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Two Reasons I Think Single-Payer HealthCare Needs to Happen

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Warning: Rant coming in 3, 2, 1

There have been times in my life when I have been so f%*king DONE with our country’s convoluted system of healthcare that I wasn’t sure whether to cry, throw myself on the floor and pound my fists until they’re black and blue or scream bloody murder from the highest peak I can find.

I know lots of folks who can relate.

Seriously. Socialized medicine, folks. I mean it.

I know it won’t make everything easy-peasy, simple and clean, but it can’t make things worse.

When I went to college, I was determined to become a pediatrician. That’s all I had wanted to be since I was in elementary school and I could see it happening. I took organic chemistry, cell physiology, medical ethics classes. I struggled with some more than others, but I loved them all. My senior year, I studied for and took the ridiculously long MCAT and spent hundreds of dollars applying to medical schools and then decided to take a year off to work in the field before deciding whether to go ahead and go.

I ended up working for several years as a surgical assistant for a small group of doctors and I learned about the other side: the business of medicine. I hung out with the business manager and discovered how to tweak our diagnosis codes and pore through the (then) printed catalogs of allowed procedures to bill things so they would get paid for. When patients came in for emergency surgery, after the OR was scrubbed of blood and every last instrument was cleaned and put in the sterilizer, we convened for a quick meeting to determine just how to position the procedure to whichever insurance company might be involved so that we could have a higher chance of being paid. This not only determined which codes we used to bill, but it often meant that the doctor had to dictate his notes in a particular way so that, in case the insurance adjuster (not a physician or a nurse in most cases) asked for them, they would fully support the billing we submitted.

During those years, I discovered that if what I truly wanted to do was build relationships with patients that impacted their lives and their health, going to medical school was not the way to do it. As the surgical assistant, I spent more time with the patients than anyone – pre and post-op – and heard about the other things going on in their lives as I changed bandages and removed stitches. The doctors, while they may have liked to have more time to spend with patients, spent the majority of their time maximizing insurance payments by dictating notes, seeing a ridiculous number of patients per day, scheduling back-to-back surgeries to maximize OR usage, and occasionally getting on the phone with an insurance company who was refusing to pay for more than two scalpels or two hours of anesthesia to defend their choices.

Needless to say, I chose not to go to medical school.  And in the next several years, I spent time fighting with insurance companies for a physical therapy business, a dermatologist, and the state mental health division, not to mention myself and my family. I learned just how insurance companies make rules that increase their profits and narrow choices for their customers. I discovered that the high-level relationships that are made between drug companies and major hospital groups and insurers almost never benefit the health or wellness of a customer unless it happens to be in alignment with the bottom line of the companies involved.

A few weeks ago I called a doctor’s office for a family member to get diagnosis and procedure codes for an anticipated surgery. I then called the insurance company armed with information to ask whether these codes were considered covered procedures. After nearly an hour on the phone I came away with a vague answer that included information about the deductible and the potential coverage depending on a number of variables over which we have no control.  If the doctor is “in network” (he is), his services are covered at X%. If the hospital is “in network” (they are), their nursing and OR services are covered at X%, as long as it is a day-surgery. Overnight stays are covered at X-Y%. If the anesthesiologist is “in network” (we have no control over that and no way of knowing until the day of the surgery who that person might be), their services are covered at X%, but if that doctor is “out of network,” services are not covered at all. Not only that, but on “out of network” providers, the amount the patient pays is not applied to the deductible or the out-of-pocket maximums for the year (presumably because we had the audacity to go rogue – even though we have no choice in the matter). There are further decisions about OR supplies (one would think that those would be considered part of the surgery facility charge, but, no, it seems they are billed separately), so if the surgeon chooses a more expensive bandage or stitches, it is likely those won’t be covered at all.  I could go on, but you get the gist.

This morning, I phoned our dentist’s office to discuss a particularly high bill we received and after another hour of talking with them and the insurance company, I was told that Lola’s emergency dental procedure last summer while we were on vacation was not only not covered (out of network), but none of the $500 we paid for it were applied to our deductible (out of network). I calmly asked the representative,

“So, this was literally an emergency. As in, the plane touched down, we stopped at the pharmacy to get pain killers for our daughter, and as soon as we hit the hotel we asked the concierge to recommend a dentist who could see her ASAP (Saturday morning in Hawaii). First of all, does your insurance company have in-network providers in Hawaii? And if so, am I expected to call all of the islands to find one who happens to practice on the weekend and is willing to see my daughter? Is that a thing I should have done?”

