Affordable Care Act and sticker shock.

I know I said I was done with writing on my blog, but now I have to put in my 2 cents on the so-called Affordable Care Act, more commonly known as Obama Care. My own health insurance rates have double in the last 2 years so that I could cover my children (which are over 30 and have been on their own for years), and so I could get maternity care and 2 free breast pumps a year (in my 50’s), and so my deductible for the year would be lower….. my husband and I have been buying our own health insurance for years, basically a catastrophic plan which would cover expenses in case we were hit by the proverbial bus or needed surgery, with a $2000 annual deductible. We are both healthy in general, don’t smoke, don’t drink, get a reasonable amount of exercise, eat pretty healthy and try to keep our weight within reason.

I got a notice from our health insurance company that we would have to “transition” to another plan in August, when we are up for renewal. This tells me our plan meets the guidelines, but that the insurance company can get a lot more money out of us with the new plans set up for Obama care. After a little research (went on the now-infamous website) and found out that only one health insurance company is authorized in our county (so much for competitive rates) and it is the one we have now. Checked on available plans, found one equivalent to what we have now, more or less. This is the so called platinum plan, and it will cost us a whopping 4 times as much as we pay now, frankly, more than the highest mortgage we ever paid. The bronze plan would cost us twice what we pay now, plus a $6000 annual deductible and they pay only 60%????? Say, what???? A 40% co-pay??? Where is the affordable part of the health insurance here? When I went on the health insurance company website, the plan quoted to me on the government site actually costs 50% MORE than the government quoted. 

I was hoping at some point to get a knee replacement as my right knee is pretty much crunching at this point, daily Aleve and repeated steroid injections have kept it going. The average cost of a TKR in Florida is about $40,000. So first I have to pay over $6,000 (that is just my insurance, double the cost for both of us) in insurance premiums for that year, then $6000 in deductible, and 40% of $40,000: $16,000. This is not including the PT I will need afterwards. Cost of knee replacement with “insurance”: $28,000 out of pocket plus PT. Uhm, what is wrong with this picture? With my current insurance, I would pay $2400 for insurance, $2000 in deductible, and that’s it.

Bottom line is I will have to pay so much money for “affordable care” health insurance for me and my husband, that we are not going to be able to save any money at all. I would have to save up $20,000 above the cost of insurance for the surgery. We will be reduced from feeling financially stable and able to save money for a “rainy day” to living pay-check to pay-check. WTF!!!!! Did I go to school for over 8 years for this? I am working in a little town for a single doctor, I am not making a huge amount of money. I love my job, and don’t want to go somewhere else to make enough money to pay for the damn health insurance. This is all F-ing ridiculous. To be honest, I have cried over this. I can’t even begin to imagine what it is like for a family with kids and less income. 

We are already getting many patients who have lost their doctors through retirement (recently, all of a sudden) and due to the insurance companies not coming into this county anymore. 

The politicians are so glib and smug, thinking they are able to FIX all of our problems. Well, they FIXED me all right, and lots of other people.

Honestly, when they said this is all about wealth redistribution and not health care, that was the truth.

“The trick is figuring out how do we structure government systems that pool resources and hence facilitate some [wealth] redistribution — because I actually believe in redistribution, at least at a certain level to make sure that everybody’s got a shot.”

Obama, 2008

 

Well, I make my own shot through hard work, and he is taking it away from me. The shame is, NO ONE is being helped in this restructuring of the government. 

 

“This is also an income shift — it’s a shift, it’s a leveling to help lower income Americans. Too often, much of late, the last couple three years the mal-distribution of income in America is gone up way too much, the wealthy are getting way, way too wealthy, and the middle income class is left behind. Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America, because healthcare is now a right for all Americans, because healthcare is now affordable for all Americans.”

US Senator Max Baucus (D-Mont.)

Oh, really?

Sigh, I guess I will never get that knee.

What has happened since..

I have finally found my spot in a private family practice in my small town. There had been several interviews, but one name kept coming up when I spoke to people I knew. I called this physician and we set up an interview.  We spoke at length, he told about his practice philosophy: treat the whole person, emphasize prevention and health maintenance, look for the underlying cause and treat that, not just treating the symptoms, spend time with the patients.

Gee, I couldn’t have said it better myself. At the end of the interview he said he would pray about it and call me. He did, I accepted. I moved into my office (my OWN office, with my own desk and everything… and 2 windows). My name is on the sign out front. The office is 10 minutes from my house,  I can go home for lunch. The staff is great, my employer is wonderful: supportive, likes to teach, has a great sense of humor and is just a downright nice guy. I guess my prayers have finally been answered.

As far as my blog is concerned, I am seriously thinking of stopping. The journey of school was a wonderful, hair-raising adventure. Blogging was a way to relieve some of the stress. I am glad it has inspired people, and my readers seemed to enjoy my little rants and stories. It is just that I am so darn contented now, I am puttering around in the garden planting stuff, playing with the dogs, looking at my goldfish in their little pond, riding my trike. Our kitchen and most of the rest of the house is done and looking good (well, not the Pepto-Bismol guest bath and the master bath, either. But they can wait for awhile). There doesn’t seem to be that drive to put stuff down on paper anymore.

I still have my moments of not knowing what to do, but my Doc is great and backs me up. There are still those 2 AM wide awake panic moments when I think of something I might have done wrong that day. In general, though, things are going well. There are several patients that followed me from the rural health clinic, and some from this practice that prefer to see me now, where things just clicked between us as NP and patient. (There are also ones that insist on seeing only the doctor, my head isn’t getting too puffed up).

