Your Health Insurance Dollar

Back in 1977, I worked for an Otologist, an ear surgeon, which he was always sure to make clear was not to be confused with an Otolaryngologist, an ENT. The man did not mess with noses or throats. Mostly he put tubes in kids' ears. Sometimes he’d have to remove a bunch of mastoid tissue, open up an ear canal, but mostly it was pretty tame. Infections and antibiotics. Decongestants. Antihistimines. And the tubes. 

We did get quite a few dizzy old folks, too. Ménière's disease and the like.

My duties working for Dr. B included reception, answering the phones and scheduling and greeting the patients. I also did the daily books and filed the insurance claims. I typed up his dictation, something that took some getting used to with this Hungarian accent and the technical terms. I did have to explain to him that it was probably better to use the term “purulent” when referring to discharges from ears rather than pussy, as he had been wont to do. If I typed out his name and professional association right now my fingers would automatically go the next line, the address, right on down to the zip code. My mouth could not tell you those things, my fingers can type them.

I had a brand new, it could back up and correct with its white over ribbon typewriter, so high tech it was heavenly. I was around eighteen at the time.

Sue, his faithful sidekick and RN and probably more than likely special friend based on the non-verbal exchanges I often observed between them, was a motherly figure, a divorcee close to Dr. B’s age, which was probably close to fifty.

He had sex books in his office, apparently they’d come across the iron curtain with him when his family fled the Russian onslaught, as the text was all in Hungarian and the folks photographed in them were clearly middle Europeans. I found it fascinating that the books with the pictures were among the things they secreted across the border, kind of goes against the grain of some of the epic struggle aspect of the story. His wife also had interesting tastes in reading, as I recall, visited the library where my sister worked and sometimes requested books that the library didn’t carry. Wouldn’t carry. Dr. B. once told me “Never trust a man who drives a Corwet. You can pick one up for a few thousand dollars.”

​He, personally, drove a 450 SL. A Mercedes Benz, something that would have appealed to Janis. 

I’m such a gossip.

And this is actually about the American “healthcare” system. You see, I’ve been pretty familiar with it for quite some time. Personally, I want nothing to do with it. I can’t imagine why anyone in her right might would. That we pay for it? Nucking futs.

Back in those days, the Insurance Industry paid doctors based on what they charged. While doctors had been constrained at that point a tiny little bit (only very recently, back then) from charging whatever they wanted to charge and getting paid for it, they hadn’t yet had the rules totally flipped on them. So, basically, he’d tell me to charge $300 for a tympanostomy (ear tube), knowing the insurance would only pay $200, but also knowing that the following year the insurance industry would raise the rate it paid if the ear guys were all charging $300. 

Like the ear guys didn’t all talk to ear other at ear guy conventions every year. Poor Dr. B. had to go to the ENT conventions, there weren’t enough ear snobs to make for a decent get together. He had to deal with those heathens who did tonsils and adenoids. Lots of risk in tonsils and adenoids.

At any rate, that was right around 1978 or so. In 1989, I completed a BS in Health Care Administration. At that point, things had gotten quite a bit different, we were messing around with DRGs, trying to create a system in which a physician got paid based on the patient’s diagnosis. One can only imagine what a mess of creative diagnostics that led to, the intricacies of insurance coding have gotten quite out of hand.

There were plenty of ideas thrown around for how to deal with this mess that had been created by Medicare, and really, when it comes down to it, as good intentioned and fine with my basically socialist heart Medicare is, when it is based upon the whims of guys who tell you never to trust someone who drives a Corwet because they are so cheap relative to his cute little Mercedes, well, it’s a bit of a problem.

One of the big ideas was “Health Maintenance Organizations”, you know HMOs. The idea was that folks were going to maintain their health. Doctors were going to encourage them to do so. There were going to be these nice little plans in place that would take care of everyone.

Yeah, right. What happened was that big Pharma saw its chance to jump right in, pills to prevent and treat everything and nothing were invented, they started marketing directly to the dumb public, the diagnosticians decided that everyone needed a mammogram and colonoscopy (which prevent nothing), and a bag of saline that ought to cost about a quarter now costs a couple of hundred bucks.

And then of course there’s the fact that nobody can tell anybody in this country what to do in terms of health maintenance, people do whatever they want to do, the food that is available in the grocery stores is barely fit to eat, and the same industry that produces that food funds the research that says it’s all just fine, now shut up and eat your glyphosate like a good citizen.

The folks who produce the pills fund it, the research on the pills, and don’t even really try to pretend it’s fine, or that the not fineness of it is simply one of those risks one must take if one wants to live forever and not endure the hardship of leg twitches. They’ve done the math, the risk is only to your life, not to their profit margin.

The lawyers pay attention to those side effects, those profit margins, those risks, as well. They’ve got to get their cut.  They’ve done the math, too.

What does your health insurance dollar fund? Well, it funds the insurance industry pretty well. It funds the pharmaceutical industry pretty well. It pays a couple of hundred bucks for a dollar bag of saline and puts out such a clusterf**k of an EOB as to boggle the mind. The charge is different for those who are insured vs. those who are not, it is different depending on the doctor and the plan, on inpatient or outpatient. That none of it has done much of anything to really improve quality or quantity of life is beside the point.

Once upon a time, the insurance industry allowed Dr. B. to drive a Mercedes. These days, an awful lot of MDs are sitting in doc in the boxes trying like hell to pay off student loans and driving for Uber on the side.They can’t even afford a Corwet. Their cut isn’t what it once was, their jobs not nearly as tolerable.
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What the health insurance dollar, public or private, sure as hell dose not fund in this country is health, not at all.