Friday, March 02, 2007

Health Care Anecdote

My snoring and my wife proved incompatible very early on in our marriage. I don’t know how some women have the fortitude to endure the pain of childbirth, yet be unable to sleep with a few rustic sound effects. If I could endure her kicks, elbows, and complaints, why couldn’t she endure the gentle sounds of a loose flapping soft pallet?

I held out hope for as long as possible that my wife would eventually adapt to her new sleeping companion, but when my couch starting looking like the shroud of Turin, I figured it was time to consult with my doctor about possible solutions. My doctor recommended a sleep study which confirmed a diagnosis of Sleep Apnea.

Since then, I have been connected to a CPAP machine while I sleep. CPAP stands for Continuous Positive Airway Pressure. CPAP therapy provides a constant airflow which holds the airway open so that uninterrupted breathing is maintained during sleep.

Initially, my Blue Shield medical insurance plan covered most the cost of the machine, the mask, and the head gear. I still have the original machine, but over the years I have had to have the mask and head gear replaced as it wears out. Last year I ordered a new face mask and head gear where I had to split the cost with Blue Shield. We both paid about $80.

Several nights ago, the mask that I only used for a few months broke when I accidentally dropped it on the floor. The medical supply company told me I would need to pay another $80 dollars co-pay to get it replaced. Searching the internet CPAP suppliers, I found the same mask for $60 without the co-pay.

I’m thankful I can get a lower price, but it seems that health care is broken when using insurance cost more than not using insurance. Perhaps my situation is not normal, but I’m wondering if Insurance, in its present form, needs to go away, and allow individuals more control over their own health care.


Rick and Gary said...

Hey David -- You may want to see if your company offers HSA accounts. This is one of the products of the Bush Administration that I think is very valuable. Basically, you take health insurance policy with a high-deductible, up to $5000 -- you know, insurance as in covering stuff that you wouldn't be able to afford to cover yourself.

Your company then takes the money it saves giving you a high deductible and deposits it tax-free into your HSA account, where the money grows, tax-free, until you use it (also tax-free) on a legitimate health expense.

It cuts all the bureaucratic overhead out of moderate health expenditures and, more importantly, makes the patient behave more like a consumer. I, for example, pushed my cardiologist to prescribe a much , much cheaper cholesterol drug for me than what he had been prescribing. And it turns out to work better!!

I won't get into the details, but my partner Gary tells me that Docs push the more expensive stuff because its somewhat more idiot proof and requires less explanation on their part of the doctor.

David M. Smith said...

Hi Rick,

Yes, we have HSA’s. My company pays about $10,000 a year and I pay about $3000 a year for Blue Shield to cover my family. My wife and I get physicals once a year. My daughters get their vaccines according to schedule. I take generic simvastatin for high cholesterol. That’s about it besides the CPAP. I have never used the HSA because we so rarely have any other medical expenses. I do have other health care insurance options including a program that is more of a catastrophic only insurance, but the risk didn’t seem worth it because of the amount my company was willing to pay.

I can’t imagine very many families needing $13,000 a year for medical expenses, but we all foot the bill for those who have really high medical bills and a lot of it is wasted in administrative costs. I agree with you that if patients were able to act like consumers a lot of the costs would go down.

I also suspect there are doctors who get legal kick-backs in the form of a consulting fee for pushing certain medications. Getting from the referring doctor to the CPAP was not seamless, but that story, as well as how I got to generic simvastatin is for another day. I’m worn out just thinking about both.

Rick and Gary said...

LOL, I know what you mean. I've been around a lot of doctors all my life, and I get the feeling that most doctors prescribe whatever medication is easiest to deal with, without regard to cost. If a drug salesman comes in and feeds them a sandwich while discussing the pros and cons of a medication (from the drug company's perspective, of course), leaving lots of free samples, they aren't going to bother reading the medical journals on it and they are aren't going to worry about price (too busy for all that)

People are just going to have to take the responsibility of being partners in their own treatment. I know the traditional social convention has been to never question doctors. But that has to change (and seems to be changing)

Buz said...

From the other side.

I have had a lot of experience with the medical system over the past 25 years. I don't know if it is just cynicism, or if doctors are a bit less reliable on the coast, but we have a lot of faith in our doctors.

Without getting into a lot of detail, let me just say that I am usually able to deduct my medical expenses on my taxes, and that is after both insurance and the medical savings account have been subtracted.

We do have a lot of faith in our doctors, but a lot of that is because in the past 20 years, they have proven that not only do they care, but that the have made the best decisions for our health care.


David M. Smith said...

Hi Buz,

I didn’t mean to paint with such a wide brush. I’ve had some great doctors and we have many friends who we love who are doctors. However, I do think health care would be better, and there would be less conflicts for doctors, in a more market driven system.