Sunday, May 5, 2013

The Elephant In The Room..................

When I talk about downsized budgets and living on a fixed income, I discuss an awfully lot of things. I talk about my living situation, utilities, hobbies, travel, you name it. The item I rarely discuss in my posts is health care or it's costs. It is, in away, the elephant in the room.

 I tend to avoid this discussion both because I understand that there is a wide spectrum of opinions on the subject and because I realized I am blessed in my health care situation. While my health care is not free, I will continue paying the same premiums (family or single) as I did when my husband was living.  In other words, I have "really good" health insurance. No cobra, no self pay. I pay two hundred dollars a month for a family insurance policy, and would be one hundred dollars a month without my college student. Yes, believe me, I do know.

Even with what most would consider reasonable, good, health insurance, I recently had some serious sticker shock. As a matter of fact I was completely appalled and alarmed. This was the first time I had been seen in the United States in an emergency or hospital situation and I was unprepared for the result. Some of you may remember my stress attack before the holidays when I was trying to get my house ready to sell. I am so completely laid back and unfamiliar with stress (grief yes, stress no) that I did not recognize the systems and identified them as a possible heart attack. Once I was in the hospital that was ruled out before I got comfortable, but you know how it is. Tests to be sure, stress tests because one is over fifty and over weight.  The end result is that for less than two days of hospital care, my billed cost was $19000.  Yes, you read correctly. Ten percent of which is my cost.

That is almost exactly the same billed amount as my husband's care for his entire cancer experience in Germany!  That care included multiple hospital stays.  It included surgery, radiology, chemotherapy, and two experimental chemo procedures. His care included more morphine patches than I care to think about now, as well as hospice care and in home nursing care. He was treated by the chief of the Frankfurt University Oncology department, and had a private room most of the time. We are NOT part of the German government system, but outside users who paid and then were reimbursed by our insurance company.

To me the problem is less about who pays, or even who manages. The problem is one of covering EVERYONE and keeping costs at bay. Eventually we all pay, whether we call it a tax, mandatory insurance or some other made up name. The difference in cost was not paid for by some mythical agency somewhere. We paid the entire cost of all of our care, when we were billed. As a result of costs like this, the German health care system had almost a six billion dollar surplus in 2012-that's a lot of medical care and research money with which to invest.

NO health care system is perfect, Lord knows. In Germany there are people who get private insurance on top of government insurance. There are certainly some things done in other countries including Germany that we would consider infringing on our rights or, heaven knows, "socialism" (an economic principle, not a governing one). In Germany, every working person below a certain pay grade has a flat percentage of his or her income put into the health care pot, as do self employed persons. People who make more can opt into the government system, or get private insurance. Long term care contributions are mandatory (gasp). In theory, some folks would consider these mandatory payments a tax, I know.  The Germans decided otherwise, and do so on a regular basis. 

