Hold The Mayo!  (Unless You Have Private Insurance)

The big news this week swirls around the now Officially Failed horrible Republican “health care bill.”  A prime reason for its failure is that the GOP cannot scrape up enough warm bodies to pass it.  Prior to the recent defections of two more Senators, one of whom cannot support it because it’s too liberal, is the mysterious illness of Senator John McCain, R-AZ.

Mr. McCain, 81, is recovering from surgery at the Mayo Clinic in Phoenix, AZ, where he had a blood clot removed from somewhere in his skull.  “Above the eye,” is what the media says, but looking at the structures “above the eye,” I only see places in the skull: the frontal sinuses being the most proximal.  Why anyone would have a blood clot there will remain a mystery until someone reveals it.

But never mind that.  I want to talk about HOW John McCain got his surgery, at the age of 81, at the prestigious Mayo Clinic.  You see, I myself sought out an appointment there, for treatment of my badly mangled left wrist.  You know, the one that has been in a splint now for almost two years.  Mayo Clinic is really good at difficult cases, or so they say.  So I called their appointment desk.

The Mayo Clinic knows how to pick their front-end staff.  Extremely polite and professional in every way, including the part where, after expressing certainty that their world-class surgeons can fix you, they tell you sympathetically (yet firmly) that the Mayo Phoenix does not accept Medicare.  Do you, perhaps, have other insurance?  No?  Oh, here: If you don’t mind travelling, call the home office in Rochester, MN.  They do accept Medicare.

Except they don’t, really.  When I called them, they already had my information that the Phoenix people had forwarded on.  

“We don’t have any appointments,” the extremely firm appointment lady said.  Firmly.

“No appointments?  Into the future?  None at all?”

“None.”

“But I thought your hospital accepts Medicare.”

“We do.  We simply don’t.  Have.  Appointments.”

If John McCain had to rely on Medicare, like the vast majority of the older Americans he claims to represent rely on Medicare, he too would face the “No Appointments” dilemma.  But he’s a Public Servant.  And therefore he’s treated to the best of the best when it comes to health care and how to pay for it.  Carte blanche for them, no copays, no limits, no nothing.

I say let our elected officials–all of them–live with exactly what they dish out to the people they live off of.  After all, they live off of our tax dollars!  Why should they get the creme de la creme when I get the bum’s rush, simply because I’m old and not rolling around in the pork barrel?

Hold the Mayo, John.  And I wish you a full recovery, with plenty of time to think about how life would be if you weren’t rich and powerful.

Study: Spinal Cord Stimulation (SCS) Therapy Reduces Need for Opioids – National Pain Report

http://nationalpainreport.com/study-spinal-cord-stimulation-scs-therapy-reduces-need-for-opioids-8832762.html

This could be a blessing, if insurances including Medicare will pay for it….

Donut Hole? Black Hole!

So after a two-year long low-grade struggle with the  American Social Security system, which ground through the process of initial rejection, denial of my appeal, and then finally a cameo appearance before a federal judge, I am Officially Disabled.  I was Disabled before that, according to my “Own Occupation” disability insurance policy (which was the only good financial decision I have ever made;  it has literally saved my life), but that applies only to the practice of Pediatrics and Adolescent Medicine and does not apply, say, to “Greeter At Walmart.”  Coincidentally, the Walmarts in my area have fired their greeters.  Perhaps the sales of Ol’ Roy Dog Food was flagging, and they needed to create a few more desperately poor elderly who might be able to spring for the 33 cent cans.  (Damn it, why does the “cent” sign no longer show up on keyboards?  Another of my conspiracy theories: the government is going to melt down all the pennies for the copper.  Think about it: we are walking around with FORTUNES worth of precious metals in our pockets and don’t even think about it!  N.B. it is a federal crime to melt down pennies, in case the idea should enter your head, as it did mine.

Where was I?  Oh yes. Normally when one gets Social Security Disability, there is a two-year waiting period before you can get Medicare health insurance.  So if you are trying to live on the approximately $1000 per month that most people are rolling in on SSD, what are you supposed to do in the meantime?  Medicaid, I guess, if you qualify.  But if you don’t qualify because your spouse had the good fortune to land a part-time job at McDonald’s with no benefits, well, you are just shit out of luck.  There is a very hole-y network of nonprofits that try to help people in this situation, but the need far exceeds the demand; thus we have an increasingly sick population, growing sicker all the time.

