Sunday, December 28, 2014

It Isn't Healthcare...It's How They Don't Care

My experience with the healthcare industry has been, for the better part of my life, consumer focused. In fact, as a child and then as a single adult, I clipped along quite well taking care of the common ailments likes colds and gastrointestinal disorders with the simple and tried and true remedies like rest and fluids. Growing up, we only visited our family doctor when the medical problem grew beyond the scope of common sense practices: when we needed stitches or clearance to play some organized sport or other. When we needed to use the system, we paid for the services at the time, much as we pay a mechanic for car repairs, or a landscaper for landscaping services and the like. The concept of medical insurance was, as all insurance used to be, something you bought or not bought depending on your perspective. For the greater part of the population, catastrophic insurance or what used to be called "major medical" was plenty. It was inexpensive but gave peace of mind.

Big business became a player in healthcare when businesses and corporations offered coverage to employees as a perk of employment. Unions have used health benefits as a bargaining chip when negotiating contracts. Insurance companies responded gleefully by offering more and more benefit plans with varying degrees of benefits and costs. As consumers relied more on their employers to provide medical insurance, they became less involved in what they actually were receiving. The result is that through the years, insurance companies, with no vested interest in anything other than a larger profit margin, began paying out fewer dollars for medical services, requiring the medical provider (whether a physician or a service entity like an imaging center or lab) to write off some of their service as a contractual obligation, or charge more for the service to cover the loss. Many people, myself included, opted out of insurance coverage, choosing to put those dollars away in a "just in case" jar and pay for medical treatment as needed. That did not last long.....

The nail in the coffin of health insurance sanity came when insurance -- not just medical insurance --became not a choice, but a legal mandate. Want a car? The law requires car insurance. Rent? Renters' insurance. Want a home? Can't be cleared for a mortgage unless you have mortgage insurance. Are you a professional of some sort? Those in trade professions are required to be licensed and bonded. Goodness knows that those persons who decide to make medicine their life and career have been required to shell out thousands and thousands of dollars each year in ever increasing increments just in case an adverse event happened to a patient, whether there was "gross negligence" or not. (This is the subject of another blog). The point is that we as consumers, and those who have chosen to help people manage their health, are being bilked out of thousands of dollars each year to the benefit of insurance CEOs, and our government (both state and federal) is complicit. This situation has greater ramifications than just the loss of consumer dollars.

I have the non-enviable position of being both a consumer of, and an employer in, a healthcare-related business. I know from experience on both sides of the sliding window (as it were) the horrors of our current healthcare situation. We see patients everyday who complain about their insurance premiums (despite their "employer paid" portion), their high deductibles (despite low premiums), their high copays (despite low premiums), and in the post-Affordable Care Act age, the lack of benefit coverage in spite of the plethora of plans. I have heard (and as an employer have seen) about plans being discontinued, to be replaced by a "comparable plan" that is (not surprising) not only at least 50% more expensive, but also offers fewer benefits. In many plans, the "insured" has to meet their deductible before the insurance will pay a dime on a claim. So the consumer not only has to pay higher and higher premiums (or portion thereof), but has to fork out even more dollars before their insurance will pay....but only if the claim is for a covered benefit. It gets worse.....

What is really so diabolical is that insurance companies have replaced trained physicians and mid-level providers in diagnosing patient medical problems. Our office sometimes spends days processing the forms and sending medical records to some insurance processor to get "approval" for medical services for our patients. If we are stonewalled, the process moves to a "nurse reviewer" and finally a "physician reviewer" who requires our providers to get on the phone (taking time away from clinic patients) in order to justify getting a heart study or a CT or a Doppler study. In the interim, the unlucky patient waits and waits, often calling us multiple times a day hoping to hear the OK to schedule the test. It seems that no matter how we try to communicate that we are doing all we can to get approval, we still bear the brunt of their frustration and anger. This is just for medical benefits: the process is even worse to get medicines approved.

The sad fact of the matter is that with all these insurance mandates and the planned confusion that comes with it, the real loser is the physician-patient relationship. Patients don't want to have to pay more on already expensive healthcare. Physicians and other providers don't want to spend their time fighting insurance companies for legitimate medical services needed to diagnose and treat their patients: they want to help their sick patients get better. The result is that most providers spend more and more time on insurance paperwork and in order to have any sort of life away from their job, they either need to see fewer patients (with the result that patients sometimes cannot be seen for several weeks out), or they see more and more patients (with the result that they spend less time with each of them). I believe that the majority of physicians, nurse practitioners and physician assistants chose their profession in order to make a difference in the lives of those who seek their care, but the system has been rigged against developing the kind of human relationship needed to really know, understand and care for people to make that difference.