While I don't know all of the cost cutting measures in Germany, I do know some of the huge differences. I expect that if we want to get past current costs, we are going to have to get past our fear of government and go with the flow. To me, some of these are common sense solutions are below-along with a couple basic rights issue that we need to get past in this country: 
  • In Germany the employer does not get to decide whether you deserve health insurance, and as the other side of that coin, you are free to work less than forty hours doing manual labor, knowing that you have coverage. For the record, German employers HAVE to provide accident insurance to all. 
  • To the employers benefit and overall cost reduction, the employer does not have a "health care" administrator or administrators. as part of their staff. The money is taken and sent to the managing agency. Employers don't have open season staff or persons whose job is to keep records or contact medical agencies
  • When I went in the hospital I took my own medications and used them. The nurses just noted what they were and how often I took them. A doctor did not have to be called for an antacid. I was also able to bring my own food or have it brought from home as long as I was not on a special diet.
  • Except for post surgical open back gowns, I was EXPECTED to bring my own towel and shower supplies. No little basket with goodies that I was charged for later.
  • There is a whole different level of malpractice insurance and attendant costs. This one is probably worth a page in itself.
  • Charges and fees for many things, including physician payments, are controlled. This does not mean there are no millionaire doctors, I went to one....just that the fees charged are based on education, skill, medical journal writing and a whole host of other factors. There is a consortium which include physicians groups who adjust fees annually.
  • While there are exceptions, seeing a specialist is not dependent on making an appointment with your GP first-and insurance approval prior to the visit is not necessary.  It is assumed that I am an intelligent person, and if I decide I want to make an appointment with an ortho doctor to have shots in my knees that is fine. The same with the actually injection. No one is paid to contact the insurance company and see if I qualify or am approved for treatment.
  • Most doctors are hospital doctors or office doctors, not both. No prestige difference, just a choice in how you want to work. There are some areas in this country where that is changing as well, from what I have seen since my return.. Hospital doctors do not need to keep outside practices or staff. I went to a Gyn, who referred me to a hospital Gyn for my D and C. My husband saw the chief of the Oncology department at Frankfurt university all during his illness-always in the hospital.
  • Because everyone receives care and is allowed to take off work to get care, the emergency staff only deals with true emergencies. When I first moved to Germany I dropped the loose, heavy, wooden piece of a bakers rack shelf on my finger (don't ask, I thought it was attached). There were no small children with runny noses or fevers, no illness that obviously should have been taken care of at the doctor's office. Just crushed fingers, broken bones and worse.
  • Self care and responsibility, along with  what I guess one would call traditional methods are encouraged-for lack of a better expression. In other words, before you go to the doctor for a cough and sore throat you should have tried tea with lemon, vitamin c and staying in bed for a day. And antibiotics are prescribed as a last resort. I was prescribed knee massage long before I took drugs for arthritis (and still do it)
  • If you are sick, you are expected to stay home. Period. From school, from work. If you have to ask if you are contagious you probably are (except when you have my annual seal bark). Your doctor will give you a note if required and it is sacrosanct
  • Most importantly, a huge amount of the bloated paperwork issue is put aside. In Germany, my health care card had a chip on it. After treatment by any doctor, new information would be added. Any doctor could look at my medical history on the chip. The chances of missing a conflicting treatment were almost none. No medical records clerks sitting in the hospital basement, or piles of files.
Some of these adjustments would be easy, some would be difficult. Some would offend some Americans ideas of "privacy". At some point though, in my opinion, we are going to have to make similar changes or costs are going to be out of control.  Oh, and you'll notice one other thing. There is no mention of insurers-other than the lack of them-above.  I wonder if all the folks who are so afraid of government management really think the insurance folks are doing some great job now?

A month ago, I went and had a mammogram-at a place I have had it for the last five years. I had to fill out paperwork for five minutes (including saying that I had a living will at home, acknowledging my financial responsibility and who knows what else.  The next day I had to go back for a sonogram followup. I had to fill out the exact same paperwork as I had done before, less than twenty four hours later. The last breast exam I had in Germany included a mammogram and a sonogram. All I did was make my appointment and take my medical card.  The billed cost was less than one fourth-and did not include separate bills for hospital, Xray, and the doctor reading the Xray

Which way makes more sense, I wonder?


  1. Ahh Barb. I am so glad that I live in Canada when I hear about medical costs down in the United States.

    We did buy more coverage, but that was mostly for drug, eye, and dental costs. Our hospital and doctor costs are covered by our national system.

    God bless.

    1. Yes, I also have to buy dental surgery and eye surgery separately. However, I dont have the option of drug insurance here, as I know!

  2. I've had socialized medicine for 30 years - through the
    Army. My daughter is having her first child outside of the military and has no idea how much they will owe in the end.
    We are given simple meds for flu and such- with the pharmacist saying wether we should head into the clinic or not.
    My files have been digitized for years.
    While in the hospital in Hong Kong my family was expected to bring my food- and my favorite pillow. They felt family helps the person feel better.
    It works. I agree.
    I cannot understand the mess we are in. I hope it gets better before I get old and am no longer able to use Army health (because Medicare is soooo much better).

    1. Yes, my experience is that for the most part the army medical system weems to work well. I remember when the medical pharmacy even had things like dimetapp so those things were offered less in the PX/Commissary.

      does the army work like my insurance..paying the part after medicare?

  3. An excellent, well-written overview of the mess we are in, largely by our own choosing, and how other countries apply common sense to a common problem.

    Our present system could only be developed by a combination of bureaucrats and a for-profit health care model. I'm afraid only when it totally collapses, after untold bankruptcies and unnecessary deaths, will we allow ourselves to move to what must happen.

    FYI, if it had been me with my policy, my cost would have been around $6,000.

    1. Oh, I know how lucky I am to have ten percent copys. I don't know how those of you with self pay policies or cobra manage.

  4. What an interesting post. We seldom get the facts on other countries' medical systems (except the oft-repeated warnings of "socialism".) Thanks for taking the time to describe your experiences.

    Oh, and by the way, I agree--do we really fear the government more than insurance companies? Obviously some folks have had a way better experience with their insurers than I have! I pay them a small fortune and they treat me like the enemy. Only in that marketplace could they get away with that!

