suffering of the sick. I would guarantee them a decent, above-average salary once they were trained. And I would nationalize the health insurance industry.
Then we could trust doctors to do what is good for us, instead of what is good for their own wallets.
But that would be socialism.
Monday, April 18, 2011
Quacks, Priests and Politicians quote
Came across this in The University Encyclopedia (of 1902). Showing humans have not changed so much:
"Quack Doctors
... The sad part of the whole matter is that mankind never seems to learn by experience; no new methods of deception are introduced, no real originality or inventive enterprise is ever shown by quacks; they rely on exactly the same old artifices as their predecessors did, and generation after generation are duped by them just as surely."
Since 1902, while politicians and priests have changed little, there has been a series of innovations in medical quackery. When radioactivity was first discovered it was promoted as healthy, and people were burned or even killed by excessive doses. Even before 1902 electromagnetism was promoted as a cure-all; at least it was usually less harmful than radioactivity. Now we give people blood tests and set the parameters narrowly so there are always plenty of people with results outside the parameters, in need of prescription drugs.
The U.S. still has the same two lying, thieving major parties it had in 1902, the Democrats and the Republicans. The more things change, the more they stay the same.
Monday, February 14, 2011
Ruinous Competition: Doctors and Healthcare
According the free-market theorists, the best of all possible economic worlds is one in which there is no government regulation. First developed coherently in Adam Smith's Wealth of Nations, this theory was based on practical observations of a society, England, that had been high regulated by a monarchical government working with feudal institutions that tried to determine most people's occupation by their status at birth.
Business men and trade-guilds that had done quite well for themselves in the past found it hard to make a profit, or even a living, once anyone could compete with them. In a free market, if a profit can be made in a certain occupation, new people will enter that occupation until competition for customers results in profit levels becoming unattractive. We call that ruinous competition.
Certain industries require quite a bit of capital to enter, so even back at the dawn of this new era, around the time of the American Revolution, profits could be made in those industries without the help of government restrictions on entering the business. Just as a beggar cannot enter the farming business without the price of at least a down-payment on a piece of land, so a laborer or small merchant would not have the capital to set up an iron-mill or buy a coal mine. So even under the growing free market system, larger enterprises had some shelter from ruinous competition.
The United States of America began as a sort of natural free-market area, and people generally benefited from that (neglecting here the use of slave labor and violent capture of Native American Indian real estate) for some time.
In the course of the 1800's, however, mainly at the level of individual states, those who did not want to be exposed to ruinous competition developed a strategy. Aside from the practice of the law, which was always limited by the government, it was argued that professions having a direct impact on the health and safety of the public needed to be vetted by the government. For instance, it was argued that not anyone could simply declare themselves to be a medical doctor. And again, there was some truth to it, although in the 1800's it appears that trained medical doctors were so ignorant of basic biology that many were just as dangerous to the public as the so called fake doctors, or charlatan (originally, sellers of Roman Catholic indulgences, but a term that came to be applied to untrained healers).
Allowing only doctors licensed under the authority of the government, and making sure there was always a shortage of such licensed doctors, would allow the group to charge more than the free market value of their medical services. In short, to overcharge the sick. This was the purpose of the American Medical Association, formed in 1847. The AMA did some good things, which don't concern us here. What they did on the economic front was require that medical practitioners be licensed (and they set up boards of their own members to decide who would qualify for a license) and they also licensed medical schools. In licensing such schools they carefully studied the demand for doctors and made sure that not enough doctors were graduated to meet the demand.
Now of course practically every profession, from cutters of hair to real estate agents to accountants and carpenters, requires a license. Some professions have not been as successful at keeping their numbers small and profits high as the doctors have done, but the general idea is there. Barriers to entry, no free market, no ruinous competition. Those who work without license are sucked dry by the fees of those who are licensed to work.
Those doctors who scream for free markets and against "socialist" government health care plans should take a good look at themselves and their ill-got millions. Because of the government preventing the operation of free markets in doctoring, in the 1950's and 1960's the term millionaire-doctor was synonymous with doctor.
If doctors don't want socialized medicine, we should open up doctoring to anyone who feels they can heal. Pharmacists should be able to make diagnoses and sell basic drugs without a doctor's prescription. For that matter doctors should be able to sell drugs in their offices, rather than having to write a prescription. People should be able to self-diagnose, if they wish to take that risk, and get any legal drug without a prescription.
If someone puts out a shingle and causes harm, they could be sued for malpractice. If they claim to have graduated from a medical school, but did not, they could be charged with fraud. If the government wants to certify people, or the AMA wants to identify their members, that is fine, but there should be no rule that you have to go to the AMA men or government men.
