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Stateside with Rosalea: Vindicare (Part 1)

Stateside with Rosalea

Vindicare, Part 1

There are only two things you need to know to understand the health-care system in the United States. It is not about health. And it is not about care. In fact, if you go to the on-line Merriam-Webster Encyclopedia and search for 'health care', you get the following response: "No entries found." Search on 'health insurance' instead and you get a lengthy entry that includes the following information:

"System for the advance financing of medical expenses through contributions or taxes paid into a common fund to pay for all or part of health services specified in an insurance policy or law. Benefits may consist of the right to certain medical services or reimbursement of the insured for specified medical costs. Private health insurance is organized and administered by an insurance company or other private agency; public health insurance is run by the government."

Medicare is the federal health insurance program; Medi-Cal is California's state health insurance program. You have to meet certain criteria to be insured by those programs - criteria to do with age, income, disability. Otherwise you have to have private health insurance, which is often arranged by employers as a benefit to their employees. I work for one of the biggest employers in this state, so you'd think my employer would have some bargaining clout to enable it to get private insurance premiums down.

Instead, the premium my employer pays is equivalent to almost one-tenth of my salary, and even then I have to top it up out of my own pocket. If I were to add up all the premiums that have been paid to private health insurance on my behalf over the past four years, it would amount to enough money to buy a new car. Taking into account that I earn only an average wage and cars here are cheap, that's still a power of money. So what have I got back on that "investment"?

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Let me personalise the story for you. Yesterday I called a medical center to make an appointment to see a doctor. I've never seen this doctor before, but hers is the name I chose from the list at the medical group I chose from the lists supplied by the health maintenance organisation (HMO) I've opted to use as my so-called care provider. I used to have a different doctor but the medical group she belonged to disbanded and she moved twenty miles away, sending me a bill for "capitation" and a demand for money if I wanted to have my medical records transferred to another doctor.

Excuse me? I didn't move twenty miles away, she did, and she's charging *me* money?

If I ever did get to see my former doctor, it was in between all the other patients she was seeing simultaneously in other examining rooms, and she seemingly had no control over the treatment I got anyway. When I went to have the prescription refilled for medicine she had prescribed, the pharmacy replaced it with other drugs without even asking her, using a generic drug instead - which saved the (nationwide) pharmacy money I suppose but made no difference to the amount I paid.

When I had a blood test a year later to see if the treatment had worked, the test results were so exactly like the original ones that the doctor accused me of not taking the medication, which just goes to show what a fat lot of use the generic drugs were. Her accusation, itself, is not so surprising, since I once did refuse to take medication she'd doled out - unasked - like lollies from the free supplies of "anxiety" pills a pharmaceutical company had handed out to her.

Those were the sort of pills that are advertised relentlessly on TV, with blandishments that you see your doctor and ask for them. Anxiety, arthritic knees, clogged arteries, anemia: you name it, and there's a barrage of print and electronic advertisements for some doctor-only cure driving people to fill up waiting rooms demanding they're given treatment. And with a $10-only co-payment for the prescription drugs on the HMO's approval list, why wouldn't anxious, arthritic-kneed, anemic, heart attack candidates be throwing pills down their throats by the fistful?

See how it works now, do you? Pharmaceutical companies create a need, driving up insurance rates in the process because so many claims are being made, and both those financial institutions get rich, while doctors struggle to see patients in the light of their Hippocratic oath instead of as a certain number of things on an assembly line that have to be processed in order to meet the quotas the HMOs demand of physicians who contract to them.

Which brings me back to my phone call yesterday, in which instead of simply being given an appointment time I was interrogated by the receptionist as if I was a barbarian at the gates. How dare I expect that giving one-tenth of my salary over to health insurance entitles me to health care as well!

Next week I'll have calmed down enough to tell you about Vindicare, or how the Feds - vindictively, it seems - punish physicians who try to take care of disabled patients' needs in spite of the government's reluctance to spend money on them. And in which we ask rhetorically: Wasn't provision of that care the whole point of Medicare in the first place?


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