20 March 2010

Thinking about Health Insurance, as one does when one is SICK

Howdy. I'm still sick.

Those expensive antibiotics? I'm halfway through the seven day script, and I dunno, they haven't kicked in the way I thought they were going to.

I should clarify something about their cost. If I'd walked into the drugstore and bought the seven pills without any insurance, they would have cost me $233.99 - or $33.43 each. I do have insurance, but since this was the first non-generic prescription I'd filled this year, I hadn't yet met my deductible. So, I had to pay $100 deductible PLUS the $30 co-pay that I'll have to pay on any future scripts, for an outlay of $130 for the seven pills.

One of the things that the scare-mongers use in lobbying against nationalized single payer health care is that it would limit choice, that you won't be able to see the doctor that you want to see. Well, in point of fact, that's already happened. Managed care, with networks of doctors, has pretty much limited one's doctor choice to a doctor who is in your network - unless one has the resources to pay out of pocket for care.

And there's a problem with that.

A couple of years ago, I had some growthy thing on my forehead. I went to the in-network dermatologist THREE times, it came back THREE times. I gave up and went to the fancy Fifth Avenue no-insurance-at-all doctor and he fixed it - it's never come back and the scar is invisible. And you know? That kind of pisses me off, because - in that case anyway - the fancy expensive doctor actually WAS better than the insurance paid hack.

A friend, a new real-life friend who happens to have a blog, who I met last month at the birthday party of a very old friend (who also happens to have a blog), recently had a health issue that wouldn't go away. She called it "the itis", and it hung around for five months. She finally found another doctor, out-of-network this time, and guess what? Cured! Again, the out-of-network turned out to be a better doctor.

My sister-in-law asked me for a recommendation for a doctor because she's got terrible bunions. As it happens, I know who the foot doctor is - three different people that I know have had him operate on their feet - he's the best, period, end of story. She called up - yes, ma'am, a consult will be $450 and we don't take any insurance.

I don't know what the moral of these stories is. But they're just indicative of another way that the system is broken. I hope it gets fixed.


Rima said...

My husband's theory is that physicians who work "out of network" have a more difficult time building up a patient base and consequently must work extra hard at making and keeping good reputations. They also have more time to give quality care and keep current in their fields because they have fewer patients and they don't have to deal with the bureaucracy.

But if you ever need a neurologist, I know a really good one who is still "in network."

Rima said...


Jenn @ Juggling Life said...

If the pneumonia doesn't get you the health care system will.

I'm so in arms over abortion being the big hold up.

So you'd rather actual living children LOSE their parents due to no insurance than allow abortion? I don't get it.

Bibliomama said...

When I was a grad student I got some weird skin thing that kept eating up my face. I had to suffer through a few doctors that were either stupid or incompetent or both, but I guess I should be grateful that when I finally got to the good dermatologist it didn't cost me anything. That said, my country definitely does have its share of dumbass shortsightedness that's only going to make the problems with our health care system worse. How do you fix something so huge and unwieldy, though? Erg.

Kyddryn said...

Mizz Magpie, I hope you recover quickly!

I'm beyond broke right now, and haven't had insurance since early last year. I'm supposed to take a certain medication twice a day, but I go months without it because: Hello, two pills a day? Expensive. Also, the medication requires costly labs on a regular basis and several self-administered tests a day that are a dollar a pop (more than 90 dollars a month if done as often as they should be!). Doctor's appointments are a no-go at upwards of $100 a visit. It sucks.

However, it galls me to think that someone else might be expected to pay my way. I'd rather do without than force even a single person to carry me.

What's a body to do?

Shade and Sweetwater,
K (who DOES have health insurance for her son, at least)

mamaloo said...

Just so you know, everything that the lobbyists say about "nationalised" health care is pure bunk.

I'm a Canadian and I can pick who I go to see. If it's a specialty, my GP vets the problem to determine if it's something that needs specialist consult and care, I just ask for my preferred provider. My GP writes up a quick letter of referral and I get in to the specialist I want.

Health care in Canada is NOT a game of Russian roulette!

My husband, who blew his knee out in a hockey game at 18, spent a year in a leg brace so that he could get the Olympic team's orthopedic surgeon fix it rather than his regional hospital's ortho surgeon. Demand for that doc was high and a blown knee isn't life threatening, so my husband happily waited for the chance to have the countries leading ortho surgeon specialising in sports related knee injuries put him back together FOR FREE!

