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Cory Doctorow

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Wednesday, August 5, 2009

Time to let my expertise out

Inspiration has struck.  I'll address the woman with the red-covered book in her hand at the 12 second mark in this video a little bit further down:

It's time to put aside the rhetoric, the hollering and every last cable news talking head.  I had not wanted to write until I thought I had something original to say. Well, that may still not be true (the original thought thing, I mean) but I  have 9 years experience working in managed care (better known as the health insurance industry) and am learning more about legal documents used to designate someone to act on ones behalf in all things financial and medical.


The public option being sought in health insurance reform works like this:
Go to your doctor for an exam, check up, etc.
Your doctor submits a claim to the "public option" people (yes, these will be government employees)
"Public option" pays the claim.

My partner has had government run health care (better known as MediCare) for most of his life as he is disabled.  In the 20 years I've been with him, a doctor has never turned around and billed him in full for a service they provided yet Medicare chose not to pay.  As we receive an Explanation of Benefits (a piece of paper that says what the doctor bills, what MediCare pays and what portion of the bill, if any, my partner needs to pay as a co-pay) for every visit and every set of lab work ordered, it's pretty easy to see for us that what my partner needs in terms of basic, regular care for his conditions, he gets.  Six doctor visits and three sets of lab work a year for a disabled man is not a big drain on the system.  Here's the math:

Doctor's visits: 6 visits at $35/visit = $210.00 a year
Lab work:  3 sets of lab work at $150/set of labs = $450.00 a year

All is not cheap these days under MediCare, though.  Sadly, my partner needs medication.  A bunch of it.  With a great deal of effort from the pharmacy and my partner, the private company that manages the MediCare Part D plan covers nearly all of the medications and only asks anywhere from $1 to $3 from my partner per medication.  

The thousands of dollars paid out for the medications would drop your jaw.  Having spent all my adult life working in businesses, the notion that a group like MediCare cannot negotiate with the pharmaceutical companies for a large-quantity discount is just bizarre!  It's as if the MediCare went to Sam's Club and was told that instead of being able to buy a 10 pack of Mac N Cheese for $6 they'd have to pay $12 for it or go to the local market and buy a box of Mac N Cheese for $1.20.

You'd laugh at that "bargain" and put the 10 pack back, wouldn't you?  Makes me wonder what would happen if our country's senior citizens and disabled could do the same with their medications.

And I know that all of us working people, small business owners and/or people on COBRA have had issues of maintaining eligibility with our insurance plan.  If there's a lapse in eligibility AND/OR the doctor bills for a service not covered by the plan AND/OR a diagnosis not covered AND/OR the physician's assistant billed instead of the M.D . . well, you get the idea

WE pay in full!


Please stop believing the whole "the Government is out to kill Grandma" talk being bandied around.  The portion of the bills to which this twisted statement is attributed speaks about MediCare now officially paying for a once every five year visit with a doctor to set up, in essence, a "Living Will".

A Living Will is a legal document (though the version you and your doctor would set up would apply, most likely, to just the hospital at which your doctor has admission privileges) that says just what you want done should you wind up hooked up to life support in a hospital.  A Living Will can say (and I am translating from the legalese I have recently learned) "Keep me hooked up to a machine forever and a day." or "Keep me hooked into a machine until three doctors agree that my condition will never improve" or "Keep me hooked to a machine until my wife says it is time to turn the machines off" (which also bleeds into a Health Care Directive/Health Care Power of Attorney.  Basically, you assign a living breathing human to act as a Living Will on your behalf).

Living Wills can also say things like "I want every last organ in my body donated to everyone if the machines are turned off" or "Only donate my liver to the local University for medical research" (my local University could write volumes on mine, what with the cholesterol meds, etc.) or even (gasp!) "Keep your freakin' mitts off my body parts. Where I'm going I need every last molecule!".

The nice thing about this doctor/patient agreement is the burden is taken off of you to decide if/when grandma is removed from life support.  Grandma and her doctor have had a heart-to-heart ahead of time and have written up directions to be followed.

If you really want to usurp Government's overreaching authority, get yourself to an attorney or at least a document preparation company with attorney oversight and have a Living Will written for yourself.  Keep the original signed version for yourself, give a copy to your doctor's office and make sure the family member you trust the most has a copy of this document as well.


If you are just not sure what to think about all of the changes being proposed in Congress (and likely to be voted upon in late September), please have an honest conversation with your friends and family.  Ask if they have ever had to pay for medical services in full or have had to max the credit cards to afford antibiotics, pain medication or high blood pressure pills OR if they've had to go without coverage because of the month by month expense.

If you find out that you or someone you love had to "just pray that no one gets sick", you need to seriously consider a "public option" to cover those who get stuck between this rock & a hard place.

I've been there and, in the right set of circumstances, could be there again someday soon.


As a Christian, regarding the woman in the video talking about the book in her hands being the "only truth she needs", contained in the version of the Bible she clutches and holds out as a shield is this version of 1 Samuel 18:1-5 (thanks to biblegateway.com)

Now it came about when he had finished speaking to Saul, that A)" style="font-size: 0.75em; line-height: 0.5em; ">(A)the soul of Jonathan was knit to the soul of David, and B)" style="font-size: 0.75em; line-height: 0.5em; ">(B)Jonathan loved him as himself.   2Saul took him that day and C)" style="font-size: 0.75em; line-height: 0.5em; ">(C)did not let him return to his father's house.   3Then D)" style="font-size: 0.75em; line-height: 0.5em; ">(D)Jonathan made a covenant with David because he loved him as himself.   4E)" style="font-size: 0.75em; line-height: 0.5em; ">(E)Jonathan stripped himself of the robe that was on him and gave it to David, with his armor, including his sword and his bow and his belt.5So David went out wherever Saul sent him, and prospered; and Saul set him over the men of war. And it was pleasing in the sight of all the people and also in the sight of Saul's servants.

It's one of my favorites as it references a love shared between two men united only by that love (not family). I'd plan my own wedding to my partner by exchanging robes, armor, sword and belts in the church, but our pastor frowns on guys getting married in their underwear (though, I swear, it would only be a couple minutes of exposure.  Nothing extreme and nothing, I'm sure, out of line with the above passage).

I'd imagine my newfound Bible totin' buddy may hold her copy a little further ahead of her if she really had a good, long, hard read through that Bible.  As a liberal, I'm partial to the version found in The Message.  Though, something gets a little, uh, watered down in the translation.

Wonder what version of the truth would work best for her and her fellow "protestors"?

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