Tuesday, April 3, 2012

May I Opt Out?

Can I opt out, too?

As I understand it, the Conservative objection to ObamaCare centers around the mandate.  Extending benefits to millions more by requiring the states to expand their definition of need seems to be an easier proposition for the Justices to examine dispassionately.  Telling me what to do has a stickier presence.

I get it.  I really do.  the Pilgrims came to our shores because they were peeved - the government was telling them how to live their lives and they wouldn't take it any more.

Of course, they got to our shores and began expelling people from their colony when beliefs clashed.  Even in elementary school I was bothered by the hypocrisy of it.  Fleeing your homeland because you couldn't pray the way you chose was a stand-alone good reason.  Sailing across the pond and doing the same thing to others always struck me as the height of hypocrisy. 

Didn't they get it?  Were the Pilgrims just looking for a spot of land where they could be as demanding ... as inhospitable.... as reluctant to accept deviation... as controlling as the King and his minions?

I saw it as an eight year old; I see it again at sixty.

I get that Rick Santorum thinks that birth control is a bad idea.  I get it that he thinks sex is for procreation and nothing else and I don't have a problem with that.  He's got his wife home with the kids, a government pension and health care provided for him and his ad infinitum at little or no cost out of the Santorums' pocket, and this is a chance to tout his beliefs - leave me alone to do what I want.

Fine, Rick.  I have no problem with that.  Just let me do the same.

Ron Paul has gotten a bad rap  - he most emphatically did NOT say that we should leave an uninsured sick person on the street rather than provide him care.  That is not the American way.  It is not my way.   It only works for insurers, it seems.

The lobbying bill early on in Obama's term was the first step toward resolving the health care crisis.  It went nowhere, and big money speaks..... as a person, according to  the Supremes.... and it speaks loudly.  But that money may be the only place where truth resides.

I saw the hand surgeon last week.  As he examined the surgery that didn't fix the problem he commiserated with me.  No, he could not explain the dollar amounts on my bill.  There was a Blue Cross Blue Shield write-down, an adjustment to the cost of the procedures, but he could only explain it (as his billing coordinator and the clerk behind the counter did, too) as "what the insurance company allows us to charge you for this."

Fine.  I get that.  But if I only pay you the cost the insurance company says I should pay, then what happens to the 25% you are not receiving, I asked.  If you tell me on the bill that the surgery costs X, what happens when you only receive 25% of X?  How do you pay your employees, your rent, your suppliers, if you are losing money on every operation?  How do you keep the doors open?

His response was the first honest answer I've gotten since I began my quest to understand medical billing in late 2010. 
You have to assume that the numbers are all made up.
Well, that stopped me in my tracks.  He was completely, totally, without a doubt serious when he said it.  I repeated it back to him and he did the same to me. 

"How do you manage your practise?" I wondered.  He could only shrug.  It is what it is.

TBG spent six hours in a local emergency room in late 2010.  Never admitted, there to determine why he was shaking like a leaf, he was discharged with medication and reassurance and a $14,000+ bill.   At least, that's what the hospital posted on the paperwork as the fee for services rendered.

There were obviously services rendered.  Humans and machinery were in and out of his cubicle.  He was taken to other spaces for tests and evaluation.  Actual people were involved, real machinery was utilized, physical supplies were applied and discarded... I saw it all.  None of it was there out of the goodness of the purveyor's soul.  This was work, and compensation was expected.  The floors were clean and the trash was emptied and the lights were on.  All of that cost money, too.

Yet, the hospital was willing to write off a sizable portion of the bill as BC/BS Adjustment. 

Trust me, denizens, that does not mean that BC/BS was making up the difference.  Nope, the hospital was willing to take the money that our insurer allowed in order to reap the rewards of having patients insured by the company coming to their doors.  Something is better than nothing.

Medicare has a similar write-down policy.  Here in Tucson, home to the elderly and the retired and the governmentally insured, private insurance companies keep the hospital doors open.  Or so they say. 

I'm still working on that write-down.  How do they keep the lights on and the floors swept if their costs are not being met. Can it be that the hand surgeon is right?  Is it true that the numbers are just an illusion? 

No wonder no one can figure out health care.  There are no facts from which to start. 

I had skin in the game for this most recent surgery; with a high deductible I knew that I would be responsible for most of the costs out of pocket.  I should have done this last year, when getting shot took care of deductibles and co-pays on the first day and my care was covered completely by the insurer.  I just couldn't face the knife again, so I waited for my heart to catch up with my body's needs.  I'm paying for this procedure myself, and I want to understand the bill.

How could I have forgotten?  "You can't always get what you want....."

There is nothing to understand. It is smoke and mirrors.  No hospital or doctor's office or radiology factory could keep its doors open if its costs were not fully covered.  Suppliers would stop delivering, physicians would stop coming to work, the electric company would turn off the power if they received only a portion of what their costs were determined to be.  And yet this doesn't happen.  The whole thing is built on sand.  The more I asked, the shakier the castle became.

I end up wondering if I should just cancel my insurance entirely.  At nearly $800 per month, I'd have covered the cost of my unsuccessful hand surgery in 4 months.  If TBG and I stay healthy and away from weaponry that gives me 8 months of not paying premiums.  I can do a lot with $6400, denizens.  And I'll know where it's going every step of the way.

