Are You Covered?

Reaching for the Sky?

Are You Covered?

The other day, Aimee and I met a couple of dear friends at our favorite coffeehouse. These two delightful people, who share with Aimee the affliction of Type 1 diabetes, struggle with a variety of conditions that are directly related to having diabetes long term. All three of these wonder women have had the condition for over 40 years. We both love to get together with “Margot” and “Hayley,” because they are just fun to be with and have great attitudes despite being chained to blood sugar control for 4 decades. As we chatted, and the conversation turned toward Medicare and “health care?” coverage, it slowly dawned on me that here is the seed of my next blog.

“Margot” was about to transition from private medical insurance to Medicare. She recently qualified for disability, which made her eligible for Medicare coverage. She and her husband began to explain the convoluted coverage plans that would soon take effect, providing Margot with prescription medication, doctor visits, even hospitalization, if needed. The amounts they discussed seemed astronomical to us. Over the course of a year, the Medicare plan would pay up to $3000 for prescriptions. If the amounts exceeded $10,000, it would start paying any amount that exceeded that limit, leaving a “hole” of around $7000 uncovered! Margot’s husband also carefully explained how the Medicare coverage would be saving them greatly from their previous private coverage, which was a monthly premium over $1400. Our other friend, Hayley, recently went through a three-year marriage and divorce which, in her words, gave her full medical coverage. As she put it, “I gave up three years of my life so I could get health care insurance.”

I grew quiet as the stark contrast before me became apparent. Here was Aimee, who had eschewed doctors and insurance for well over thirty years. She has always opted for being her own doctor, choosing to research health and healing and following her own prescription for managing her diabetes. The other two, for all their wonderful qualities, had always been medical “insiders,” relying on doctor visits, doctor’s recommendations, “proven” dietary plans and insulin regimens, and all the latest technology to manage their diabetes. Both had fairly severe complications, including some blindness, nerve damage, heart disease, surgery, all fairly routine scenarios for long term diabetics. Aimee, on the other hand, rarely visited any type of doctor, used the lowest tech tools for glucose management (syringes, vials of insulin, a simple glucose meter) and relied on strict dietary protocols that she researched herself through reading and the Internet. Yet she had virtually no diabetic complications. No heart disease, no nerve damage, no eye damage, very little skeletal damage, and only a hand condition that her father had that is aggravated by diabetes. This is not coincidence.

We totaled the amount of money she spent on diabetes management each month: around $50! This wouldn’t even approach the deductible or the copay for most insurance plans. Here in this microcosmic coffee house scene was the playing out of the great American drama—for all the exorbitant money spent on so-called health care, personal, individual responsibility for one’s health far exceeds all the embarrassingly expensive high-tech, pharmaceutical driven, corporate fixes that are only made possible by “Health?” Insurance. When an individual has to rely on their own creativity, both economically and spiritually, they are empowered to create health. Yet when they surrender that power to well-intentioned “providers” who have very limited resources, the results are nearly always a predictable downward health spiral. (I’m reminded of the wise phrase: When all you have is a hammer, every problem looks like a nail!) When surgery and pharmacy and MRI and CAT scan are all you have, everything looks like a candidate for surgery or a prescription. There is no deep understanding of the energetic systems behind human health. And of course there is no example of excellent health held up as a model to aspire toward. It is simply cut, burn, medicate, with very little thought for tomorrow’s consequences.

Some time later, Aimee and I saw Hayley again at the coffee house. I told her I talked about her in my latest blog. She was excited about this and was very forthcoming with her thoughts. When I told her what I was writing about, she said, “It’s a game, and I’m locked in the game. I don’t want to be a player, but I am a player. I have to get prescriptions, but I don’t need them [I think she means the doctors]. But they’ve got me now.” Wow!

I’m fond of saying, “everything is a trade-off.” By trading personal empowerment for “security,” many of us have completely given up the ability to control our own lives, particularly our health. Even the insurance scheme, which initially proposed a relatively low monthly insurance premium in exchange for the comfort of knowing unexpected medical exigencies would be covered, has taken a dark turn. As costs have spiraled upward, and corporate insurance bean counters look to deepen bottom lines, “health?” insurance has become virtually unaffordable for most people. It even dictates career choices, leading many to follow their “heads” over their “hearts” for fear they will be left as uninsured medical “pariahs.” An entire population is shaking in their boots over the catastrophic medical scenario that will wipe out their life savings. Yet, the reality is, despite coverage, many are left hanging out to dry by the insurance companies who hide behind a host of riders and pre-existing exemptions to avoid paying up. So a Catch-22 of enormous magnitude now darkens the skies over Medical America, as citizens quake with fear of being without coverage, then hope that, if disaster strikes, the whimsical insurers will follow through. If it weren’t so sad, it might be funny.

