I should pay my plumber more than my neurosurgeon

Yumabev made a joke about one of my posts on twitter, that I've been mulling over for a few days.

@yopd1 I know what u mean, my DBS surgeon got paid $1500 for drilling holes in my head & my neighbor paid $2500 for a plumber to fix a leak
— Parkinson's Humor (@YumaBev) December 9, 2013

After a few days, I realized, no shit, her plumber should be making more.  You see, when you get a bill from the hospital, it is usually includes everything, including that $20 aspirin that they charged you 5 times for, but you only took once.  But I digress.

Included in that bill is the amount that the neurosurgeon is paid for the 5 hours of surgery that he performed on my head.  However, the neurosurgeon is only being paid for his time.  He didn't bring in a scalpel, anesthesia, gloves, gowns, let alone the actual device that was implanted in my head.

When you pay your plumber, you are paying for everything, including all of his overhead and expenses.  The better question is after the plumber paid for vehicle expenses to get to your home, parts, a staff at the office to take your appointment, all the inventory he/she has to carry, let alone all the specialized equipment he/she had to buy and maintain, what is he taking home at the end of the day and what is the neurosurgeon.  I'd say the neurosurgeon is taking home an amount much closer than to $1500 than the plumber is, let alone the $2500.

Why Are American Health Care Costs So High?

Best explanation I've seen of the problem with healthcare in the US. EVERYTHING is overpriced and costs to much and there is no sense in why things are charged except to screw over the patients and get as much money out of them as possible. Most interesting fact: We spend more on government provided healthcare in the US per capita than any other nation, but don't provide everyone with healthcare.

How is anyone supposed to make sense of health care costs?

I got my bill for the hospital stay when I had my DBS electrodes installed.  Granted this did not include my stay at rehab due to my stroke or my subsequent outpatient surgery for the pulse generator.  What pisses me off, confuses me and/or frustrates me is the nonsensical billing system we have in the US.

Without giving exact numbers, the hospital billed my insurance company approximately $171k for my surgery and stays.  The insurance company paid just about $24k of that.  There is also a line that states adjustments for approximately $146k.  If you look up hospital adjustment online it states,

“Adjustment” refers to the portion of your bill that your hospital or doctor has agreed not to charge you.

Now, I understand that insurance companies get discounts for bringing in large populations of folks.  However, my insurance company paid basically 15% of what the hospital charged.  I wonder how many folks without insurance or with worse insurance than mine could possibly get the hospital even close to that value.

The fact that most people probably don't know this is even more incredible.  When I hear of doctors not wanting to take ACA or medicaid/medi-cal or some other non-premium insurance, I just have to laugh, because the premium insurance companies are definitely not paying full price, let alone wholesale prices.

UPDATE:  Another issue with this is the way co-pays are calculated.  Luckily, my insurance is a flat fee co-pay for a hospital stay.  However, if I had a percentage based co-pay, my co-pay would have been calculated based upon the original hospital bill of $171k.  Therefore, I would have been liable for 10-20% of that bill up to my out of pocket maximum, while the insurance company knew it would be paying the lower fee.

Either the insurance company is paying less than even $24k for the surgery if my co-pay is calculated based upon a percentage of the $171k.  Or the hospital is getting more money because they can take the $24k the insurance company agreed to plus my co-pay.  Either way, there is no incentive for either the hospital or the insurance company to bill the patient correctly and the patient gets screwed.  The higher the hospital makes the bill, no matter what they've negotiated with the insurance company, the more money comes out of the patients pocket while the insurance company possibly reduces what they are paying the hospital or the hospital brings in more money and the patient gets screwed.

Conservative 'logic' on Obamacare

A relative has been going off on facebook for weeks/months about Obamacare.  I've stopped engaging because he is always changing the subject and is so over the top that I just got tired of it.  However, I'd really like to understand the logic, if there is any.  So, based upon his posts, this is what I understand is his thinking.

The fact that people under 27 have an option for lower price insurance under their parents plan is bad, but the fact that they don't buy insurance when they are young was okay because they shouldn't have to buy it and their irresponsibility is their problem, even though those of us who bought insurance were covering those who didn't in the past because they would usually skate on the bills when something did happen. You are also okay with the fact that if young people waited to buy insurance, they would not be able to after the fact because of the no-pre-existing conditions clauses or they often were buying cheap insurance policies that would drop them at the hint of filing a claim because of some technicality the insurance carrier found or they'd often reach their lifetime max just when they'd need their insurance the most.  

The biggest issue to worry about with respect to access to insurance is that a website doesn't work from the get go, even though folks have three months to sign up and statistics have shown that historically younger people wait until the last few weeks to sign up.  And the costs are way too high, even though the CBO, a non-partisan entity, has shown that the ACA will actually reduce deficits.  And the fact that most of the dropped policies are irrelevant to the 90% or greater that do not buy insurance on the individual market and 75% of those who buy on the individual market are eligible for subsidies does not matter because one anecdotal story or even 100 anecdotal stories are more important than the millions who have already seen the benefits of the ACA even if they are one of those anecdotes.

Am I missing anything?

How OptumRX legally screwed me out of $150

I take a number of drugs for Parkinson's.  One of those drugs is Requip XL (Ropinerole ER).  This drug is the same as the drug Requip (Ropinerole), except it has a time release capability which means the drug company that created it, could keep it from going generic, longer.  The advantage of taking the time release version is that you get a little bit of the drug over the whole day as opposed to large doses that taper off.  The good news is that the drug just went generic.  The bad news is that my prescription plan through UHC has not yet approved it for generic pricing.

