Who doesn’t love a deal? I certainly do! If my local market advertises cans of peas as ‘Buy 2, get 1 free, you can bet that I’m going to get that free can … and I don’t even like peas!
I recently made a discovery about my prescription plan – if I pick up 3 months supply of a prescription, I only have to pay 2 months worth of co-pays. I knew that I could get these savings if I ordered my prescriptions using my plan’s mail order service, but they recently informed me that the same deal is available when I get my meds at my local pharmacy.
Apparently, my local pharmacy never told me this because the savings comes out of their profits and not my prescription carriers. Too bad for them – I don’t care who is paying for that free month’s co-pay so long as it isn’t me. Couple this with some internet ‘coupons’ and you can save some serious money on your prescriptions. Your plan, or course, might differ, but hey, why not give them a call?
The ridiculous cost of prescription drugs has turned me into a coupon-clipping bargain shopper – who’d a thunk it?
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No, not Marvin the Martian. As far as I now, Marvin is alive and kicking, somewhere out there in Looneytoon Land.
I am referring to Mr. Marvin Pollet, of Louisiana. Marvin Pollet is dead.
He was killed by his health insurance carrier.
Mt. Pollet’s case was featured recently on an episode of ABC’s fantastic new documentary Boston Med. If you haven’t seen it yet – please tune in. It airs on Thursday nights at Ten. You can read all about Mr. Pollet’s tragic case here:
Mr. Pollet suffered from a rare condition amyloidosis, which was slowly destroying his heart. His cardiologist in Louisiana referred Mr. Pollet to Massachusetts General Hospital for evaluation for a heart transplant, but his health insurance carrier denied the visit at the last minute. As his heart continued to deteriorate, Mr. Pollet’s family finally brought him to Massachusetts General Hospital three weeks later. The transplant team, after evaluating him, gave the green light for a transplant, but poor Mr. Pollet did not survive the wait. His doctors concurred that, if he came three weeks earlier, as originally scheduled, Mr. Pollet would have had his heart in time to save his life.
While nothing now can bring Mr. Pollet back, there is something that his family can do to avenge his death and, perhaps, prevent a similar injustice from happening to another patient in the future. First, they should find out WHO at the health insurance carrier made the ultimate decision not to allow the initial visit with Massachusetts General Hospital. Most likely, the responsibility will fall on a ‘Medical Director’. For those of you unfamiliar with the term, an insurance company ‘Medical Director’ is a soulless physician who could not make a living practicing medicine in the real world, so they spend their days saving health insurance carriers money by denying care. Anyway, once this ‘Medical Director’ is identified, they should see if he or she is licensed to practice medicine in both Louisiana AND Massachusetts. If they are not licensed in BOTH States, Mr. Pollet’s family should sue them for wrongful death and practicing medicine without a license. If, by small chance, they are licensed in both States, they should be sued for medical malpractice. In either case, ‘Medical Directors’ everywhere should be put on notice that bad medicine cannot hide behind the facade of an insurance carrier. Would they win their case? It’s debatable, but is patients don’t start fighting back, preventable deaths like Mr. Pollet’s will be repeated again and again.
There is another thing that Mr. Pollet can teach us all, and perhaps save our life someday, or the life of a loved one. Here is that little pearl of wisdom – please right it down somewhere:
When it comes to our health, especially when the situation is critical, it is better to ask for forgiveness afterward then it is to ask for permission before.
In other words, always go with the opinion of a doctor that you trust, and is who is intimately familiar with the case, over the opinion of some faceless insurance company bureaucrat who couldn’t pick the patient out of a lineup. If the care is indeed justified, the insurance company will eventually pay, even if you have to fight for the payment. If needed, you can always file a complaint with your State’s Department of Insurance, whose job is to oversee all insurance carriers and make sure that they pay the legitimate claims of their policyholders.
Rest in peace, Marvin.