    1. Yep' and sometimes it jyst deoends on which person you deal consistency at all.

  5. I have an HMO and all my records are digitized. It's very convenient for all the docs and also for me.

    I agree on the costs, though. We have a bizarre system here in the US.

  6. I live in Australia, and here we have free healthcare to ALL.If you are on the low income
    you do not pay for anything drugs,therapy etc.
    One can have private health insurance it is tax deductable.
    Love your blog Brab

    1. Thanks for visiting! I assume your system is funded by taxes so I suppose not free, but still a system we could learn something from.
      We seem to be the only moidern country weith these medical issues.

  7. GREAT post Barb. If it weren't for the health care elephant, I would be planning to retire 2-4 years earlier than I am. I will be retirement-eligible at 58, with better terms at 60, but can't even think of retiring that early due to the $1500 plus per month to continue my family's health insurance which we have through my work. As it is, I have to budget $60,000 in health insurance just for the three years between my anticipated retirement at 62 and medicare and because my husband is younger than me the total will be much higher. It is a HUGE problem. I couldn't agree with you more that when one looks around at health care in all the other industrialized countries, it is hard to believe that THIS is the system we choose.

    1. This problem will get bigger I think, and is hard for those folks forced into early retirement.

  8. As a retired nurse and medical office manager I can attest to the craziness of our nation's health care system.You could pay $20,000 for your DandC or you could end up pwying 50,000.A crap shoot. The way Obamacare is set up, well, I suppose we need a first step, but I expect chaos in January--as insurance are not ready and congress has not given money for the development of IT infrastructure to support this HUGE CHANGE in how anerican gets health care.

    Several of my extended family memebrs have lost jobs due to employers cutting staff due to new insurance regulations.

    I have NO IDEA what Ken and I will have to pay for our policy in 2014..we do not have group insurance and have always chosen high deductibles and an HSA. The kind of plan we now have is not going to be be allowed under Obamacare.

    Luckily we do not live far form Mexico--but how sad to have to think this way!!!!!!!

    1. Hubby and I used to discuss retiring in Germany at least semi seriously.Even with the dollar to Euro rate and additional taxes we felt we would have come out ahead because of the medical system.Here's to medical tourism.

  9. Yes we pay taxes for free healt insurance but it is not much at all.
    If you senior or low income there is no levy

    from our taxation department
    Medicare is the scheme that gives Australian residents access to health care. To help fund the scheme, most taxpayers pay a Medicare levy of 1.5% of their taxable income.

    We will work out your Medicare levy, including any Medicare levy reduction, from the information you provide on your tax return.

    If you want to work out your Medicare levy, you can use the Medicare levy calculator.

    Reduction for people on low incomes

    Your Medicare levy is reduced if your income is below a certain threshold and in some cases you may not have to pay the levy at all. The thresholds are higher for seniors. If your income is above the thresholds, you may still qualify for a reduction based on your family taxable income.

  10. Medical care in the US is atrocious. Of course if you have fabulous insurance the care itself is pretty good but if you don't have insurance (or a high percentage you need to pay) you are screwed (and often bankrupted). So sad. Having exceptionally good, nearly free, health insurance is one of the major reasons we were able to retire on a small, fixed income.

  11. Hi Barb Sandy from NZ here. I have just started reading my way through your blog. Greetings to you. I am always amazed and saddened at the amount of time, energy, money, and angst that your health system causes for your average american. It seems endlessly worrying. In NZ we have universal free public hospital care and for under 6year olds Dr visits are free. (Well it's not free it comes out of our quite high taxes) A prescription is normally $5.00 unless it is a non subsidised drug and that would be more expensive. You can choose to pay for private healthcare if you wish through an insurer and you get a percentage of your fees back for things like Dr visits, prescriptions, specialist visits and mammograms etc. Also you would expect to get your procedure/operation done earlier if carried out privately. The public system (free) is not without problems of course. For non urgent procedures the wait can be lengthy but for acute care it is fantastic and immediate. Also cancer care comes under the public system so is free. Of course there is not enough money for all the bells and whistles that Drs and the public would like and it takes a huge amount of government expenditure. Also dentistry is not free or subsidised so that can be costly but I do feel very fortunate to live here and not have to worry about any healthcare costs for me or my family.

  12. Australias system sounds similar to Germanys, we pay a levy via out taxes, it's not perfect but people get seen for free in emergency departments the disadvantaged are taken care of in general.
    I am often horrified by the stories I read about Americas lack of health care - that any modern country could treat their own people that way is just completely beyond my understanding.


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