None of this stands to reason. When I am sick, I expect to be able to seek out medical care and it should not cost an arm and a leg. As a consumer, I expect that my healthcare dollars will be available when I need them and for whatever I legitimately need. As for my provider, I should expect that she should be paid according to her experience, time and skill, and not have to "write off" a significant portion of her fee to be pocketed by some insurance administrator or suit, or to improve an insurance company's bottom line.

So for what it is worth, I will likely continue to shell out thousands of dollars each month for health insurance, continue to commiserate with patients and medical professionals about the sad state of affairs, and will continue to wonder how it ever happened that health insurance became a "right" when it is not specifically mentioned in any constitution, whether state or federal. I will also keep praying that consumers wake up and push back against this travesty, or that the whole system will implode and we can begin again with more sane minds managing the system.

Monday, December 15, 2014

Well-behaved Women

Bumper stickers can speak volumes about the person who own the vehicle. Apart from the free political advertising that adorns many car bumpers, we can be easily entertained while tooling through town or across the country by clever wing dings that challenge us to COEXIST, encourage support of one sports team or another, and my favorite: the humorous sayings with a subtle philosophical edge. The one that I have seen quite frequently of late is that insipid statement that "Well-behaved women seldom make history."

I fully understand the point: the bumper sticker owner wants us to believe that in order for a woman to achieve anything of value in this world, she must set aside convention and embrace that which is not typically considered "womanly." We are expected to believe that unless the woman was a revolutionary of some sort....Susan B. Anthony, Nancy Pelosi, Hillary Clinton, Miley other words, some radical who challenges societal norms, her impact on the world is unremarkable. I would challenge this opinion.

History is rich with the women who, without defying convention, have made significant contributions to the world in a variety of areas: science, music, writing, the arts, politics and religion. Let me focus on three women, whose lives were played out in the world of politics and religion, yet whose impact has been long standing.

The author Irving Stone wrote a book about the relationship between John and Abigail Adams, Those Who Love. In this relationship, we see a woman leading a more or less conventional life for the time in which she lived: she was a wife and a mother, and endured all the suffering that comes with trying to keep life normal for her children while her spouse was involved in standing against convention and advocating for American freedom. From the "confines" of her vocation as wife and mother, Abigail Adams both challenged and supported her husband's opinions and actions as he argued in favor of American Independence, and later in the establishment of our country. She was an influential guide as a mother (sometimes a single mother), having a son who later became President of the United States. Her influence on American history is deep and reaching, yet there were no splashy headlines about her; she did not challenge societal norms regarding the role of women. Living and loving in the scope of her calling as a wife and mother, Abigail Adams is one of my favorite role models. I would consider her a "well-behaved woman" of her times and for all times, and she is remembered in history.

In the world of religion, Thursday, December 4, the Catholic Church celebrated the feast of my patron saint, St. Barbara. According to traditional sources, St. Barbara led a pure and virtuous life, committing herself to serving God as a Christian, and sacrificing a life in the world for one of service to Him. She vowed to remain a virgin, but was ultimately sacrificed at the hands of her father, a pagan, who wanted her to marry against her will. One could argue that she chose to defy convention, which really dictated that she honor her father's wishes and marry (for his convenience). Did she really?

She defied her father. She defied the convention of the time, which would have her living in the world as a wife and mother. She stood strong in her belief and in her love for God. Was she a "well-behaved woman?" I would argue that she, and countless thousands of women, who chose to serve God above the conventions of the world, and who are among the canonized saints of the Church because of their love and piety, truly is a "well-behaved woman."

In our own time, we have a wonderful woman who illustrates that being "well-behaved" does not lessen your impact on history: Blessed Mother Teresa of Calcutta.  Like St. Barbara, Blessed Mother Teresa chose a higher calling than many women today. Quietly, calmly and very much under the radar of headlines and the glare of the media spotlight, Blessed Mother Teresa's impact on the souls under her care is profound. They, and all women who are honored by the Church as saints, are great role models for me as well.

So for what it's worth, the idea that someone, a woman in particular, has to be an attention-getter in order to make history is really rather short-sighted.

Wednesday, December 3, 2014

Skyscapes, Sunsets and Jeannine

The other night a friend and I stepped outside my house and he commented, "I like to look at my favorite artist's work," and his gaze directed me to a fantastic sunset. This actually was less a sunset as it was a skyscape, as the houses in the neighborhood obscured a better view of the sun setting over the Coast Range in Oregon. Be that as it may, the rose hues, mauves and purples mingled with the golden sunlight and clouds of a winter afternoon, providing a stunning backdrop to the large and majestic conifers which landscaped my neighbors' yards.

