Sunday, February 10, 2019

My Log 698 Feb 10 2019: Chronicles from my Tenth Decade: 132; My latest post on Facebook by Ben Richardson; a Canadian take on US healthcare.

My eldest son Ben, who lives in Austin, Texas, has recently described his experiences when searching for adequate health care, which has always come at an extravagant price, and has compared it with the single payer system in Canada.  This is a  detailed ailment-by-ailment account that should convince the most sceptical reader. I am happy to open up my Chronicles to allow for such an eloquent piece on the superiority of socialized medicine to one dominated by private profit.

I am getting really sick of people telling me that single payer healthcare is a pipe dream.  It has worked so well for so many countries.  The people who are against it really want to maintain the status quo.  I’m not shitting on Obamacare because it is so much better than what came before it, but it is basically flawed without the single payer option.
        After ten years of living in the US as a non resident alien on assorted work visas, I met my wife Natalie in 2012 and we were married in 2014.  Natalie, while generally healthy has a lot of stomach problems and some other ailments.  
I got my Permanent Resident status in 2015 in time to sign up for Obamacare.  As I am a self employed musician/touring soundman and she is in the service industry we average around between $20000 to $45000 a year taxable income (depending on how much work I can drum up).  So when we signed up, we picked a Silver Plan from Humana, which seemed like a good deal.  $6900 a year was the cost of the plan, but with the subsidy we only had to pay $1440 a year.  For this we got Primary Care doctor and urgent care visits for a $35 copay, Specialists were $50 copay.  Anything extra we had to pay 100% till we reached a $1400 deductible and once we reached that limit, we had to pay a coinsurance of 20%.  Once we reached $4500 in additional spending the insurance would cover 100% from then on.  Drugs were also cheaper through the plan
It worked fairly well for the first few months until I got an unanticipated job for quite a bit more money.  Once I had corrected my projected income through the Obamacare website our subsidy dropped and our yearly payment rose to a total of $3840.
The coverage was good. Humana had lots of urgent care clinics in their network.  While we never got around to using the policy to it’s full potential (finding a primary care doctor, having a physical etc..), whenever Natalie had a problem, we would go to the appropriate provider and for $35 she could see a doctor.  A couple of times, I got small bills in the mail for tests and such for around $100-$150 which I paid with no problem.  
This year when I went to renew, I found that the Humana plan we were on had raised it’s rates by about $150 extra a month.  So I went on the website and tried to find a similar Silver Plan.  I found one from Ambetter that was about the same cost as the Humana plan had been in 2015.  It seemed similar, although i had to admit the whole process is quite confusing and not set up well for comparisons between plans.
Well a few days after that Natalie got sick at work, and the next day I went on the Ambetter website to find a doctor to take her to.  The first couple of clinics that came up were both less than a mile away from our house.  That seemed like a good sign, but was not to be.  The first clinic turned out to be the clinic inside the Del Valle Jail.  The second clinic on the list turned out to be the children's clinic inside the Delle Valle Primary School.  The next two places I called, only took appointments and didn’t have anything available till next week.  the next place I called, the woman registered us, then had a consultation over the phone with Natalie.  After spending a good thirty minutes on the phone, she told us that no one was available and to go to the emergency room.  She was extremely insistent that she should go right away.  I asked her if she could recommend any urgent care clinics and she kept insisting that we go to emergency.  I finally searched urgent care on the Ambetter website and was directed to the only one in Austin. It turned out to be inside a CVS drugstore.  When we got there, the nurse said that they didn’t have any doctors there and that Natalie should go to emergency.  I finally got a guy from Ambetter on the phone and as it was getting late, he said that he would find us a doctor early the next morning.
The next morning he called back and gave me the telephone numbers to both the primary school and the prison, at which point I lost my cool and asked him pointedly and sarcastically if the $6900 that this Plan cost, really entitled us to a doctor.  I then posted my story on the Ambetter Facebook page, telling them that they sucked.  I soon received a call from a lady from Ambetter who, after I took her to task on the lack of walk in clinics in their network, promised me that she would get me an appointment in the next hour.  She called back and gave me the number of a doctor who could fit us in at 2:30PM.  Talk to Betty, she said.  So I called Betty right away, only to be told in a most unpleasant manner that the doctor had NO openings that day.  By this time, Natalie was starting to feel a little better and we both basically gave up exhausted and frustrated.  
The only silver lining in this whole mess, is that a couple of weeks before the end of the enrollment period, one of the fine folks at the Health Alliance for Austin Musicians had called me to tell me about a Silver Plan that they were pushing that turned out to be a bit cheaper, so they signed me up with The Sendero Silver Plan.  Looking on their website, they had a lot more urgent care and walk in clinics in their network and turned out to be much better.
“So why didn’t you just take her to the emergency” I hear someone asking.  Well I am pretty suspicious of hospital emergency rooms in the US.  That was what Natalie did for healthcare before she met me.  
I was on travel insurance for the first ten years here, when I went to the hospital one night with a sore abdomen.  Four hours later I walked out with a diagnosis of a strained abdomen.  They presented me with a bill for over $12000, and tried to get me to pay for it and get reimbursed by the insurance company even though the insurance rep had told me that that hospital could direct bill them.  Needless to say I didn’t pay them.  When I later followed up with the insurance company to make sure that the bill had been paid, they told me that they had asked the hospital for a detailed accounting of all charges.  The hospital had responded by sending another bill for $900 which the insurance paid and that was the end of it.  Can you believe they tried to rip me off for $11100?