Still to be addressed is the spiraling costs of “health?” care. How did we go from a scenario where most people paid out of pocket for medical treatment as recently as the 1960’s and 1970’s to the astronomical costs facing even the simplest procedures today. I decided to look at the common diagnostic procedure of an MRI (Magnetic Resonance Imaging). I came across this statement on a website (http://wiki.answers.com/Q/What_the_average_cost_of_an_MRI_of_the_lumbar_spine) from someone who experienced the convoluted pricing system that faces today’s patient:

“I recently had a lumbar spine MRI with and without contrast. My insurance company was charged $4,307 plus an additional $700+ for the radiologist’s fee. When I saw the bill, I laughed thinking there must have been a mistake. Nevertheless, the insurance company actually approved $2,500 of the charges. I’ve had several other MRIs in the past which cost anywhere from $500 to $1750, including the radiologist’s report. Since receiving the bill, I called some local imaging clinics whose charges range from $500 to $600 for a cash-pay lumbar spine MRI with and without contrast including the films and the radiologist’s report. 

My conclusion is there is no such thing as an ‘average cost’ for a lumbar spine MRI. The cost is whatever the clinic wants to charge. Unfortunately, the doctor who orders the MRI usually sends you to the MRI clinic associated with his practice and he has no idea of the cost. And the patient usually trusts the doctor and doesn’t bother asking the price ahead of time or shopping around. That was what happened in my case, and now I know why insurance premiums are so high. The moral: always shop around..”.

My massage therapist, who is from Thailand, said it’s very popular for Americans to visit Thailand on a kind of “MRI Vacation.” There the cost of an MRI is around $300. So Americans, who may be forced to pay several thousand dollars out of pocket for one, take a vacation to Thailand with doctor’s orders for an MRI. They’re able to pay for an airplane ticket, take a mini-Thai vacation, get the MRI, and often pocket a few hundred dollars saved in the bargain.

Where would medical costs be if they had been allowed to rise naturally with patient needs, scientific advancement, doctors’ ethical cautions? Without the insurance scheme/scam, would pharmaceuticals be so aggressively marketed with little regard for efficacy or long term impact on health? Would giant hospitals, filled with multi-million dollar high-tech equipment that must be used in order to be paid for, be dominating the cityscape of nearly every community across the Western world? When is the last time you drove by a hospital that was not either under construction or proposing the new addition of a wing devoted to this or that condition? And how about the physicians’ offices that surround the megalith like satellite moons invisibly tethered to a giant, lumbering planet? All of this is only possible by the clever insurance scheme that now dictates the behavior of the entire population of planet earth. Play our game and we’ll take care of you (maybe, if it suits our bottom line). Opt out and you’re on your own, left to care for you and yours using just your own resources and your wit. Actually, this could be the best choice.

As I mentioned in my previous blog, Aimee and I are reading the book, Gut and Psychology Syndrome, by Doctor Natasha Campbell-McBride. (Ever noticed how those of us critical of the medical establishment trot out the “Doctor” moniker when it’s needed to lend credibility to our argument?) She came from deep inside the system as a neurosurgeon to become perhaps the world’s leading authority on the relationship of gut health to overall health, especially as it relates to mental health and all things neurological. It’s a compelling argument, backed up both by research, clinical practice, and personal experience with her son, who was autistic. Like so many “breakthroughs” in health, this one began as a search by a loving parent to free her child from the dungeon of autism. As she began this personal journey, she uncovered principles of universal human health that she then began to implement in her own practice. Hundreds of cases later, her personal discoveries were confirmed as patient after patient showed remarkable responses to her “radical” treatments of dietary changes that led to the elimination of confounding diseases that modern science had no answer for. Of course all of this falls outside of the medical holy trinity of doctor/pharmacy/insurance that sucks fearful patients into its web and won’t let them go unless and until they break out and discover there is another world of treatment available to them.

Here’s how Dr. Campbell-McBride puts it in her chapter on the treatment of epilepsy:

“The way the health system is structured, the parents are locked into repeat appointments, where the child has to visit their epilepsy treatment team every few months to review the drug prescription. If the parents do not turn up for appointments, or do not administer the drug to the child, they feel they will get into trouble with the authorities.” p. 78

When we walk through the doors into the halls of the holy trinity, we surrender much of our power to decide for ourselves what the keys to true health are. A caveat is in order here. I am not saying the individuals who work within this system are sinister in either motive or action. Quite the contrary. I know many who do, and they are kind, compassionate, loving souls who give their hearts and minds to the cause that they serve, that being the health and well-being of the patient. And if I am carried in on a gurney after an accident or such, I have no doubt that the treatment I receive will be of the highest and most professional available. The intentions or the actions of individuals within the “health?” care system are not the objects of my complaints. It is rather the paradigm that enables the unsuspecting patient, weakening their ability to care for themselves, in much the same way a well-intentioned parent weakens their own child or children by “caring” for them even into adulthood instead of allowing them to care for themselves—even if that involves stepping back as they crash into themselves and their choices on the journey to maturity. When we trade in our creativity and sovereignty for the “security” of “health?” care, we give up the divine mandate to create our own world and stand on our own spiritual legs.