Should you happen to live through two years of being uninsured, then you get Medicare!  Yay!  I was extra lucky: because the Social Security system denied my claim automatically instead of looking at it, the judge ruled that my Medicare eligibility was up for “time served,” to begin not only immediately, but retroactively.  I got my hearing in December, and my benefits started ticking the previous October.  Confused?  Me too.

Strangely enough, the Social Security system does not give you a choice about federal insurance plans.  Previous to becoming Officially Disabled, I had a fairly expensive but pretty darn good plan through the Federal High Risk Pool, which is YES, PART OF OBAMACARE, which made it possible for me to get insurance after I had been denied by private insurers.  It was a standard choose-your-own deductible, then copays for doctor visits and 80-20 for hospital stuff up to a reasonably low out-of-pocket, which I found quite livable.  The drug plan was good, rarely demanded precerts, and had pretty standard copays.

And then.  And then….I am suddenly catapulted into the murky and confusing world of Medicare, because if you’re on SSD you have to be on Medicare. So at first gasp it doesn’t look too daunting:  there’s only part A, B, C, and D to worry about finding providers for.  I said to my therapist, whose idea this whole rat’s nest was in the first place (thank you, B__), um, don’t you think I should go and see a social worker to help guide me through the system?  Oh, no, she chirps, just call up the AARP.  They’ll walk you through it.  They have the best supplemental plans.  Oh. Er, what’s a “supplemental plan”?  That’s Part C, which pays for doctor visits, and Part D, which is your drug plan.  Parts A and B have to do with hospital care.

OK.  So I get my Medicare card, which automatically means my Federal Risk Pool insurance is cancelled.  So now I have to QUICKLY do something about transferring pharmacies, because I have my brand-new Part D card for medicines, and they have a mail-order pharmacy through which you can get three months’ worth of medicine with only one copay instead of three.  YEE-HAH!  So, off I go on the merry-go-round of chasing down doctors’ assistants and nurses to call my prescriptions in to the new pharmacy, because no, you CAN’T just transfer them from the one you already have.

One of my meds, the one I use to digest all my food with because for some reason my body doesn’t make those enzymes, took FIVE phone calls from the long-suffering physician assistant to get it right.  Ay-ay-ay, I’m having visions of chimpanzees in puffy white caps pouring pills into bottles.  Not encouraging.  So finally they managed to get everything right, and in the meantime I’m surviving on my hoard of meds that I brought back from Israel in October.  Had it not been for them, I would have been up shit creek without a paddle.

So the nice lady calls from the pharmacy and we go over the Rx’s one last time to make sure she’s got them right, and then we place the order, putting all the copays on my American Express Card that gets the mileage points for every dollar you spend, and…”Oh dear, are you sure you want this entire order?  It puts you into the Donut Hole right away.”  The what?  Donut Hole?  Isn’t that something you get with coffee?

Oh no.  That’s what you get with Medicare when the retail (I repeat, RETAIL, because that’s the part they don’t explain to you up front) expenditure hits $1950 (plus or minus a bit, I don’t have it in front of me.)  So here’s how it works:  You pay a premium of about $40 per month for prescription drug coverage.  When you buy a prescription, you pay a pretty normal copay based on a tiered system, anywhere from $3 to 1/3 of the actual cost of the drug if it is a specialty drug.  After the plan has bought you $1950 worth of drug, then the plan pays NOTHING until you have paid $4,750 out of your pocket (if you have one), at which point the plan goes into hyperdrive (“Catastrophic,” they call it, just for drama) and you pay almost nothing until the whole sonofabitching thing resets itself at the top of the year.

So what, I ask in my innocence, do you do if you do not happen to have nearly $5000 kicking around?  Oh, Medicare has a program for “Assistance,” but almost nobody qualifies for it.

There are community programs (in some communities) that help.   If you are indigent according to the Medicaid standards, you can just get Medicaid.

Otherwise you’re screwed.  Many disabled and elderly persons find themselves with too much money to qualify for assistance programs but not enough money to buy their medicines.  So let’s see, what happens when someone can’t afford their expensive blood pressure medicine and (G-d forbid) have a stroke?  Well then, Medicare Parts A and B kick in then.  No worries there, got you covered.  So if you can’t afford to take your medicine, don’t fret, because Big Government is gonna take care of you in the hospital after the heart attack you get when you can’t afford your Plavix (very expensive anti-platelet drug that sounds like a kind of mouthwash).