There have been moments that stand out where I feel lucky to have really helped a patient: to manage their diabetes, overcome grief and depression over the loss of a family member, found a lung cancer in time for cure, recognized pneumonia in a 89 year-old with no symptoms other than fatigue, loss of appetite and blood tinged cough. He felt wonderful within 48 hours of starting the Levaquin, told me “You’re great Doc, you really fixed me up”. (Am I going to be committing a felony now by Florida law, if I don’t correct him and say I am not a doctor but a nurse practitioner? I always tell them I am a nurse practitioner, but some patients just like to say Doc, I think).

Other patients have not been so easy, like the one who came in not feeling well for a long time, was losing weight, but was hungry all the time. We dipped her urine because it was burning, found glucose and then discovered her blood glucose was in the 400’s on doing an Accucheck. We started her on Lantus, gave her a glucometer, instructed her thoroughly in how to monitor her sugars and titrate the Lantus accordingly from the base rate we started her on. She was to follow up in a week. The next week she came in looking like death warmed over, felt horrible. Turns out she had not checked her sugar after the first day, “I didn’t feel well enough”, but had kept increasing her Lantus anyway. Her sugars had dropped into the 40’s. “Was I supposed to call you when I felt so bad?” She asked. Lord, give me patience. She did finally get it and is doing well now.

I have found that in a small town, options for specialties to refer to are somewhat limited, so we do a lot in-house. News gets around fast, your reputation is important. It is good to hear that word is getting around and we are getting a lot of new patients who hear this practice is good. It is a happy place to be, I just have to get over the feeling of waiting for the other shoe to drop after so many trials and tribulations. I believe maybe it is all going to be okay now.

It’s been great. Thanks readers, you helped me through it all.

Update

Sorry I haven’t been around to post recently. We just bought a house, a fixer-upper and have been completely busy and exhausted putting in the new kitchen. The results are good, it came out beautiful, but I would never want to go through that again! You should have seen us covered in insulation fluff when the drop ceiling turned out not to be a “dropped ceiling” and just a seven foot ceiling opening directly to the attic. Not only did we have to replace cabinets, etc. , we had to basically gut and rebuild the whole room.

As soon as we are all done unpacking, setting up the house and my sewing room/office, I will be back on track again. Soon, I promise.

Mondays

Monday in a rural health clinic is, well, interesting. As in the old Chinese curse “May you live in interesting times”. I am sitting in my little office cubby at the back of the building tackling the teetering pile of charts that have messages or lab and test results to be read, when I hear a panicked voice yelling “We need you NOW!”. Dashing out, I am directed to the waiting area where a young man is laying on the floor and the other patients who were waiting to be seen are backing out the door, wide-eyed.

The man was unconscious, not responding and his breath whistled whheep, whheeeep, wheeep, like a kid with epiglotitis. Oh, crap, he probably has something lodged in his throat. I turn him around to check his airway, and check his mouth and he coughs a little, mucous tinged with blood dribbles out. I put him back on his side. Panicked staff crowd around, “What do we do?” one yelled. “Call 911, get me oxygen and the ambubag!” I replied.

He is still not responding, though the wheeping is slowing down a little, and suddenly stops. “Shit, he stoppped breathing!”, I have a sinking feeling in my chest, this guy is going to die on me. I grab him by the shoulders and shake him. “Don’t you DARE stop breathing!” I yell into his ear. He suddenly gasps a little, with a more normal sound, and starts to come round, his eyes open. He whispers “Anxiety attack”. The 911 crew arrives, just as he is starting to sit up. They ask the story and I tell them what happened. At the mention of the words “anxiety attack”, their interest cools considerably. A staff member hands me the patient’s chart, as they now know who it is. He has esophageal ulcers, asthma and GERD listed in his problem list. I pass this information along to the now bored EMTs. I mention they might want to check his lungs as possibly he may have aspirated some stomach acid, they say “thanks, sure” and out they go.

Two days later, the guy shows up for an office visit with his mom. She thanks me profusely for saving his life. When I asked him what precipitated his anxiety attack, he said “Nothing. I was just driving along and started coughing, I couldn’t catch my breath and then the panic started.” I see on his med list he is supposed to be taking Advair for asthma, and Nexium for acid reflux and the esophageal ulcers. He admits to not taking his medicine, that he didn’t feel it was necessary. I explained that a combination of refluxed stomach acid and bronchial spasms from the asthma had probably led to his coughing and panic attack. His mother gave him the stink-eye and said “I TOLD you to take your medicines!” The guy sheepishly promised to take all of his meds in the future.

Later, a guy walks in with a hospital gown on over his jeans and a hard neck brace on his neck. He hands me a pile of papers which are hospital records from an ED visit last night. The records show he has a transverse C4 fracture, nondisplaced. The story of how he got the broken neck was colorful and included beer, motorcycles and police officers and a total lack of memory about how it happened. There were multiple scrapes, bruises and marks on him, one of which looked like a boot print. Quite a night.

“I was supposed to see a spinal surgeon today,” he tells me. “But, the one I was told to see doesn’t take Medicaid. He said I had to get a referral from my primary.” That would be us. The nearest spinal surgeon that accepts Medicaid is at Shands, which is over an hour away. The patient would have to drive himself. When our scheduler called Shands, they told us they would call back to set an appointment after noon tomorrow. Our scheduler “suggested” that she would fax the referral and the pertinent information from the hospital records now and she would call them first thing in the morning to see what time the patient should show up tomorrow. We’ll see how well that goes. I pointedly reminded him to keep the brace on and not try to turn his head until seen by the spine doctor.

The sad part is, if the hospital had admitted him, he could have been seen by the local spine surgeon in the hospital, had his surgery and it would have been covered by Medicaid.

What is wrong with this picture?