But that is irresponsible, TBG assures me.  We can afford to cover our care, and we should do so.  The insurance system is all that exists right now, so we participate.

But, in participating, we are also covering the costs of those who are uninsured - by choice or by exclusion.  Those people do get sick and require care.  That's where the padding comes in.  That's why the numbers don't make sense.  They include my share of the burden of paying for those who cannot or will not pay for themselves.

I'm finished with that.  Just as I don't want to pay for Medicaid coverage of the idiot who sustained a head injury while riding his motor-cycle without a helmet, I don't want to cover the costs of those who refuse to buy health insurance.  I'm done having my values (I won't leave you to die along the side of the road) translate into paying for you because you refuse to do it yourself.

I can understand a citizen's reluctance to acquiesce to more regulation.  The 55 mph speed limit, no alcohol til you're 21, abortion delays and trans-vaginal ultrasounds.... the list goes on and on.  But your flauting of those rules doesn't cost me money.  Your refulsal to buy health insurance does.

So, I'd like to opt out, please.  If you won't pay for it yourself, that's your right.  Just don't make me pay for it on your behalf.  Exercise your freedoms, as long as they don't bump into mine.  I'll make charitable contributions to institutions which serve the needy, institutions which have done good work on my bullet-ridden body, institutions on the cutting edge of technology.  I just don't want to make a contribution to someone who doesn't want to pay for his medical bills himself.

It's beating a dead horse, I know, to state that Congress has no clue because their health care costs are covered.  I was in that situation, too, with health benefits paid by an employer and little need for care myself.  Then retirement and moving to a new state and suddenly TBG's knee is a pre-existing condition.... just by moving across the state line.... and I'm paying exorbitant amounts based on fantasy and negotiation. 

He may have botched the surgery, but my surgeon's honesty redeemed him in my eyes.  The numbers are all made up.  No one can solve the problem, because there are no hard facts.  I'm going to take my cue from the right - you can't make me do something I don't want to do.  Right now, I don't want to pay for you. 

You have the right to be stubborn.   I have the right to protect my assets. 

Do you disagree?  Do you think that I'm making a mountain out of a molehill?  Ask your physician at your next check up how your $35 co-pay and the insurer's contribution stack up against her actual costs.  Then, ask her how she keeps the doors open.

It's a mystery to me.


  1. And that is why we need a single-payer system, sooner rather than later. Laura

  2. And, once again, The Cheese's come up with a solution!

  3. It IS a mountain. The entire health care industry is a mountain of some stinking putrid mess. Personally, I would keep your insurance, without it you will pay the prices BEFORE the write-downs, the non-negotiated prices. For those who are uninsured, those are the bills they get, which they can't pay. If real, unmade up numbers were used, maybe the uninsured could go to a doctor before it's an emergency. One of my Canadian snow bird friends broke her collar bone this winter, The first estimate was $40k to fix it, they had a $15k limit on what their travel insurance would cover. Her husband called around, negotiated on her behalf and was able to have her surgery done at Tucson Orthopedic (out by TMC) for $7200. Where is the sense in this? With no visible real prices, people can't shop for care based on affordability, market forces are never brought to bear and numbers really ARE just made up. As you can tell, this is sort a hot button for me. I'd really like to know why insurance for medical care is a for-profit industry, anyway. Ok, done now.

  4. That is why one of my favorite docs is in a group practice instead of the solo practice he had for years. Add to this the vast numbers of just out of school docs who can not make enough money to pay their huge loan payments.... We really need a single payer system. Ours is broken.

  5. I agree with comments that we need a single payer system. If our system is so good, why are we at the bottom of the list of modern countries in the quality of health care. It is a disgrace to have millions of people unable to even purchase insurance. My sister had an individual Blue Cross policy which she paid for 20 years because her employer did not provide insurance. As soon as she got Non Hodgkins, they dropped her. Because she was not in a group she had no rights. People say they don't want the government interfering with their doctor's decisions. When I had knee replacement, my insurance company would not allow the 16 physical therapy sessions the doctor ordered. I had to fight for 13 and I was paying a hefty co pay. We must fix this health care mess.

  6. Luckily, I had the funds to cover the out of pocket costs. The inability to comparison shop, the dropping of coverage, the angst and anger..... it's all so unnecessary, isn't it?

    If women ruled the world.......

  7. Another blog on April 3rd on the same subject:


    It's all just insane! And to think when I had our two sons, the doctor charged $110 for delivery and all visits previous to the birth. (The extra ten was for the circumcisions.)

  8. Thanks for an excellent article! I appreciate your insights and agree with what you wrote. http://floridaadvertisingagency.net

  9. Thanks, Hilda. I often feel like I'm preaching to the choir, but I do so like our tune!

    Ellenshead's April 3rd post is so similar it's scary. Wouldn't it be nice if the donations which paid for her care were used for basic research and prevention instead of covering inflated bills?

  10. A voice of reason! I know we just met, but I think I might love you.

  11. Thanks for the love, Word Nerd <3 I've always believed in love at first sight anyway :)

  12. Thanks for such a nice Blog and very useful information. I need to share with my friends. Keep it up dear.


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