“No. It’s not a thing,” he says.

“Explain that to me, please.”

“Was it a medical emergency? Because if it was, you should have run it through your medical claim instead of dental, and then it might have been covered even if it were out of network. But it wasn’t, and it’s too late now. It was processed as out of network and that’s how it’s going to stay. And, no, we don’t have any in-network providers in Hawaii.”

So, ultimately, it’s my fault that I didn’t sell it as a medical emergency? Or is it the dentists’ office fault? The dentist who got up on a Saturday morning and spent three and a half hours with Lola patiently tending to her and then calling us that night to make sure she was ok.

And why wasn’t my out of pocket amount applied to the deductible? Because we went rogue. Because we didn’t follow the rules. Because, if it had been, the insurance company (Premera Blue Cross, btw) would have been on the hook for all the rest of the follow up procedures that have taken place as a result of this situation in the last nine months. But they aren’t, because it all started with us needing dental care somewhere else in a hurry.  When I pointed this out to the representative this was his response:

“Well, you just really want to have your dental emergencies when you’re at home. That’s the best way to do it.”

Duly noted.

Socialized medicine, folks. Single payer. The same rules for everyone.

Health care (even dental care). It’s a basic need.

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I Hate Throw Pillows

I know it’s inane, but they really do drive me nuts.  And I’m willing to admit it and I feel like I am old enough to do away with them altogether without apology.

I was a child of the 70s. My sister and I shared a bedroom with matching twin beds covered in matching Holly Hobbie bedspreads – yellow with yellow lace around the edges – and pillow shams.  Our beds were made every morning after we reluctantly rolled out of them to start the day.

As a teenager (of the 80s), I was lucky enough to have the thing most of my friends wanted – a waterbed.  It was my mother’s concession to marrying a man who moved us from the town we had lived in the longest to the beach where he had always wanted to live.  My brother and I both got one – a double-size waterbed with stuffed naugahyde padding around the edges and a built-in headboard with padded doors hinged at the top so you could hide books or other things inside.  When we got the beds, we were warned sternly by my stepfather that it was important to always make the bed because if you didn’t two (bad) things could happen:

1. The heat from the water mattress would escape up into the room, causing the bed’s heater to work on overdrive to keep the mattress/water inside warm and drive up the electric bill, and

2. The cats could jump up on to the bed, drawn by its warmth, and dig their claws in, puncturing the mattress.

Since the cat(s) often slept in my bed, I became quite good at patching holes in the bed.
Since my stepfather didn’t really understand the notion of privacy, I dutifully pulled the thick comforter over my bed every morning before heading to school.

As soon as I left for college, I vowed to never make my bed again.  It is one of those things that always seemed silly to me, like those people who brush their teeth right before bed and then again first thing in the morning.  Seriously? Yes, you can tell your dentist that you brush twice a day, but you haven’t eaten anything in between those two brushings, so what does it matter? Wouldn’t it make more sense to brush them on your way out the door after breakfast? Or mid-morning? After lunch?

Anyway, over the years I have stuck to that vow.  Once a week or so, I change the sheets on the bed and then I make it because it would be ridiculous not to. But otherwise, I rarely feel compelled to get out of bed and tidy it before starting my day.  And I have never felt compelled to dress it up with a pile of pretty pillows made just for that purpose. Until last year, when we put our house on the market and my realtor started talking about staging the house for showings.  She advised me to go out and get a new comforter set, complete with pillow shams and coordinating throw pillows.  Even though I knew she was right, it made me nuts to go spend a few hundred dollars on something like that.

The house sold in three days and now I’m stuck with that comforter set.  It has two King-size pillow shams and two square pillow shams for a total of four extra (enormous) pillows that will never fall under the weight of someone’s head.  Want to know where they are? Two of them routinely find themselves propped on top of the laundry basket in my room where I have to shove them aside every time I want to put some dirty clothes in. The other two rotate between the cedar chest under the window and the top of the dresser. I won’t put them on the hardwood floor because the dog would assume they were his new bed, and I don’t put them on the bed during the day because that is too close to ‘making the bed’ for my taste.  One day a week, when the sheets get changed, they make it to their prescribed spots, arranged at the head of the bed. Otherwise, they are simply in my way.  And yet, I don’t get rid of them. Because who gives two King-size pillows (with shams) and two 14×14″ pillows (with shams) to Goodwill without the matching comforter?