One time, on the road, Natalie had terrible stomach pains and I took her to the hospital for a three hour visit.  I later received a bill for over $4000.  
Another time after she was rear ended by another driver and had to go to the hospital that night, and return the next day feeling worse for a total of two visits.  I had decent car insurance, the other driver had none. My Insurance company covered the repairs to the car, and assured me that they had taken care of all the medical bills to the tune of almost $3000 (the maximum they were legally obligated to pay).  Imagine my shock six months later to get a bill for over $14000 for the second hospital visit from a collection agency.  
I think this is because the doctors just cavalierly order the tests and not once in my experience have they ever mentioned that these tests are costing you thousands of dollars.  Even when I would question the need for so many tests, the nurses would just cheerily brush off your concerns by saying “the doctor has ordered them”.
Once we had signed up for coverage, we were coming home from a Caribbean holiday and feared that she had caught some kind of biting insect.  We were driving from Dallas Airport back to Austin late in the evening and she called a hospital in Waco and asked them if they took our Humana Insurance, which they assured us that they did.  We were there for two hours when upon examination they gave her a clean bill of health.  I specifically asked them if there were any charges as we left, and they said no the insurance has got it.  A month later I received two bills, one from the hospital and one from the doctor totaling over $900.  The Humana contribution was $96.  But nobody tells you any of that.  They usually tell you as little as possible till they’ve done every possible test they can think of, and then present you with a massive bill.   To add insult to injury, in not one of these cases I’ve talked about was there anything seriously wrong with us.  Stomach pains were stomach pains, my abdominal pain was a strained abdomen, and the insect infestation we feared turned out to be a figment of our imagination.  Nothing that should cost $12000, or $14000, or $4000, or $900.  This is highway robbery by the whole medical insurance industry.  
So this is Obamacare.  Much much better than the previous system where the insurance companies could deny coverage at anytime and if you had a preexisting condition you either didn’t get insurance or had to pay a small fortune for it.  The only reason that I became a permanent resident was because it looked like Obamacare would cover us for not too much money.  But the whole system is so skewed towards making a profit that it really is obscene to a Canadian like me.  
The whole day I was looking for a doctor for Natalie, it didn’t seem like one of the people I talked to was really concerned about her welfare.  All they cared about was whether they took our insurance.
I lived in Canada from the age of 7, till I left for Austin at the age of 43.  I confess for that whole period I never gave a single thought to healthcare because it was just there.
The system is administered by the provinces, so each province has a little bit of a different way of doing things, but the bottom line is that all essential healthcare is covered.  
The province (in my case Ontario) issues you a health card, and you just give the doctor or hospital your health card and almost all the charges are covered by the government.  No copays and no deductibles and almost no paperwork.
When I was 20 years old, I grew a cyst the size of a tennis ball on my forehead, and had to spend a week in the hospital as they drained it to make sure the infection didn’t spread to my brain.  The cost to me… $0.  When I was 24, my lung collapsed.  That was another week in the hospital.  Then it collapsed again.  One more week in hospital.  Then I had to go in for chest surgery to fix it.  That was a MONTH in the hospital.  Again… the cost to me.. $0.
Five years ago, my Dad almost lost his left eye.  Only a specialist in optic surgery was able to save it.  Cost to him… $0
In 2007 my mother died after two years of daily at home nursing and doctor visits plus on and off, a good month in the hospital.  Her care was uniformly excellent.  Again.. cost to my Dad… $0.
Oh but you’re paying way more in taxes” I hear someone saying.  Well as someone who has paid taxes in both the US and Canada, I think I can say with authority, that I wasn’t paying any more in income taxes in Canada than I was in the US.  Alcohol, cigarettes and gas are definitely more expensive, and the cost of living can be higher, but that is really because Canada and most other first world countries have higher standards of living, and access to excellent healthcare.  And I have spent roughly the same amount of time waiting in emergency rooms in both the US and Canada.  
The US spends twice (that is double) what most other countries pay for healthcare per capita, and I can see why.  So much time, energy and money is spent trying to eke a profit out of the consumer that it’s no wonder Americans are so unhealthy.
There’s certain dignity that comes with being confident that when you get sick, you will be taken care of.  That dignity is sorely lacking here in the US and that is why the citizens need to elect someone like Bernie Sanders to put the idea of single payer healthcare squarely on the table.
It will save us a ton of money and lower costs in the process.  The other aspect that no one seems to be talking about is that it will be amazing for business.  I saw somewhere that the average cost to the employer for healthcare is now in the neighborhood of $12000 per employee.  So even if the taxes were $3000 per person for the government to pay all the costs, businesses would still be saving a ton.  Hell if I had to pay $3000 in extra taxes I would still come out ahead of Obamacare.
I wasn’t able to vote in the last election, but by the time the next one rolls around I will be a US citizen and I’ll be voting for the candidate who is the closest to promising a single payer option.

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