February 14, 2010

Health rant: Medicine fails on paper, in person

Health care advocacy is so tiring, whether we advocate for ourselves, our family, our friends, or the past.

Forget the battle for a fair, affordable health care plan in the United States. Worry about the loss of family doctors or general practioners in the land of specialization.

Remember the people who are crafting the national policy are the ones who created Medicare, which reimburses doctors, hospitals and pharmacists less then the medical community gets from patients with health insurace through employers or self.

Part D not for dummies

Remember also the people who are writing the details of a plan to ensure those who need help can get it before dying are the same people who created Medicare Part D, a prescription program for our parents, grandparents and others who should gain respect just by the shear fact they've lived past 62.

Instead, the smart guys who created Part D make our people choose a new plan each year - I had 48 plans to consider for my mother, 60 some for my stepdad, and, a high of 84 plans for another person.

That required inputting what medicines at what dosage are being taken now - do you know what prescriptions you'll need next month, much less all year? Then, you chose the plan that covers the most prescriptions, or at least the most expensive prescriptions. Remember, though, there's a clause that says the insurance company can stop covering a drug at anytime.

Part D not for the sick

Let's not forget the donut hole - that area where you get no help from the plan of your choice after you pay. First, you pay a deductible for your drugs and then you get some help from the plan for approved drugs. But once you reach $2,830 in total drug costs (total drug costs, not your share), you get nothing until your out-of-pocket cost reaches $4,550. Then, you usually get all or most of your drug costs covered. The meter is reset each year.

It's easy and scary to find out your drug costs by asking the pharmacy. For instance, one drug I take costs about $1,000 a month and I pay a $20 co-pay. I  pay that same co-pay for drugs that cost less then $10. 

But think back to Medicare Part D. If you need nearly $3000 worth of drugs in less then a year, aren't you sick enough to require help, not ignorance, for the rest of the prescriptions.

So I have no faith in the crafting of a good for me/us national health care policy.

New D - insurance denials

I'm not encouraged either by the insurance industry. January is the month of denials, when people learn that the insurance they thought they had disappeared either correctly or wrong. First notification comes when the pharmacist asks for $525 instead of an expected $25 co-pay.Blame all the new year changes that sneak in.

This is also when you review the expeneses of the past years as you prepare for taxes. I confess that I cried while sorting out what went where for what. Perhaps broken toes highten my sensitivity. But paying for and tracking my daughter's treatment of breast cancer continues to annoy - doctors and institutions that don't send itemized bills, or bill the wrong insurance or forget to bill until months down the ine.

Calling for 1 doctor

Equally disappointing is how the changes in distributing medicine in this century can harm us unless we are our own medical advocate, staying ontop of the literature and medical advances.

For instance, a new issue of Neurology talks about the possibility of bone problems for those who have multiple sclerosis. The scariest phrase for me is "Even most neurologists don't know about this." Oh, we should?

Certainly, I've never told mine that I've been breaking toes and the same foot over and over and over this past year. 

For the record, on Thursday a doctor suggested I up my intake of Vitamin D to counter what's become an ongoing problem.. On Friday, I broke a few toes. On Saturday, I get a magazine that says those with multiple sclerosis are at risk of bad bones and should up their Vitamin D.

Did we hurt ourselves when we lost family doctors, someone who knew us, our family. Have we lost in this age of specialization - each doctor treating parts with coordination staying with the patient?

I'm overdue for a visit with the man I believe in charge of my multiple sclerosis. (A big snowstorm meant I canceled the last appointment; some expect an earthquake in March in Michigan will prevent the next one.)  So this new development worries me.

I like the doctors in my medicine stable and enjoy their williness to avoid duplication via sharing of records. But I hate going to all of them, to any of them. I never know what to say to which one despite notes. And, after all of these years, I still can't tell when it is time to get their help and not rely on their previous advice.

Tell the guy who specializes in the nervous system about my poor foot and toes? Tell the foot doctor about an eye problem? The eye guy about .....

Many days, I want to return to the doctor who treated me as a child. He knew my parents and grandparents so I didn't have to remidn him which of those were diabetic. He knew. I'm sure I wouldn't have to remember what to tell him other doctors treated because I'd be at a one-stop shop, which sounds very good today.

Right now, I'm looking for something to stop the aching toes, knowing that only time, especially time off my feet, will remove that challenge.


Post a Comment