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So, what is the very simple solution to ridding our overloaded Emergency Rooms of GOMERS, and making Emergency Care more affordable? Here’s a hint – the answer is NOT National Health Care. The answer is simpler still – FREE HEALTHCARE FOR ALL AMERICANS !
Think about it – American charities dispense free health care all around the world – why not offer it here as well, available to ALL AMERICANS, regardless of income, social status, or locality. Hey, if Warren Buffet wanted free health care, we would give it to him – everyone is invited to participate. The SAME FREE HEALTH CARE is available to everybody – no one is excluded and everyone gets treated the same. We can call it FREEDOMCARE – what could be more American than that? It can really be that simple – but there are a few catches – so pay close attention.
FIRST, we construct a nationwide network of free clinics across the country, and concentrate them, initially, in areas where there are large numbers of uninsured. Ideally, they could be situated close to large hospitals, but we don’t have to be limited to this. They will be no-frills affairs, with bare-bones waiting rooms and no private treatment rooms. They will be located in the cheapest space we can find – maybe a converted warehouse or inner city loft. Whatever it takes to minimize costs.
SECOND, we staff the clinics with a whole range of health care professionals, a large portion of which will be active military medical personnel. Hey, our military might even increase the number of recruits it trains for medical positions to meet the need. After all, knowing how to change a dressing is a better real-world skill then driving a tank is. Other medical professionals will be required under law to serve some time here. Here are some of those candidates. If you receive a medical education in this country, and that education was financed in whole or part by a US government loan, you must dedicate at least some time every month in a free clinic for 5 years after graduation. Likewise, if you are a foreign national who wishes to emigrate and practice medicine in this country, you must also serve in a free clinic. If you are a doctor convicted of Medicare fraud, instead of serving your time in prison, you will be placed under house arrest and serve your sentence working in a free clinic. In fact, if you are any health care professional convicted of a non-violent crime, the free clinic will become your prison. Hey, we could use non-violent convict labor to fill a whole range of clinic duty, including custodial work and maintenance. With a little creative thinking, I am sure we can find enough qualified personnel to staff these free clinics at very little expense.
THIRD, you will never get to see a doctor unless you REALLY need to see a doctor. In fact, many people will have to endure a gauntlet of medical professionals before they see an actual MD. You may need to see an Army medic, then a registered nurse, then a physicians assistant, and then a nurse practitioner before you actually see a medical doctor – and then only if you really need to.
FOURTH, medications that are dispensed will only be generics – no drug company representatives will be allowed on premises unless they are a patient presenting for care.
The entire operation will be decidedly no frills. No appointments will be necessary – or even given – patients will be seen first come – first serve - after they have been triaged by condition. In fact, patients should expect to wait a good amount of time – that’s just the way it will be.
Oh, and one other thing: All patients must sign a waiver for malpractice prior to being seen. No waiver – no treatment. What do you want for nothing … rubber biscuit??
One final caveat – the ER will be allowed to turn people away by referring them to the free clinic. Hey, they could even offer a free shuttle service. They will be able to do this totally without consequence or liability.
Of course, EVERYONE will have the option of using our traditional, full service system that we enjoy today – nothing about that will change – except that the rates we pay for care and health insurance will drop significantly.
OK, this is just a germ of an idea – there will be a lot of bugs to work out – but at least it would be a start. But do me a favor – don’t say “That will never work BECAUSE”…please say instead “That will never work UNLESS…” – we need to keep a positive attitude.
Looking forward to your comments….
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In a recent post, I questioned why Emergency Room visits were so expensive. One major reason is this man. Well, sort of.
Children of the 60’s will recognize this man as Gomer Pyle, USMC, a.k.a. Jim Nabors. Actually, Jim has absolutely nothing to do with the high cost of ER care (at least, to the best of my knowledge!) BUT his alter ego, Gomer Pyle does. Well, sort of.
Let me backtrack for a minute.