Nevertheless, my pharmacy, OptumRX, in their infinite wisdom as a generic pharmacy sent me the generic version of the drug.  They also charged me the same rate as it would have cost if I they had sent me the brand name of the drug.  I called them and asked since I was paying brand name prices, I wanted the brand name drug.  They basically said, tough.  They sent it out and there was no indication on the prescription to fill as ordered instead of using a generic version of the drug.

Now understand this, I would prefer to have the generic version of the drug, but for generic prices.  The fact that I called them immediately upon receiving the medication and they did not call me back is indicative that they knew what they were doing.  I called back a few weeks later, and after discussing with a customer service representative and her supervisor, I asked to talk to the pharmacist who was in charge of making the decision.  I was told by the supervisor that the pharmacist would not speak to me and the decision was final.

The problem is, I have no recourse and the pharmacy knows this.  They are the only mail order prescription service that my health plan uses and they are on the whole much less expensive then going to the local drug store.  Nevertheless, I will probably be transferring this prescription to a local drug store, because then I will be able to see what I am receiving and quickly be able to determine whether the generic brand has been accepted by my health plan and the price will go down.

For reference, my plan offers Tier III drugs such as Requip XL for $170 for a three month supply, while a generic brand will cost $20.

Open Letter to my Family

I was thinking of sending this letter to members of my family that have said they will not vote for Obama.  I know it probably will not convince any of them; however, I'd like to know what others think.

I know election time is coming up and it is not a big surprise that I am voting for Obama.  However, I am writing this letter to ask you to vote for him as well.  I know that some of you did not vote for him in 2008 and some of you who did are switching over to Romney because you don't like how he implemented his policies over the last four years.  I do have one argument to make and if that does not convince you fine; but, I'd like you to consider one thing when you do vote for Romney.

My daughter.

Now I know many of you have or continue to have health issues.  And the fact that you don't see how "Obamacare" is most likely the reason you will have healthcare in your old age is beyond me.  If Romney and Ryan are voted in with a majority in Congress and the Senate (definite possibilities) and you have any pre-existing condition and buy your insurance on the open market, you will not be able to buy an affordable plan.  If you reach an out-of-pocket maximum which will become legal again if Obamacare is repealed, an expensive monthly treatment will soon eat into that lifetime maximum along with any hospital stays you may have.  If you are out of work or lose your insurance for 90 days, you will automatically not be eligible for an individual policy that excludes pre-existing conditions.

Oh, and if you say, I'm already over 65 and receive medicare, they won't change mine.  Yeah, right.  Once everyone else sees that they have no chance to receive healthcare like the baby-boomer generation does, I'm pretty sure the rest of us will make sure that discrepancy goes away.  Also, I know the baby-boomers are considered the me generation, but "F.U., I've got mine", is no way to treat your children and grandchildren.

However, getting back to my daughter.  Do you really think there is a chance in hell that she will be able to get any form of health insurance after I stop working?  The only reason we are able to cover her is because I am on my large employer's group policy.  What do you think is one of the reasons I've worked there for over 19 years is?  Also, you say she receives some medi-cal to help offset many of her other medical expenses (copay and deductibles) we've faced over the past six years.  However, they have already stated that most states will receive 30% less in medicaid dollars if "Obamacare" is repealed.  Who do you think will be one of the first to be kicked off the medi-cal rolls, someone who uses medi-cal as supplemental insurance or someone who uses it for everything?

And if you think this is 20 years down the road, you are kidding yourself even more.  Yes, my Parkinson's is under control, but it is a deteriorating neurological disease.  While I hope for better treatments and possibly a cure in the next 20 years, I really have no clue how long I will be able to work.  My doctor gives me ranges of 10-20 years.  What happens to the rest of my (our) family after that?  Many of you know I have already begun discussing DBS with my neurologist.  Thank goodness I have insurance that will probably be willing to pay for this.  See my length of employment for reasons why.

As for another example, Romney's plan calls for making the Individuals with Disabilities Education Act, or IDEA, into a national voucher program.  Part of this program helps fund all the therapists and aides that are required by the school to meet the needs of children with disabilities.  Please, relatives who worked in education their entire lives, explain how a voucher program will assist my daughter in receiving the OT, PT, Speech Therapy, DHH and other therapies and assistance that she receives from the school district.  She currently receives a larger percentage than most children and with a broken neck, may require even more for the next few months.  Do you really believe any voucher program would allow for different monetary values per child and do you believe she'd continue to get these services in school.  Since we'd get vouchers, the school districts wouldn't need to hire anyone because they could then tell us to use outside providers.

Thanks for taking the time to read this.  If you're still going to vote for Romney fine.  But I hope you can come up with a better answer than I just don't trust Obama,  Because if you trust Romney more, we are at an impossible impasse.

Pre-existing Conditions and the Presidential Debate

If anyone with Parkinson's watched the debate last night on domestic issues and felt that their healthcare would be safe under a Romney administration, think again.  In fact,

Mitt Romney’s top advisers acknowledged that, as a result Romney’s plan to repeal Obamacare, people with pre-existing medical conditions would likely be unable to purchase insurance.

The fact of the matter is, that Obama even explained the details of Romney's plan better than Romney, right after Romney said that pre-existing conditions would be covered under his plan.  Obama said,

But let’s go back to what Governor Romney indicated, that under his plan he would be able to cover people with pre-existing conditions. Well, actually, Governor, that isn’t what your plan does. What your plan does is to duplicate what’s already the law, which says if you are out of health insurance for three months then you can end up getting continuous coverage and an insurance company can’t deny you if you’ve -- if it’s been under 90 days.

What that means is if you are not currently covered or you lose your insurance for more than 90 days, you're out of the system and have no way to get back in because of your pre-existing conditions.  I find it ridiculous that Obama had to explain to Romney how his health plan works. Although, it is not surprising that Romney did not accept the explanation.