So what am I going to do about this?  Luckily, I just got one of those packets of checks from the credit card company where I can write myself an interest-free loan for a year.  That’s what I’ll do, because I don’t have any other choice.  And I’ll pay it off in installments over the year.  I’m damned grateful to have opened that packet instead of chucking it directly in the paper recycle like I usually do.  Must have been that guardian angel again.

And speaking of guardian angels, the one that convinced me back in 1992 when I was hale and healthy except for the occasional skiing wreck, and making what was for me a freakin’ lot of money, THAT guardian angel who convinced me to sign on the bottom line of a very expensive, very comprehensive private disability plan….THAT guardian angel gets a set of gilded wings from me, today and every day, because if not for that policy I would be, well, to tell you the truth I would probably be dead, because I would not have been able to support both my life and my diseases.

My blessings are many, many, many.  This whole SSD process has opened my eyes to the heinous and disgusting devaluation of the disabled and elderly that has become a legacy of shame in this country.  I want to do something, but don’t have a clue where to begin.  I can’t even go to Washington and set myself on fire on the White House steps because I’m terrified of fire.  But one thing is certain: with the aging of our population, if Medicare doesn’t get fixed, there will be many of our ill and elderly going not only into the donut hole, but into the black hole, never to emerge.

It’s Official: I’m Crazy!

Yes, I know I’m writing on the Sabbath again.  It was a choice between that, or taking lethal doses of drugs that I have especially tucked away for the purpose, should the time come when I really can’t bear it anymore.

I went before a federal disability judge today.  He looked exactly the way I saw him in my dream last night: 40-ish, dark haired, looking beneficent in his dark robes.  If he were not so cherubic he might recall the Grim Reaper.

The hearing lasted all of fifteen minutes, quite the anticlimax for a two year span spent gathering a stack of paper charts and reports several feet thick, going to court-appointed mental health examiners, showing up at lawyer appointments, ad nauseam, and for all that not really knowing what the benefit to myself could possibly be.  I have a very nice (thank God) private disability policy that I paid for out of my pocket while I was working, and I had to fight tooth and nail to force the *&^% insurance company to pay up when I got sick, all the while so deep in depression that I could not get out of my chair, let alone fight a battle with an insurance company that would stop at nothing (including surveillance) to keep from parting with their money.  That was in the early years of the 2000’s, and I have been kept not nearly as comfortable as I was when I was working, yet certainly not starving.

And now comes my therapist and starts pushing me to apply for Social Security Disability, mostly because half of my present income goes to paying deductibles and co-payments, and she feels that the Medicare that comes with the SSD would provide substantial financial relief.

I suppose that is true.  I won’t receive more income really, because the private insurance might possibly decrease in proportion to the government payments, which won’t be much anyway because of the twelve years that I was a student becoming a doctor and did not earn enough to pay taxes.  Ironic, that.

But all of that financial stuff is not what has me writing on the Sabbath.

It is the judgement, the final judgement, and the finality of the judgement, that I am mentally disabled.  That I cannot go back to work in the profession I love, that I was so deeply in love with that I sacrificed almost everything.

I am Officially Crazy.

I feel like I should immediately take shopping bags and fill them with dirty clothes and go out on the street with my hair looking wild.

Maybe I should have a scarlet letter “C” tattooed on my forehead.

I’m glad I have an anti-suicide pact with my oldest friend (I wonder if he remembers).  It helps me to stay away from the lethal cocktail.

I wonder, will the news reach the State Medical Board, and will they take away my license?  Even though I haven’t practiced medicine since April 4, 2000, I have carefully maintained my license, religiously racking up the Continuing Medical Education points every year, even though I can no longer afford to go to the snazzy conferences that I used to go to, to learn about all kinds of tips and tricks and topics and shmooze with the colleagues, when they would speak to me: after word got around that I am mentally ill, I found myself shunned by my pediatrics chums so I took up going to surgery meetings instead, where nobody knew me and I could learn in peace.  Ah well, those were the days; they are no more.  I will never practice medicine again.  It has been too long, and the disease and the drugs have taken their toll on my cognition.

I think I’ll just keep on getting drunk tonight.  I have a pretty good start already.  I don’t like being drunk, generally speaking; but I need something to numb the pain, and I don’t dare open a pill bottle.

Crazy Person, good night.