Wednesday, March 20, 2013

Odds ‘n’ Ends about medical care

I did not closely follow the debate  or rather public squabbles  about “Obamacare” -- a word that was coined as an insult but which, if it all works out, could become a badge of honor, like “The Marshall Plan” (which really was Truman’s plan but, for various reasons,  he gave the risk/credit to Marshall).   The issue is crucial and is becoming moreso as the population ages,  and as -- a separate issue entirely -- ever more expensive and at times outlandish or even immoral medical interventions become possible.   But the ratio of noise to information in what came streaming out of the media  did not replay attention.

The Republican/Tea Party side of the spectacle was often especially bone-headed:  but that is because this party has become -- almost explicitly and avowedly -- the Party for Stupid People, so that they are bound to muddle things up  even in cases where, underlyingly, there may be powerful arguments to be made on their side.

So anyhow, since I confessedly know little of value (and, along with the rest of you, am told less) about the intricacies of the issues here, I shall remain mumchance;  yet venture to observe, simply as a sociological fact about being in one’s sixties in the present century, that the debate seemed to concern, not life on Earth, but some parallel civilization on a closely-akin but still different planet.    A planet on which having medical insurance means you are among the privileged, while those without  are in dire straits.
My own insurance comes from the federal government, and thus is the supposedly “cadillac” premium plan sneered at by those opposed to federal workers.   I’ve never had a large medical bill, and don’t know what would happen if I were to incur one;  but I do occasionally have an issue with teeth.  And, despite having purchased a special dental insurance over and above the basic federal medical one, reimbursement for the biggest bills  has been as follows:
Crown (including the work that leads up to it).  Cost: between $1000 and $2000 depending on the tooth.  Reimbursement:  A couple of hundred.
Root canal.  Cost: $1000.  Reimbursement:  Zero.

In my immediate office there is a young father of three,  with certain highly specialized skills useful to a mission that even those who like to throw brickbats at the gummint  would no doubt shamefacedly admit is essential, who -- months ago -- had a tooth removed.   He carries the same insurance as the rest of us (though, again, he separately purchased extra dental protection) -- but it is useless, it won’t pay for the needed replacement at all, so now he walks around with a giant hole in his mouth -- worse off even than George Washington with his wooden pegs -- the neighboring teeth slowly toppling into the gap.   This, if you please, is one of the privileged. 

And again just today,   I saw my ophthalmologist, who is sixty-two, and has been practicing successfully for decades.  He seems to be in excellent health.   But he can no longer afford his own insurance, the price of which was just raised to something like $15,000 a year -- and that, with a six thousand dollar deductible!   Which means, he gets absolutely nothing out of it, and financially would be better off just to drop it.  But, under Romneycare (and its later extension, Obamacare), that will be illegal, and the criminal (you) will be subject to a fine.
Something doesn’t compute.

Well!   At least health-care providers must be making out like bandits, since society spends so much money in their area, right? 
Probably so, somewhere along the links of the serpentine money-chain -- nursing-home operators and beneficiaries of kickbacks from drug companies and the like -- but I can tell you this:  It ain’t nurses.
My wife is an RN, with a bachelor’s in nursing from a good school, and decades on the job.   She has worked in a number of areas, but for the past ten years, in homecare for the severely disabled.   The cost of this care is picked up entirely by the taxpayer, since the patients have no assets.   Her pay is at the bottom of the RN payscale -- hard so say even why she stuck with it for so long; something to do with the Stockholm syndrome, I suspect.  Anyhow, the pay is even less than it looks, because there is a cap on the number of hours that will be reimbursed per week, and she regularly was forced to work substantially more of them -- both in direct medical care, and in running tedious errands for her patients (like buying them groceries, often out of her own pocket, which for some reason their family refuses to do).   In other words, when she worked overtime, instead of getting time-and-a-half, she got … zero.  Sweet deal, right?  (For the bosses.)
Then a few years ago, Medicaid further reduced the amount they would reimburse, at which point -- to their credit -- the nursing agency she works for decided to swallow the loss rather than reduce the nurses’ already modest paychecks.

Eventually she realized what a dead-end this is, and she quit (apart from pitching-in part time in emergencies) to go back to cardiac care (good choice!  exclaims your servant with the wonky ticker).   So her income has dropped to near zero, less than the cost of tuition and textbooks for the various courses she needs to make the switch, not to mention the year’s worth of malpractice insurance she was required to by as a prerequite to even being admitted to her Nursing Refresher course.
At today’s meeting of that course, there was an interesting guest lecturer:  a lawyer who, for twenty years, has specialized in defending nurses against lawsuits, and who is herself a Registered Nurse;  indeed, she took that same refresher course herself a couple of years ago, just to keep up with the field of her clients the defendants. 
The lecture was not encouraging.   Nurses in local hospitals are in increasing danger of being sued.  En revanche, should a nurse contract a serious illness as a direct result of her job  (a growing danger, what with MRSA), she cannot expect the hospital to pay for any of the costs of her care.   So, the nurse cannot sue, but she can be sued.
But the topper, la goutte qui a fait déborder le vase,  and which finally led me to put aside wrestling with the Riemann Hypothesis  and to write this post -- and which brings us back to the insurance question with which we began -- is this.   The attorney, as a fruit of long experience in this area, urged the nurses not to purchase individual malpractice insurance.   The reason being that plaintiffs can find out if you have any, and if you do, they will specifically list you by name as a defendant, in addition to the hospital.  At which point you embark upon a world of pain.

Welcome to the world of work in the twenty-first century.

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