"God is my favorite artist," he stated simply. I have to agree. While we can blend paint colors to create wonderful landscape paintings or carefully orchestrate a camera lens to snap a photo, these pale in comparison to the original: a daily gift we receive if we are open to appreciating it.

I admit that I have not always appreciated sunrises, sunsets and the skycapes we can see each day. It was only about four or five years ago that my fascination with these daily gifts piqued, and my awareness increased. It was not just in Oregon, either. We traveled to Colorado by car a few years ago, and from my vantage point in the back set, I was able to snap dozens and dozens of skycapes from Oregon, through Idaho, Utah, Wyoming and finally Colorado. From sunrises and sunsets, to thunderstorms brewing across the flat landscape of Wyoming and the towering peaks in the Rocky Mountains, I had a grand time with my digital camera, and it seemed that nothing was escaping my notice and need to create these keepsakes.

On our return, my backseat companion and young daughter, Jeannine, asked if she could look at the pictures I had taken on the trip. Or so I thought. After about a half hour I asked for the camera, as a particularly interesting cloud formation caught my eye. I quickly snapped the picture and looked to see if it was satisfactory. Happy with the result, I decided to review the photos I had taken along the trip. To my surprise and dismay, all of my photos were gone. The only pictures left in memory were those of Jeannine: with her friends or family, or just her alone.

It seemed that life had intervened and Jeannine had spent the last half hour not just looking at the pictures, but deleting any photos not related to her. Rather than becoming annoyed and upset about what had just happened (although it was frustrating), I had to take a deep breath and admire what she did. You see, Jeannine has Down syndrome, and we spend quite a bit of time attempting to move her to activities of daily getting out of bed in the morning and taking a shower or brushing her teeth. When it comes to technology, however, she has a facility of mind that will surpass even her typical peers. She figured out how to not only move from shot to shot, but took it upon herself to manage my photos with the thing that is most important -- her.

So I still have the gift of sunrises and sunsets to see and appreciate, but perhaps the greatest gift I have been given by the greatest Artist of all is Jeannine. The challenge is to be able to appreciate.

Monday, December 1, 2014

Branching Out of the Comfort Zone

It is difficult to believe that we have entered into the final month of 2014. For most of us it has been a roller-coaster ride of enormous speed, twists, turns and topsy-turvy events. Many among my acquaintance cannot wait until 2015 bursts forth from the future into present time; others are not so sure. This past year has been one of self-reflection for me, as life has intervened and required more action and planning on my part than I have ever remembered. In this last month, December 2014, I am not waiting for the ball to drop or the champagne corks to pop to take on some new directions in my life.

I have never been a person to seek out challenges, plan a course of action and follow through on it, or take on something that could not be concluded in a week or less. Generally speaking, I have just let life happen and have made choices based on what seemed to be reasonable at the time. I have to say that this method of getting through life worked quite well for me....until these last few years. As my children have grown, parents have aged or passed to a better place, and business changes, it dawned on me that I should be more brave. Starting this blog is one of my firsts acts of courage and determination to step out of the shadows to see where it takes me.

The first thing that I have noticed in this step into the sun, as it were, is that there are many creative people out and about. It took me 20 minutes to find a .blogspot name that wasn't taken, but at the same time one that I could easily remember. Trying to settle on a theme was another challenge: perhaps unlike most people, I don't have a "passion" for anything in particular. I have friends who love to garden; I have friends who love anything that has to do with knitting or yarn work; I have friends who are passionate about wine and food. I have secretly admired them for years because I just could not find anything that interested me enough to pursue as a hobby.

So I took to heart an exercise I read about whose purpose was to help me identify and focus on what mattered most, what talents and abilities were sitting dormant inside just waiting be born. After this self reflection and writing down all my interests (it is harder than it sounds), step two required that I go to those people who know me best and find out what they see in me that I can't. It was very telling that my spouse of 31 years had a difficult time coming up with anything apart from a great talent to argue with him. Other opinions are still pending, which does not bode well. Could I be one of those persons born with absolutely no talent and ability other than to breathe? Wow, the realization is quite humbling.

In a previous life I taught writing and grammar to middle schoolers. I liked teaching it, and in the course of this labor I discovered that I also liked writing. Through the years I have written essays on many topics, but was not brave enough to throw these musings out into the marketplace. A few were published in the local paper, but the hope that some "brilliant editor" would read these wonders of the pen and offer me a job never materialized.

So for what it's worth, this last month of 2014 is the beginning of a braver, more focused, goal setting and goal achieving me. I hope you follow along.