Healthcare Fail/s

Fail #1 – I take medicine.  I don’t think that’s an Earth moving statement.  Many of us do.  Mine happens to be required every day.  Fine.  Another non-statement.  And, insurance covers much of the cost of the meds.  Now, that’s different for everyone, but as a State employee, it’s a little better for me than you.  I haven’t gotten a raise in 7 years, but I get healthcare.  Which would you rather (a blog post for another time)? 

So, when Medco/Express Scripts said, “We’ll reduce your payment on your meds further if you just subscribe with us for automatic refills and mail-order delivery,” well, hot damn, that’s just too good to be true.  And it was. 

I could end this blog here and you’d be stuck nodding your head in agreement without any good story behind it.  Frankly, it’s not a great story, but you asked (or didn’t) and here it is.  The drug I need is name brand.  Insurance companies and their subsidiary pharmacies (i.e. Medco) don’t like giving those out.  Why?  It costs them more while my premium stays the same.  So, routinely, after a script is up, they try to switch my meds.  I get the letter/e-mail indicating that there are other generics that could work as well and if I don’t get a special note from my doctor, they’re going to switch me.  I’ve got a “if it ain’t broke” mentality about meds, so, every 3 refills, I get my doc to write another script and letter as to why I need name brand.  Fine?  Fine.  My issue is that, instead of working from health-related science in order to change my script, they’re looking at their bottom line.  It’s cheaper for them, so let’s short our patient of what they need/works for them.  The problem is that there’s practically no financial difference for me.  So, why should I switch?  And so the game goes on.

This time around, Medco sent a letter indicating that my refill was being processed followed by an e-mail saying that I couldn’t get a refill now because it was too soon since the last one.  Uh, hello?  You, Medco, sent me the last one.  It’s time for more meds, you incoherent bastards.  Can’t you imbecilic idiots count to 30?  That was a 20 minute conversation with their customer service, a number I’ve called too many times.  Effing computer.  Effing Medco.

Fail #2 – I got a letter in the mail regarding my physical therapy.  (You didn’t know I broke my leg?  Fall down go boom, yadda yadda yadda, PT for weeks, pain killers, etc.)  I’ll paraphrase:

“Mr. August, based on the PT reevaluation information provided to us by the therapist, your reported pain and range of motion tests indicate that you don’t need PT any more.  Good day.  I SAID GOOD DAY!.”

Riiiiiiiiiiiiiight.  OK, so the decision to end my therapy was based, not off of physical ability or level of healing, but on reported pain…which is an arbitrary fucking number between 1 and 10 without any unit of measure associated with it…and my range of motion…which I was nearly 100% 2 weeks after surgery.  Never you mind that the muscles were so atrophied that it looked like I was peg-legged in a pair of shorts.  In fact, the same reevaluation indicated that I had between 50% and 75% strength in the bad leg, and had a marginal level of ability to do simple things like jog, jump, etc. compared with the good leg.  MEASUREABLE STATISTICS NEED NOT APPLY.  Again, if the insurance company doesn’t want to pay then you need to beat feet and get going because you’re not going to get the medical treatment you deserve.  Don’t let the door hit you on your crippled ass on the way out.

I guess it’s just amazing that we allow this to continue to happen.  I’m willing to bet that for every person like myself that needs treatment, 20 are perfectly healthy and are just paying into a system that they’ll never fully take advantage of…leaving the insurance companies fat and logy.  To be fair, I did have an opportunity to appeal, but then I’d need to solicit not only my PT, but also the orthopaedist to send letters on my behalf.  And, by the time I had gotten the letter of denial, I had been out of PT for 2 weeks already because the insurance co. put them on notice that payments were going to stop after a certain number of sessions.  They just didn’t get around to telling me until 3 weeks later…through snail mail.  Welcome to 1956. 

No matter what you think of Obama-Care, it’s there.  And, in my opinion, it was like a 3-legged horse right out of the gate.  I know that it works…but it works like all the other insurance companies.  In my limited opinion, we as a people really, missed an opportunity for true healthcare reform.  Your health was never meant to be a money making venture.  It shouldn’t be.  I understand that every time someone is covered, that provider is taking a risk that the money going into the system will not equal what needs to come out when a tragedy happens or medical treatment is absolutely necessary.  So, how do they buffer that?  By taking on thousands of patients in hopes that everyone doesn’t get the flu at the same time.  That should be it.  Instead, the companies are constantly looking at ways to cut corners, offer less to their subscribers, and profit on your obligation to carry insurance in the first place.  What’s worse is that there are plenty of other nations out there that have figured it out, and instead of embracing something that will reduce costs for EVERYONE, we call them socialists or communists and point fingers and say “that won’t work here” without any substantial logic backing up the claim.  That’s an ignorant “freedom fries” mentality.  Instead, we should be taking notes and start employing strategies that are good for people, not corporations, which would make things cheaper and more comfortable to everybody.  I don’t know what that is, but I know that we’re a smart enough country to figure it out…that is, if everyone can take a break from eating freedom fries.