As everyone knows, the medical profession uses many acronyms – I think that they are second only to the US military in this regard. They have MRI’s, CAT scans, IV’s, and ER’s. There are ECG’s, EMG’s EKG’s, and EMT’s – you get the picture. But, did you know that they have other acronyms that most people have never heard of? For example, one of my favorites is (you guessed it), GOMER.
GOMER stands for “Get Out of My Emergency Room”. It is applied to the many patients who present for care at the ER, but who really don’t belong there. However, the ER staff can never turn anyone away for care without risking fines, lawsuits and bad press. So, GOMER’s continue to pour into our ER’s nationwide.
GOMER’s fit in three distinct categories. First, we have regular patients with non-emergent conditions that could be best treated by their family doctor or even an independent Medi-Merge center. This includes patients with mild colds and flu, small cuts, abrasions, or minor breaks and sprains. Frankly, if your injury or condition is not life-threatening, will not require advanced testing, is not life threatening, and will not ever result in you bring admitted into the hospital, you probably don’t need to be in the ER, taking attention and focus away from those patients who truly need to be there.
The second group is the uninsured. Usually, these people DO need to be there, but they could have prevented this need by seeking medical attention at an earlier date. Typically, they become ill, but do not seek medical attention until the condition becomes so acute that they have no choice but go to the ER. I have a great amount of sympathy for these patients, but we need to offer them dome concrete alternatives for care before their situations become dire.
The third group is the homeless. They will often fake or create a condition in order to get a warm bed and some free meals. A common ploy is to eat cigarette ashes, which will create a temporary condition of acute gastric distress. They know that they will be admitted into the hospital from the ER, where they will have a solid day or two for testing and evaluation before they are released. Many of these patients are mentally ill or drug addicted, and will appear in the same ER over and over again.
All three of these groups are getting their health care at the single most expensive place in the world to get health care – a US Emergency Room. Many of them cannot or will not pay for this care, so the cost is passed onto those patients who can pay, and the end result is the $5,000 ER visit.
The sad thing is that there is little that anyone can do about this situation under the current system.
The best that ER staff can now do is to employ a tactic called “make them wait”. ER staffs will often ignore a non-emergency patient in hopes that they will leave and go elsewhere. Did you ever hear someone complain that they were in the ER, the place was empty, but they had to wait for twelve hours to be seen? Chances are, the triage nurse determined that they were a GOMER, and tried to make them go away.
The GOMER situation is very sad, as it represents the absolute worst in our health care system. Not only is it a fiscal waste, many people are not getting the care that they need in a timely and efficient manner. There is, however, a very simple solution to this fiasco. Want to know what it is? Stay tuned….
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Poor Bernie Madoff. He seemed like such a smart guy. He was reaping in gobs of money – until the bottom fell out of his Ponzi scheme.
His ultimate downfall was that he led his investors to believe that they would eventually get their money back with dividends, but when his investment group got too large, he could no longer deliver on this promise. Yada, yada, yada – he’s going to be locked up for a very long time.
I guess poor Bernie wasn’t so smart after all. If he was truly smart, he would have set up a health insurance company instead.
Health Insurance companies take lots of money from you every month – a sizeable chunk of which never goes toward your health care. Instead, they funnel huge amounts of money into what is referred to as a reserve fund. This money is then reinvested, and it grows and grows. These funds usually represent many billions of dollars for each carrier. For many people, even though they don’t know it, their contribution to their health carriers reserve fund can be their largest investment vehicle. Too bad they will never see a dime of that money….
The idea behind these reserve funds is that they can use this money in an emergency to cover ‘unexpected’ payments – like if the United States were to be hit by the black plague. But, to the best of my knowledge, no health insurance carrier ever has tapped their fund for this purpose. So your money sits in their fund, working and growing, month by month, year by year.
So, what happens when you change your health insurance carrier – do you get any of your reserve fund contributions back? Nope. How about if your total contribution in premiums exceeds the benefits paid on your behalf, plus administrative costs – surely you would qualify for some type of payout? Nope.