What do you say, Republicans and Tea-Party people? Are you really ready to give free markets a chance? I'm certainly ready to hang out a shingle, if the Republican run government is willing to let me. I'll start a medical insurance company too, a coop that benefits the members. That should put some pressure on Anthem et. al.
Business men and trade-guilds that had done quite well for themselves in the past found it hard to make a profit, or even a living, once anyone could compete with them. In a free market, if a profit can be made in a certain occupation, new people will enter that occupation until competition for customers results in profit levels becoming unattractive. We call that ruinous competition.
Certain industries require quite a bit of capital to enter, so even back at the dawn of this new era, around the time of the American Revolution, profits could be made in those industries without the help of government restrictions on entering the business. Just as a beggar cannot enter the farming business without the price of at least a down-payment on a piece of land, so a laborer or small merchant would not have the capital to set up an iron-mill or buy a coal mine. So even under the growing free market system, larger enterprises had some shelter from ruinous competition.
The United States of America began as a sort of natural free-market area, and people generally benefited from that (neglecting here the use of slave labor and violent capture of Native American Indian real estate) for some time.
In the course of the 1800's, however, mainly at the level of individual states, those who did not want to be exposed to ruinous competition developed a strategy. Aside from the practice of the law, which was always limited by the government, it was argued that professions having a direct impact on the health and safety of the public needed to be vetted by the government. For instance, it was argued that not anyone could simply declare themselves to be a medical doctor. And again, there was some truth to it, although in the 1800's it appears that trained medical doctors were so ignorant of basic biology that many were just as dangerous to the public as the so called fake doctors, or charlatan (originally, sellers of Roman Catholic indulgences, but a term that came to be applied to untrained healers).
Allowing only doctors licensed under the authority of the government, and making sure there was always a shortage of such licensed doctors, would allow the group to charge more than the free market value of their medical services. In short, to overcharge the sick. This was the purpose of the American Medical Association, formed in 1847. The AMA did some good things, which don't concern us here. What they did on the economic front was require that medical practitioners be licensed (and they set up boards of their own members to decide who would qualify for a license) and they also licensed medical schools. In licensing such schools they carefully studied the demand for doctors and made sure that not enough doctors were graduated to meet the demand.
Now of course practically every profession, from cutters of hair to real estate agents to accountants and carpenters, requires a license. Some professions have not been as successful at keeping their numbers small and profits high as the doctors have done, but the general idea is there. Barriers to entry, no free market, no ruinous competition. Those who work without license are sucked dry by the fees of those who are licensed to work.
Those doctors who scream for free markets and against "socialist" government health care plans should take a good look at themselves and their ill-got millions. Because of the government preventing the operation of free markets in doctoring, in the 1950's and 1960's the term millionaire-doctor was synonymous with doctor.
If doctors don't want socialized medicine, we should open up doctoring to anyone who feels they can heal. Pharmacists should be able to make diagnoses and sell basic drugs without a doctor's prescription. For that matter doctors should be able to sell drugs in their offices, rather than having to write a prescription. People should be able to self-diagnose, if they wish to take that risk, and get any legal drug without a prescription.
If someone puts out a shingle and causes harm, they could be sued for malpractice. If they claim to have graduated from a medical school, but did not, they could be charged with fraud. If the government wants to certify people, or the AMA wants to identify their members, that is fine, but there should be no rule that you have to go to the AMA men or government men.
What do you say, Republicans and Tea-Party people? Are you really ready to give free markets a chance? I'm certainly ready to hang out a shingle, if the Republican run government is willing to let me. I'll start a medical insurance company too, a coop that benefits the members. That should put some pressure on Anthem et. al.
Note: many doctors have come out for Universal Health Care. For instance see Physicians for a National Health Care Program.
Saturday, February 13, 2010
Medical Insurance Death Spiral
Private medical insurance seems to be going into a death spiral. While Congress and state legislatures failed to act, Adam Smith's Invisible Hand decided to act on its own.
Even before the headlines came out, I got my family (Jan and my) medical insurance bill from "Anthem Blue Cross," which is really WellPoint once you break through the corporate unaccountability firewalls. It went up to $541 per month, from $408 per month, a 33% increase. It is a pretty minimal plan, far worse, for instance, than the one our local public school teachers have (I know from past service on the local school board for 8 years). We've had it around fifteen years, and it has never actually paid for anything, but it does limit how much we get reamed by medical service providers. In my case part of my increase may be because I recently had my 55th birthday.
Jan and I are fighting now about what to do. I am for dumping the insurance entirely, she wants to see if there is an even-higher deductible option. But she can't find out because it is a three day weekend.
The recession was the initial cause of the problem, apparently, but that does not mean that as the economy recovers rates will go back down.
