For those who don’t know, I have sleeping problems that surround an overactive brain and narrow breathing passages which gives me extreme fatigue and general extra assholery for an attitude. In short, unless I am using a sleep machine I never get the sleep that a regular fully functioning person gets. Up until a year ago I didn’t even know I had this problem so when I found out it was the eye opener. I thought everybody was as tired as I was, I never knew any different. So it really sent me for a loop to realize something I had accepted as the norm was bad. especially when I was told that if I didn’t do something about it, by the time I’m 70ish I will have lost most of my coherent mind. Actually pretty scary to me because I view my single most defining characteristic to be my mind, whether it actually is will be an entirely different discussion. Not to be thwarted and be a debbie downer, as long as I do what I need to do I will be okay.
Now you are up to speed.
Went to my doctor and after almost a year of using the machine, I’m still not where I need to be. I need to take medicine. I’m not overly excited about being dependent on a pill to function, but I will do what I have to do in order to be better. I get the prescription and zip on over to my neighborhood Walgreens where I am then told my insurance doesn’t cover it. Then I made the horrible mistake of asking how much would it cost out-of-pocket out right. The answer will give me nightmares for years to come. It will be 5k a month to take the medicine I need to be a normal functioning person.
I can’t do that.
My alternatives are taking a less effective medication that has around a 10% success rate or amphetamines with a high rate of success and addiction with a large chance my insurance also won’t cover it.
I know I know, people have way worse issues than what I am going through. I shouldn’t complain, I really shouldn’t. My step dad is going through kidney dialysis and that is about 10000000000000 times worse than my ordeal. It just blows my mind how convoluted the system has become.
We have businesses treating healthcare like a piggy bank, inflating middlemen to increase profits and bogging progress down with so much bureaucratic nonsense that if the public was actually aware of the goings on of the industry there would be riots tomorrow. My doctor told me that for most HMOs, the owning business for most medical companies takes 20% of my pay before I even park my ass in the chair at the doctor’s room. Now I cannot confirm the accuracy of his statement, I don’t have access that sort of information but I think it does warrant a moment’s pause and thought.
Lets just follow the money. This is my understanding of how it works. I’m sure parts are wrong so feel free to correct me on them.
You pay an insurance company X amount of money in case something happens to you or you need some sort of medical assistance (pills, tests, whatever) and they spread the cost across you and the other group members. Believe it or not, that is socialism – but that isn’t on point. It is a business so they want you to pay as much as possible with them paying as little as possible. So insert rules to protect their money like limiting the extent of treatment or medicine you can have depending on circumstances like pre-existing conditions and if there is any chance at alternatives. But remember, at some point insurance has to do something else the government gets really upset.
You go to the doctor and charges you a price set on many factors; his expertise, years in practice, size of practice, relationship with medical companies and/or insurance companies, malpractice insurance, general overhead and labor for his staff, etc. Sometimes though, if the doctor (or hospital) realizes that you have very good insurance, they might bolster your treatments to get that little extra money out of your insurance company.
The more money that gets pulled out of the insurance company, the less for profit, which means the more you will have to pay to make up the difference from some other person’s medical needs. After all businesses exist to make money.
Some medical problems are sooooo damned expensive because the treatment is soooo damned hard to do or specialized that insurance companies say no, which kind of goes hand in hand with pre-existing conditions. This isn’t really a problem anymore with the new health care bills, the FY has just been spread out a little more.
Step in the Government. They tell everybody how to do everything. Some of the regulation helps protect you as a consumer/business, some of it hurts you as a consumer/business. Really depends on where you stand in the equation. The game of any politician is to run for office, get elected, and stay in office as long as possible. So sometimes governments threaten or pass deals that might hurt businesses, so we begin some lobbying to contribute to the campaigning of the politician. Now that politician might care somewhere deep inside about your healthcare, but ultimately they only care more about staying in office. You aren’t giving them funds for campaigning, so you don’t really get the say in how their deals go do. Remember, corporations are people, and the supreme court decided that money equals speech, so business that throw the most money at politicians have the loudest voice. I seriously doubt major corporations sit around and think about what they can do to help out the average worker, I’m betting board meetings surround the concept of maximizing profits – at least that is what experience has taught me.
But lets say that the government sneaks a beneficial bill in and it gets passed. Think about that.
The more the government tells people to do things. The more work people have to do the more money it costs,cause time = money. This works across the board but mostly for the businesses. Like telling pharmaceutical companies they cannot use bleach to kill AIDS. Although bleach kills AIDS, it also kills you in the process.
Drug companies also get to patent their work. After years and years or research and the risk of getting their pants sued off of them because a side effect includes monkeys flying out of your ass to cure depression, these companies can patent a drug for 10 to 17 years depending on when the drug hit the market. That means they can charge a price they set for the drug, and because no other company is allowed to use the formula they have no direct competition – usually….
So when you run to the store to get a drug that you need to be a normal functioning citizen, you can get slapped by the insurance company saying no go cheaper or pay the 5k out of your pocket.
The insurance can tell you no on things specifically if there is even remotely a chance that something might work, percentage of 1 is included.
I am just frustrated and needed to vent. I do feel better.
BTW if you quote any of that for any sort of truth without checking the facts, I question your intelligence whether I’m right about it or not. I don’t claim to know or understand the entire system, this is just what I have been able to pick up on and read about.