Thursday, August 30, 2012

Missing from the Healthcare debate...

In the spring of 2011, I fell off my bike and broke my arm.  No cast was needed, but I did have x-rays taken 3 times and had 3 office visits to confirm that my arm was broken and was healing.  I would have been fine with just getting the information after the first or second session, since I was not getting any treatment such as a cast.  Instead, my insurance got billed for almost $2000.

In the spring of 2012, I was experiencing some shoulder pain when I worked out, especially doing a few exercises.  I went back to the same arm guy, had x-rays, was told I have tendinitis, and was sent to physical therapy for 12 sessions.  The majority of the sessions consisted of using exercise equipment, doing stretching exercises and putting a heating pad on.  I could have just as easily done these at home or at the gym.  Each of these sessions was billed to my insurance at about $90/pop, and my out-of-pocket expenses were roughly 50%.  This doesn't include the initial assessment.  I am supposed to go back to the arm doc for a follow-up, but I don't want to pay anymore or have my health insurance plan have to pay any more just to be told I'm good.  

Both of these are examples of what I consider to be an aspect of our broken and costly healthcare system that is ignored but is perhaps an area that we could all agree on: while we do need a safety net for covering the basics and the vitals, there is a strong element in the system that over-prescribes and exploits minor ailments in order to "feed the beast."  In this system, we the consumer are often not very informed about things, and blindly do what we are told.  I'm no exception.  I did just what the doctor ordered.  But here's how I would like it to have gone, and perhaps would like to see it go in the future: a frank discussion about the diagnosis, and then a more thorough look at options.  For example, I would have been fine with the initial doctor saying I have tendinitis, and getting a recommendation to meet with a physical therapist to learn about exercises and a bit more about tendinitis.  After that, it's up to me.  I'm in my 50's, am not a lefty (except when I eat).  I can live with tendinitis; I have had shin splints since high school, and have learned to accommodate.  I broke my knee, and have arthritis there, but still do ok.  I can handle this.  It was really not necessary to have the system milk me and my insurance.

This is one of the fundamental problems that I think also needs to be addressed, and I think that universal healthcare is one way to bring it forward.  There are others, but we don't seem to use them.  I did question some orders for blood tests from an MD once, stating I didn't want to pay for them since I wasn't really willing to do the treatment.  Drove him nuts, but I think we need to move to a serious conversation not just about comprehensive healthcare but also informed consumerism.  My priority is to get my HIV treatment.  Beyond that, I'll live with the aches and pains.  If I have something I need a diagnosis and perhaps some recommendations, I'd like that as well.  It's the unnecessary and costly visits that trouble me, but that's what you get when you have people whose livelihood is dependent on people having maladies.  I think that if we are to have a sustainable system, we need to become equal partners with our physicians and insurance companies, not just pegs moved around for financial gain.

1 comment:

A wayfaring man said...

Sometimes there is no replacement for the gentle care of another human being, even if we think we can or may be able to do it on our own. I think the key is being given options. For some of us the symptoms can be so bothersome that receiving assistance or a reassessment of the effectiveness of the exercises is helpful as symptoms or conditions change. I hear you, in fact, I told my own PT, "doesn't make much sense for me to come here and do this, if this is the only time this happens or these exercises take place." There needs to be a balance and that comes down to collaboration and discussion.