Category Archives: Health Care

Dignity to the End

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Ed Cone linked to this must read article.  Since my Mom doled out my brother's and my responsibilities I've thought a lot about end of life issues (she wisely put him in charge of finances, and, hopefully also wisely, me in charge of the plug).  Really, please read the article as it raises some important questions we need to answer in our society. An excerpt:

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

Lest you think I'm not serious about my responsibilities based on my use of the flippant phrase "in charge of the plug" you should know that I take it very seriously.  Humor, in my case, is definitely a defense mechanism. In my mind someone's last wishes are just that, and to countermand those wishes for the very selfish reason that you don't want to let go is just plain wrong. On the other hand I don't think any person can really know what they'll do in that situation so I'm also very worried that I won't have the courage to live my convictions.  

One of the reasons I'm concerned about my ability to follow through is that I'm a hopeless believer in the possible. I truly believe that any game can be won with a last-second "Hail Mary."  As the author points out, this can be problematic for those trying to make end of life decisions in today's technologically advanced world:

These days, swift catastrophic illness is the exception; for most people, death comes only after long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost. As for last words, they hardly seem to exist anymore. Technology sustains our organs until we are well past the point of awareness and coherence. Besides, how do you attend to the thoughts and concerns of the dying when medicine has made it almost impossible to be sure who the dying even are? Is someone with terminal cancer, dementia, incurable congestive heart failure dying, exactly?

Well, no one said it's supposed to be easy.

$608?

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So I got a call from my wife letting me know that my daughter's routine wellness visit to the doctor was going to cost someone $608.  I say someone is going to pay it because it won't be just us.  Our insurer will be picking up a healthy chunk of the bill, as they should since that's why we pay them ransom premiums every month, but the interesting thing to me is that the only reason we actually know the cost is because the doctor's office still has us in their system as an "out of pocket" patient and they send the bills directly to our house.  The reason for this is we used to have an HSA plan so all the bills were paid directly by us, but we've been on our current "regular" insurance plan for over a year so we shouldn't be getting these bills. Can we say inefficiency? 

You have to wonder how we've gotten to the point that a simple wellness visit that takes 15 minutes and involves a routine vaccination can cost north of $600.  Sheesh.

But wait, there's more.  It ends up that the doctor's office billed for something they didn't do.  When my wife called they said that the thing they billed for was a standard part of a wellness check, which is why they billed it even though they didn't provide the service.  They assured her that it would be removed from the bill that the insurer receives. Riiiight.

Here's my questions: What would have happened if we'd never seen the bill?  How often does this kind of thing happen and what is it costing on a state or nationwide basis? When did practice managers start going to the same management school as car dealership repair shop managers?

What a cluster.

This Can’t Happen

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Congress' attempt at health care reform is a big issue right now, and if you watch the news about what our Congresscritters are up to you can surmise that hardly anyone will be happy with the results.  On the other hand most people seem to be holding their breath and hoping that, if nothing else, the changes to the system will at least be an improvement on the status quo.

Whatever the result we need to make sure that situations like this will never arise. From the story:

The financially strapped Jackson Health System has stopped paying for dialysis treatments for 175 poor patients with failing kidneys — a decision that experts say could be deadly.

“It is no game,'' says Emelina García Cordoví, 67, whose treatments at a South Miami-Dade center were cut off Dec. 31. “We are talking of the lives of persons who depend exclusively on their dialysis.''

Jackson, Miami-Dade's government health system intended to be a safety net for the poor and uninsured, said it expects to save $4.2 million by stopping payments for outpatient dialysis treatment for the 175 patients. Of those, other avenues for care have been found for all but 41, says spokesman Robert Alonso. About a third of those are undocumented immigrants, who are not eligible for government programs.