The fact is that the money you unwittingly and unwillingly paid into your carriers reserve fund is theirs to keep – whether you like it or not. After all, they never promised you or led you to believe that they would ever pay this investment capital back to you.
Smart people, these insurance folks. The never promised you a dime back. Heck, 95% of their policyholders are blissfully unaware that they even paid this money in the first place. So no one is confiscating the personal property of these insurance company executives, or sending them up the river for a very long time. No one is writing newspaper articles about them, and how they ripped of millions of Americans. In fact, they are getting away Scott-free.
Poor Bernie never got involved in this profitable, consequence-free game …and THAT'S where Bernie went wrong.
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My absolute BEST college professor wasn’t really a professor at all. He was an independent consultant who taught a course in statistics at the local county college. I needed to take a course in statistics for my degree, and I decided to take it over the summer at the county college instead of at the university. Here I met Dr. Stanley Marash, founder of Stat-A-Matrix,who was to be my new statistics professor.
I dreaded the thought of this course – all of those formulas to memorize – but Dr. Marash made the subject come alive for me. I will always remember his lecture on ‘lying with statistics’. Hiis pet peeve was how organizations and advertisers would misuse statistics in order to make their point. If you did not understand statistics, you would be led into making the wrong interpretation of the result. He showed us many examples of how companies did this in their advertising. His mantra was ‘if they show you statistical data, look for the lie”. I never will forget this lesson, and it has served me well over the years.
Scary Statistics
Here’s a case in point: A recent report from the Journal of Hospital Medicine quoted some very scary statistics. It seems that people without health insurance are 50% MORE likely to die from a heart attack or stroke then those patients with insurance. Wow – health insurance agents must be bracing themselves for a huge surge in business. Well, hold on there – let’s not be so reactionary….snd remember Dr. Stanley Marash’s lesson.
First of all, the key word here is MORE. A little 4 letter word that most people scan right over. But as we delve deeper into the report, it seems that the heart attack/stroke mortality rate for patients with health insurance is around 2%, and the rate for people without insurance is around 3%. Technically. 3% is 50% more then 2%, so the report is not lying, per se, but many people reading the headline would skip right over that little word MORE and assume that the uninsured have a 50% mortality rate from heart attack or stroke – and this is far from the truth…but it does catch ones attention, doesn’t it?
So, even though a person without health insurance is 50% more likely to die from a heart attack or stroke, they still are not at all likely to do so. 3 chances out of a hundred are still very good odds in anyone’s book.
But there a still is a difference in mortality rates-why? Well, there are several obvious reasons. The most important one is that people without health insurance tend to put off seeking medical attention until their situation becomes dire and they have no other choice. Ask any doctor – delay in diagnosis and treatment will have a very negative effect on mortality rates. A second reason is more of a socio-economic one. People without insurance are tend to be poorer – and poorer people tend to eat a lot of fast foods and fat – and these will contribute, in turn, to cardiovascular disease, including heart attacks and strokes. In fact, when you consider these factors, it is to the credit of our health care system that there is only a 1% increase in mortality for the uninsured.
But that’s not what the powers-that-be want you to think. Their message is clear - if you don’t have health insurance, the hospital will ignore you and you’re going to die. We’ve got the statistics to prove this – that is, if you never heard of Dr. Stanley Marash. But, dear readers, now you have. Don’t you feel empowered?
Oh, sorry – there was nothing about sex in this posting. Mea culpa. I lied. But I did get you to read it all the way through, didn’t I?
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Several people have commented on how much they enjoyed my recent post on how we can apply Spin Doctor Techniques to help the medical profession. As promised, here are some additional medical terms, pre and post Spin Doctoring.
Since almost everyone is wary of people with Mental Health issues, I’ve decided that this is an area that could definitely benefit from Spin Doctoring.