Two things happened. With so many people unemployed, or trying to reduce their monthly budgets even if employed, many simply dropped their insurance. Of course, healthy people dropped; sick people did not. So there is a smaller pool of fools like me paying in to cover the sick people. In addition, many people already had the talk Jan and I had today, and already increased their deductibles. In the short run that just means WellPoint has less dollars coming in, without any significant decrease in immediate expense.
Of course the WellPoint management is not willing to forego profits for a year to break the downward cycle. In 2009 WellPoint made $2.7 billion in net income (profit for shareholders) on insurance premium revenues of $14 billion, per their January 27, 2010 press release.
But what about the future? You can depend on the politicians to do nothing. You can figure that numerous people like Jan and I are going to drop or diminish our coverage. WellPoint will increase their rates again as soon as possible. Then more people will drop out. At some point only the sick will no longer be subsidized by premiums from the well. WellPoint will take out 30% for profits and administrative costs, the maximum allowed by the state of California. So even the sick, as a group, will need to pay premiums 30% of their collective costs of care just to keep WellPoint in business.
I would not think WellPoint would be in business much longer; a few years at most. Except they have at least one other option: stop paying claims. Start rejecting claims for any and all reasons. Or, the more systemic equivalent, send out policy renewals redlining out most benefits. "For a claim to be valid, the patient must first see a doctor in our Paris, France office. Surgery is now classified as Acupuncture and is not covered if it requires sharp cutting instruments other than acupuncture needles."
In other words, a wise person would now plan for paying for your medicine as you go, unless you are a welfare bum on Medicaid or a senior citizen on Medicare. Expect nothing from the Democratic Party or the Republican Party except heartache.
Once enough of those of us who have tried working for a living, and failed, are on Medicaid, that system will collapse too. If not of itself, with the inability of the Federal Government to endlessly increase the national debt.
Of course, you could try to figure out a way to put me in charge. I would execute a few insurance company executives and owners. I would take pack all the payouts to stockholders WellPoint has made in the past ten years as fraudulent transfers, and use that money to get medical services started again. What would you do?
Even before the headlines came out, I got my family (Jan and my) medical insurance bill from "Anthem Blue Cross," which is really WellPoint once you break through the corporate unaccountability firewalls. It went up to $541 per month, from $408 per month, a 33% increase. It is a pretty minimal plan, far worse, for instance, than the one our local public school teachers have (I know from past service on the local school board for 8 years). We've had it around fifteen years, and it has never actually paid for anything, but it does limit how much we get reamed by medical service providers. In my case part of my increase may be because I recently had my 55th birthday.
Jan and I are fighting now about what to do. I am for dumping the insurance entirely, she wants to see if there is an even-higher deductible option. But she can't find out because it is a three day weekend.
The recession was the initial cause of the problem, apparently, but that does not mean that as the economy recovers rates will go back down.
Two things happened. With so many people unemployed, or trying to reduce their monthly budgets even if employed, many simply dropped their insurance. Of course, healthy people dropped; sick people did not. So there is a smaller pool of fools like me paying in to cover the sick people. In addition, many people already had the talk Jan and I had today, and already increased their deductibles. In the short run that just means WellPoint has less dollars coming in, without any significant decrease in immediate expense.
Of course the WellPoint management is not willing to forego profits for a year to break the downward cycle. In 2009 WellPoint made $2.7 billion in net income (profit for shareholders) on insurance premium revenues of $14 billion, per their January 27, 2010 press release.
But what about the future? You can depend on the politicians to do nothing. You can figure that numerous people like Jan and I are going to drop or diminish our coverage. WellPoint will increase their rates again as soon as possible. Then more people will drop out. At some point only the sick will no longer be subsidized by premiums from the well. WellPoint will take out 30% for profits and administrative costs, the maximum allowed by the state of California. So even the sick, as a group, will need to pay premiums 30% of their collective costs of care just to keep WellPoint in business.
I would not think WellPoint would be in business much longer; a few years at most. Except they have at least one other option: stop paying claims. Start rejecting claims for any and all reasons. Or, the more systemic equivalent, send out policy renewals redlining out most benefits. "For a claim to be valid, the patient must first see a doctor in our Paris, France office. Surgery is now classified as Acupuncture and is not covered if it requires sharp cutting instruments other than acupuncture needles."
In other words, a wise person would now plan for paying for your medicine as you go, unless you are a welfare bum on Medicaid or a senior citizen on Medicare. Expect nothing from the Democratic Party or the Republican Party except heartache.
Once enough of those of us who have tried working for a living, and failed, are on Medicaid, that system will collapse too. If not of itself, with the inability of the Federal Government to endlessly increase the national debt.
Of course, you could try to figure out a way to put me in charge. I would execute a few insurance company executives and owners. I would take pack all the payouts to stockholders WellPoint has made in the past ten years as fraudulent transfers, and use that money to get medical services started again. What would you do?
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.
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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