Author: Rocky D. Bilhartz (page 1 of 9)

Divergent Visions

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Visions define us.

Viewpoints alter our assessment of the facts.

Mine. Yours. All of ours.

The more we realize it, the more productive our discussions will ultimately be.

Sometimes, visions affect us so much so that we have no real interest in empirically reviewing what we already want to believe. Evaluating and re-evaluating the reality created by our beliefs intrigues us very little. We prefer to see the evidence that supports our vision. And, we ignore the rest.

A clash of visions plays out all around us—economically, politically, and socially. Here’s one example in the debate over healthcare reform policies.

l’ll begin with this graph from Our World in Data:

ftotHealthExp_pC_USD_long

 

The X-axis is health expenditure. The Y-axis is life expectancy. The United States appears by itself at the bottom-right of it. And, here we go…

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“Mapping” Madness

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I had to bring in another one.

Another company.

I’ve now lost count.

I just know the number of 3rd-parties involved with documenting the medical care I provide exponentially dwarfs the actual people that I have providing it.

The latest company deals with something called “mapping.”

Certified mapping, if you will.

Now, take what I’m about to say with caution, because I’m not here to steer you wrong. But, when it comes to healthcare in this country, the following advice comes from my own experience:

Whenever you learn about someone, or something, or some other entity getting another medical “certification,” run away from them. Go the other direction. For one, it means that you probably won’t be able to afford them. But two, the certified medical system has just gone haywire.

I’ll break it down for you.

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Spare Me The Tire

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Spare tires have become TERRIBLE.

What is the matter with those things?

We call them donuts. But this comparison is a disgrace to the donut. Powdered sugar is more durable.

As for a balloon? I’ve seen sturdier ones at a birthday party.

It wasn’t always like that. It used to be a real tire. Then, something happened. And, its function suddenly became atrocious.

Even the jack suffered a similar fate. It became two chopsticks with a plastic twisty piece overnight. Did all of the automobile manufactures just get together and determine it was time to anger their customers?

Maybe. But, if being a part of America’s healthcare system has taught me anything, it’s that madness frequently has even simpler beginnings.

*  *  *

Shortly before I entered medical school, a change in healthcare delivery was already taking affect. It was called Hospital Medicine.

Don’t let me confuse you. Yes, we already had medicine going on in hospitals. But, this was indeed something new.

Different doctors (called hospitalists) were beginning to take care of you whenever you ended up in the hospital. These hospitalists weren’t your main doctor—the one who you saw frequently in the clinic. They were different. Your main doctor didn’t go to the hospital anymore.

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A Pre-existing Dilemma

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Tom is a forty-three year-old self-employed painter and father of two.

He’s currently in remission from lung cancer, having been first diagnosed five years ago. At the time of his diagnosis, he did not have health insurance.  Thankfully, for him, American law had finally made it illegal for health insurance companies to discriminate against individuals with preexisting conditions.

This means Tom had to be offered insurance at community rates. And, this was a good thing for him. His medical expenses exceeded $100,000 annually for his first two years of treatment. No one deserves to go without care for a serious medical condition.

*   *   *

Jenny is a married mother of two.

She in employed by a local small business where she has worked for the last 12 years. Her daughter has an uncommon but treatable blood disorder that requires occasional laboratory testing and infrequent blood transfusions.

Jenny’s employer has provided for the health insurance of both Jenny and her daughter for the last decade. It has been a part of Jenny’s benefits plan.

Unfortunately for Jenny, over the last few years, the cost to her employer to provide this plan has risen dramatically. The small business she works for has had no choice but to pass down many of these rising costs to her.

Jenny now pays her employer a markedly higher monthly premium for her family to be included on her plan. Her medical deductible is 10 times what it was just six years ago. And, her coverage is far worse.

Forced to cut costs even further last year, her employer only offered insurance options with more narrow networks of physicians. Jenny is currently driving 90 minutes for her daughter to receive the specialist care she requires. Five years ago, she drove four miles down the street.

Thankfully, Jenny has still found a way to make ends meet despite these obstacles. But, next year is looking to be even worse regarding the cost and quality of her insurance.