First, let’s can the term ‘Mentally Ill’ – a term with terrible connotations. I will admit that ‘Mentally Ill’ sounds much better then the old standard ‘Crazy’, but we can do much better. From this day forward, let’s start calling afflicted persons ‘Different Thinkers’ - a much more positive term. As an illustration, let’s consider ‘Bob’ – a fictional person with a mental disorder. How do you think he would like to be referred to?:
A) Bob is Crazy
B) Bob is Mentally Ill
C) Bob is a Different Thinker
I can’t speak for Bob, but you would have to be nuts not to prefer ‘C’.
Here are some other mental Health Terms, before and after Spin Doctoring:
Hyperactive = Perky
Psychosis = Brain-Sprain
Bi-Polar = Spontaneous
Manic = Energetic
Alcoholic = Fun at Parties
Nymphomaniac = LOTS of Fun at Parties
Cathartic = Relaxed
Delusional = Democratic
Narcissistic = Republican
Depressed = Low Key
Obsessive-Compulsive = Detail oriented
Anorexic = Svelte
Paranoid = Cautious
We can even apply the same techniques to very scary medical procedures associated with Mental Health. For example, “Electroconvulsive Therapy” could now be called “Catching a Buzz”. A Frontal Lobotomy could be referred to as “Getting a Trim”.
Yes, the world of mental Health would benefit immensely from some Spin Doctoring. Why should only Pharmaceutical Companies and Health Insurance Carriers be the only ones using this wonderful technique?
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I’ve been following with great interest the case of the Michigan man was fired from Wal-Mart for using marijuana. No big shocker, at first – after all, many corporations have policies in place in regards to illicit drug use. Seems that the former employee, 30 year old Joseph Casias, was fired last year when he tested positive for marijuana after he injured his knee at work. But like Paul Harvey said, here’s the rest of the story....
It turns out that this married father of two has an inoperable brain tumor as well as sinus cancer. His oncologist prescribed medical marijuana, WHICH IS LEGAL IN MICHIGAN, to help him deal with the chronic pain. Poor bastard. He has brain cancer, sinus cancer, a twisted knee AND he works at Wal Mart? Job had it easier.
Joseph Casias, 30, said he was fired late last year after five years of employment at a Wal-Mart store in his hometown of Battle Creek.
Wal-Mart, in their defense, stated that it “does not approve” of the legal use of medical marijuana. "Like other companies, we have to consider the overall safety of our customers and our associates, including Mr. Casias, when making a difficult decision like this".
Well, I can see their point. After all, there are other alternatives to Medical Marijuana. For example, Mr. Casias could try a nice safe prescription drug like Celebrex, whose only side effects are stomach bleeding, heart attack, stroke, nausea, constipation, dizziness, headache, drowsiness, and vomiting. Or, he could use an opium-derived pain killer, which work great. Also, LOTS of doctors endorse their use. One doctor in particular comes to mind ....
The only downside to opiate-based pain killers is their highly addictive nature and the very real risk for overdose and death. But they won't give you bloodshot eyes, make you crave twinkies, or smell funny. Put down that joint, Mr. Casias – Wal-Mart says safety first.
The real point of this story is that Wal-Mart would have fired Mr. Casias if he was smoking opium to relieve his pain and it showed up on a drug screening. Which all boils down to Wal-Mart only wants their employees to use legally prescribed pain killers that are made and distributed by our pharmaceutical industry. Since this means opiates, the pretty red flower wins out over the ugly green weed, in spite of the much greater risks. Wal-Mart, one of the largest retailers of pharmaceuticals in the US, knows what side it’s bread is buttered on.
Too bad the pharmaceutical industry never read my earlier post on medical marijuana - poor Mr. Casias would be red-eyed, stoned, and happy, greeting polyester-clad overweight people as they walked through the doors of the Battle Creek store.
Yeah, I know that I sound like a wacky conspiracy theorist, but here’s some further proof: Here’s a screen-shot from the Reuters news story about the Casias case. Note the pop-up ad on the left side of the screen – it’s for Pfizer Pharmaceuticals, the manufacturers of Celebrex. The people in the ad seem quite happy, despite their risks for a heart attack or stroke.
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