And so I ask, for the people who have throw pillows on their beds and who actually make their beds every day; what do you do with the pillows at night when you’re sleeping? Do they take up space on a chair in your room? Do they get unceremoniously tossed on the floor? Where do they live? And how did this trend of decorating our beds even begin in the first place?

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HURRY UP!!!

Every time I see the advertisement on television for this product I cringe. And I thank the Lord above that I am not a new mother, sleep-deprived and desperate to make sure that my child has every possible advantage available to her. Feeling badly that I enrolled her in preschool without the ability to read, speak a foreign language and leap tall buildings in a single bound.
Why are we in such a hurry? What happened to babyhood? We’ve already begun chipping away at childhood by giving our elementary students hours of homework and standardized tests and expecting them to go to soccer practice three days a week. Our society places a high value on getting the jump on things. The day after Christmas, the Target store in my neighborhood has ripped down the trees and ornaments and images of Santa Claus and replaced them with shiny red hearts and boxes of candy and lacy doilies. Suburban mothers are encouraged to sign their newborns up for baby swim classes and begin shopping for preschools.
By mid-February there are bikinis displayed in the kids’ section of Macy’s and if I wait until May to look for sandals I am out of luck. Even if I get the sandals early, it is impossible to find any without a two-inch heel. Even the flip-flops in my eight-year-old’s size have a wedge heel.
Parents do mental gymnastics after playdates, wondering how they can ensure that their child gets rid of the training wheels before Johnny does or graduates to a big-boy bed before anyone else in their kid circle. And now this. Before your child learns to walk (read: captive audience), they can read. If you just buy this and sit them in front of the DVD for an hour at a time. You must capitalize on this narrow window of time when your child’s brain is ripe for language and TEACH THEM TO READ NOW!!! Or what?
I can remember agonizing over whether or not to let Eve quit violin after six months. She was five. It seems ridiculous now, but at the time, I honestly couldn’t decide whether I was letting her “give up” or “cop out” if she stopped lessons. I didn’t want to waste the six months she had put into the violin and, even though I had only rented the instrument, it seemed as though I might be giving up an opportunity to have her truly excel at something she had shown talent for if she quit. Thank goodness some rational voice came out of the skies and said, “She’s not losing any brain cells if she quits. If she isn’t enjoying it, why should she do it? She’s five years old. And if she regrets it, she can always start again sometime later. Even when she’s forty.”
And that was it. I mean, what if she gets hit by a bus tomorrow? Do I want her entire childhood to have been crammed with educational opportunities instead of mud pies and lazy days swinging at the park? When I look back at my favorite memories, they don’t involve getting straight A’s on my report card. I remember hide-and-seek with my cousins, climbing trees, riding my bike down the steepest hill in town and the day my girlfriends and I skipped school and drove to the beach to act like five-year-olds for the day.
I don’t want my life or my children’s lives to be fraught with competition, every moment measured against some arbitrary standard or some other kid’s accomplishments. I don’t want to be burdened by always doing more than the next guy or defending my lack of ability. If you are a new parent, let me tell you a secret: the things that your child needs to learn, they will. As you’re agonizing about potty training, let me reassure you that eventually, your child will learn to use the toilet. They may be three or four or ten, but they’re not going to go to high school wearing Pull-Ups. Now, do yourself a favor and substitute “sleeping in their own bed” or “sleeping all night” or “reading” or “writing their own name” or “talking” or any other milestone for “potty training” and read it out loud. In front of a mirror. These things will happen, probably regardless of your blood, sweat, and tears.
We could all buy into this notion that we OUGHT to be doing more and being more and kill ourselves each and every day to get the educational/financial/social advantages that may (or may not) come along with those things, or we pour the Kool-Aid down the drain and get a nice glass of water instead, give it to our kids, and watch their little faces light up when they pour it out and play in it. Because when I look back at my favorite memories of my children’s childhoods so far, they have nothing to do with reading or writing or potty training. Nope, I remember the first time Lola discovered that her food could double as finger paint and she coated the window in butterscotch pudding and yelled “Ta-da!” I remember Eve shoving her baby doll up inside her shirt and “breastfeeding” her all hours of the day while pushing her play vacuum around the house. I remember touching worms and splashing in puddles and their first experiences with snow. I remember those moments when they discovered something nobody set out to teach them and they were first astonished and then proud of themselves. It’s not rocket science. There’s plenty of time for that. But there isn’t enough time to be a kid and just play. The least you can do as a parent is protect this time for them.
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