*   *   *

Healthcare is once again a major focus of political conversation, so it’s important we understand a few things.

Our President-elect has said he will work to repeal “Obamacare,” but at this point, the details are not clear. Will his replacement product be better than what it’s replacing?

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Freedom’s Last Stand

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We’ve been trading freedom for security.

One day at a time.

The former previously defined us—the “Land of the Free”—but apparently that’s less so, now.

They tell us we’ve dwindled down to being the 15th most free nation in the world.  Fourteen other countries provide their citizens more personal freedom.

There was a day when someone said if we lost freedom here, there would be no place to escape to. That we were the last stand on earth. But, our actions seem to suggest we find freedom to be over-rated.

*   *   *

Two things that are frequently misconstrued about healthcare came to my attention after reading a recent article by a writer I respect.

I don’t agree with this author on everything. Far from it. But, she comes across as someone you can discuss legitimate issues with—regardless of your point-of-view.

She’s a self-proclaimed Liberal, who apparently voted for Trump. (Seems she wasn’t the only one.) In her article, she provided healthcare advice to our next President.

My intent is not to refute it. Much of it, in fact, I agree with. But, I want to elaborate on two things that came to me after reading a quote in this article. I will examine the concept of (1) shopping for healthcare, and (2) how it relates to your life.

Here’s the quote:

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Business As Usual

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It’s business as usual at the office.

Another Fall season is here.

It’s time, once again, to sort through all the madness.

I wish it were “Midnight Madness.” Because, I like college basketball. That’s the name we give to the first formal practice of the season. The one where you get a glimpse of your local team’s talent.

Unfortunately, that’s not what I’m talking about at all. But, there are some similarities.

For example, the madness (I speak of) spans numerous midnights and deals with a practice—albeit a physician operated one.

My office is currently back at it again trying to figure out how we can continue to see Medicare patients. One day soon, we might just give up. But, if you are one of my Medicare patients, don’t call me in panic. Call your congress member instead. Click here if you don’t know who that is.

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What the *Beep*?

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“Beep,” went the machine.

I left a message and hung up.

My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.

I was leaving a message on his behalf.

You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers every day. It’s the system we’ve come to expect for both the extreme and the routine in our medical care.

Most of us dislike it.

But, we’ve been taught we can’t afford it any other way. The cruel paradox—of course—is that the majority of us are being out-priced by the status quo.

Mr. G’s medicine was working fine. It’s the only one of its type that he has tolerated without side effects. The insurance company covered it last year. They changed their mind about it this year. And, until we accept the logic that entrusting third parties to pay for our health might be harmful to our health, they will be the ones who keep getting to decide.

I was told I could appeal the decision waged upon Mr. G by getting in touch with a “doctor” working for the insurance company.

If you read that again, it’s an unbelievably humorous statement.

Physicians, scientists, and researchers are routinely condemned by the most virtuous of stone throwers for having even the slightest lean toward a conflict of interest. Yet, having me appeal your insurance case to someone who works for the insurance company remains noticeably absent from their aim.

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Evidence Based Medicine & The Art of Flipping Coins

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It’s become a major problem in our quest to obtain a perfect healthcare system.

It’s called science.

Now, don’t get me wrong. I have nothing against observation and experimentation. But, since blind pursuit of anything can lead to destruction, it’s time to take more notice.

To be fair, it’s not science, per se, we are talking about. It’s our interpretation of it—how we perceive its role to be within the framework of medicine.

I’ll begin with a simple illustration.

I will flip a coin 10 times. I will tabulate the number of instances the coin returns heads or tails. Then, I will repeat the experiment 10 more times.

In fact, here are the results:

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How Arbitrary Feels

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We are assembling too many panels of people in the name of health these days. Too many.

They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.

I might have been wrong.

There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.

I was wrong because the medical world is now full of panels. And, paradoxically, it seems more confusing and arbitrary than ever before.

Recently, I’ve taken some interest in economics. I thought I understood it before. That was when I didn’t understand it at all. I used to believe the goal was to create jobs, since jobs obviously drive the economy. I was almost on the right track. Until I realized I wasn’t tracking at all.

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