Bee said...

I don't know what the moral is, but I'm afraid that having the money to pay for the BEST care will always trump any other system. I am so grateful for the NHS in England, and I would defend it with most of my breath . . . but the truth is that you can't really choose your doctor and that you have to wait for things . . . and sometimes that doesn't add up to the best possible care.

Stimey said...

Exactly. I'm getting madder and madder about this whole thing. I just need the bickering to stop and the passing of the bill to start.

Anjali said...

Agreed. There are just so many thing wrong, I hope at least something gets fixed.

Kyla said...

Sometimes it works that way. Sometimes, as in the case of our pediatrician, she takes ALL insurances (CHIP and even Medicaid) and she is the cream of the crop. We had an absolute idiot before her and we were paying out of pocket.

You know that I firmly believe things need to change...I worry that the things that need to change the most have been dropped from the health reform bill. We don't just need ANY change...we need the RIGHT change. My fingers are crossed for that outcome.

nonlineargirl said...

You have outlined a problem that no reform is likely to fix (and which CERTAINLY won't go away under the status quo).

What CAN be fixed is that people who don't have insurance now will have access to providers in a way that is not true today. People who have to weigh whether the $300+ prescription is worth it, even if that means they can't pay rent or buy food or gas or whatever else.

My fingers are crossed all day that the bill passes, even though it will effectively have NO effect on me or my insurance.

The Library Lady said...

One more reason for single payer coverage--you'd be able to pick any doctor.

Right now I am waiting anxiously on this vote. It's only the first step, but it's in the right direction...

If you don't feel better in a day or so, call in. It took a combination of two different antibiotics to cure the Man's pneumonia, as I recall.


The Library Lady said...

One more reason for single payer coverage--you'd be able to pick any doctor.

Right now I am waiting anxiously on this vote. It's only the first step, but it's in the right direction...

If you don't feel better in a day or so, call in. It took a combination of two different antibiotics to cure the Man's pneumonia, as I recall.


Julia said...

I had the z-pack back for bronchitis in January, and found that I wasn't feeling the way I thought I should until after day 5. There was progress, but it wasn't dramatic. But the meds do taper on their own (and I sure appreciated only having to remember one pill a day), and by the end of the ten-day period I was feeling better.

Hope you're feeling better soon.

mayberry said...

The insurance situation sucks. I've complained more than once about having to go to an orthodontist that's way inconvenient because that's the one our insurance covers. But then I've been reminded that many people's dental insurance (if they even have it at all) doesn't cover orthodontia.

I hope your drugs kick in soon.

painted maypole said...

oy. health care on the brain today, of course. I can't quite rejoice, though, even now that the vote has passed, because I feel like so much that was once in the bill has disappeared from it. It's a start, I guess, but I can't help feeling disappointed. And pissed off. Pissed that Obama's trying to make this a bipartisan thing ended up watering it down so much, and it STILL isn't bipartisan. Pissed that the Republicans were so hell bent on not allowing Obama a victory in their own electoral hopes that they were willing to sacrifice the health of our country. arg. arg. arg.


I hope you feel better soon.

Unknown said...

Having eloped for health care this year, I truly thought all of my problems would be solved, but my husband's insurance is one of the all time worst. Less than half of the doctors listed as on the plan are actually on it. And the doctors that are on it, are usually in factory clinics where they try to get as many people as possible in and out to meet whatever 'quota' the business plan sets out. Sigh. If you want to see a specialist -- good fricken luck.

sorry you are still not well. will they let you buy another round of the pills without having to go see the doctor?


Kelly @ Student of the year said...

It's absurd. Completely. I have a friend (with insurance) who pays over $200 for migraine medication. We're talking 9 pills. It's insane, and infuriating.

Julie Pippert said...

A-to the-MEN. And feel better soon.

Look on the bright side, my friend, you could live in Texas. :) Where insurance is unregulated. Imagine how high my premiums and deductibles are and how low my coverage and service.

Tabitha Blue said...

Wow, that is pretty incredible. We'll have to see how everything turns out, I'm hoping its much better than we all think it will be. And mostly, I hope you feel better soon!!


Dora said...

Yup. It's very broken. I have very good insurance now, but went without for many years. It was scary.

BTW, does the no insurance foot dr's name start with an "O"? If so, then he's the man for sure. My OB wanted me to go to someone else when I needed foot surgery while pg, but I was not willing to let anyone else operate on my foot.