I never imagined I'd write an article on the mismanaged health care system in our country. Nope, not me! Comfortably insured and blessed with good health, I had no reason to. Then the reason found me.
I have experienced firsthand the reality of the unhealthy and unjust guidelines unilaterally enforced by so-called Health Maintenance Organizations. Call them what you will. Managed care is a form of socialized medicine dictated solely by capitalists, pure and simple. It really makes me ill.
I was for the concept of "all for one and one for all" in the days I flew internationally as a flight attendant for United Airlines. Maximizing the fly-free-anywhere-in-the-world perk, could I dare complain about paying three dollars for treatment of a ski injury in Canada? Or having to dish out thirty shillings for a throat culture in the Austrian Alps? I think not. But that was in the '80s, gang. Another time, another place. In the here and now, that concept has not worked within our mighty walls of democracy. A country of the people, by the people, for the people? Not anymore. The richest nation in the world has become our own worst enemy in terms of our personal health issues.
I was married to a successful surgeon during the gradual transition from the long-established doctor's fee for services to HMO's controlling the doctor's fee and overriding that doctor's ability to determine the level of a patient's care. I'd listen to my husband's concerns over the dismal future of medicine, and I would downplay the significance of his pessimism. I could not, would not accept that our country would abuse the medical profession--men and women devoting their lives to improving ours and institutions built to ensure we receive necessary care. They, and we, are all now at the cruel mercy of a detached bureaucracy. United we fall, and we can't afford to get up.
I am not talking about a nation of slackers. I am talking about hardworking seniors who finally are able to retire and find they've depleted their savings in less than three years on supplemental insurance policies. Those seniors who receive barely enough from Social Security to live on yet just enough to disqualify them from receiving financial aid for prescription medications. Yes, there are HMOs that offer prescription coverage for an additional premium. But their prescription plans have a $1500.00 annual cap.
Sound fair? It does, until you ask your local pharmacist how far that will stretch for the average senior these days. Aricept (for Alzheimer), Cordarone (for the heart), Prozac, and Claritin are just four common medications prescribed regularly. The price of each of those would cap out a senior's $1500.00 annual maximum in less than two months. So, what happens when the senior needs their medicine but can't pay for it? Either their kids have to foot the bill, or they don't get the medicine. Period.
When my dad passed away, his corporate insurance covering my mother went with him. The majority of her nest egg is spent on providing her own health care because Health Maintenance Organizations don't care. Why should they? This woman is now at their mercy. Her quarterly premiums and prescription bills were outrageous. She was literally forced into managed health care. And, as I write this, she is being abused by that very system that is supposed to be helping her.
Radical surgery on December 21st of last year landed her in intensive care twice with major post-op complications after being discharged prematurely by HMO case workers. Tomorrow an ambulance is taking her to the hospital from her skilled nursing care facility (a.k.a. nursing home) where she will receive an outpatient Doppler to determine if, in fact, she does have a potentially fatal blood clot in her leg. Her case worker still has her being discharged from the nursing home (per the reports from her physical therapists) this Tuesday. The fact that she cannot move unassisted from point A to point B is irrelevant. She does not require intravenous injections therefore she is capable of going home. And she doesn't qualify for a visiting nurse. We shall see or we shall sue.
My ex-husband (the surgeon) pays for my health insurance through his corporation. I have the same HMO as he, our kids, his employees and the majority of people in our region. I recently learned that I have a fibroid tumor that needs to be removed. It took three emergency room visits before the tests necessary to determine this were permitted. You see, I had MANAGED CARE stamped on the top of my left hand. No joke. In big, black letters. Sort of like being diminished to the "less than" area. And, believe me, the care is not there.
My gynecologist of nine years explained to me that I needed radical surgery to remove the tumor. He explained that I would be knocked out of commission for six weeks, I wouldn't be able to get off of my back for the first two, and that I would have to wear a catheter for at least a week since the incision would have to go through my old Cesarean section scar and, subsequently, cut through scar tissue that has since adhered my bladder wall to my uterus.
So what, you say? Well, according to former Surgeon General C. Everett Koop, the minimum hospital stay for such surgery is between seven and ten days. My gynecologist made a copy of Koop's statement (taken off of Koop's web site) but it didn't change the fact that I would only be permitted to stay in the hospital for two days total. My HMO decided that two days were enough to be cost-efficient. So what if I am a single mom of two teenage boys who are not yet old enough to drive themselves anywhere much less take care of me? And wearing that catheter around the house for a week? I don't think so. Oh, I would qualify for home nurse care if there were complications.
Well, I am already having at least one complication. Complication with understanding why doctors and patients are getting the shaft while, according to the Pittsburgh Business Times, basic salary levels for the top executives of local insurers average over half a million per year. Aetna U.S. Healthcare president Michael Cardillo's base salary rose 9 percent to $668,506 in 1997 from the previous year. But his total compensation plummeted to $707,509 from $5.24 million for 1996. Mr. Cardillo's 1996 total pay was inflated by $4 million in "other compensation" that included a bonus paid to him for staying after Aetna's acquisition of U.S. Healthcare, plus the exercise of certain U.S. Healthcare stock options. Highmark Blue Cross Blue Shield's president and chief executive officer John Brouse was paid $632,954 in 1997 including a $100,000 bonus. Yet the pressure to cut patient's costs has increased; hence the decision to limit my hospital stay to just two days. So, I've decided not to have the surgery. I'd rather deal with discomfort than blatant neglect.
I must add that I did check into various HMO and Managed Care companies but was denied information because they "...do not provide individual health care coverage." What does that mean, exactly? That even they are aware that no one outside of those with employment supplemental coverage could possibly afford insurance? That, while healthcare representatives and executives are getting their fannies covered with designer wear and their pockets lined with our government representatives' overflow, those who can't find employment providing healthcare benefits lose their rights to health care? Yep! And corporate America simply does not care.
What's the answer? The bottom line is us. Fight for right and fight with might. Tell your state senators and representatives and all who will listen, "I'm mad as hell, and I'm not going to take it anymore!" It works for me.
Now I must go rest. I cannot afford to get sick.
Jolie Kenney is the author of ASK JES (Ingram, 1999), and has been a contracted writer for America Online for the past four years. Her work has also been published in the "6th Helping of Chicken Soup for the Soul" and she is included in the twenty-first edition of "Who's Who of American Women."
E-mail Jolie Kenney
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