Thursday, August 6, 2015

Scrubs Enlightenment RE: Health Care & Politics

As I’ve mentioned before, I’ve been on a bit of a Scrubs binge on Netflix. 

That show is SO good! Although I enjoyed watching it 10 years ago when it first came on, re-watching it from the beginning has been even better, because I am old and can now relate to more late-twenty-something issues. 

Yes, it’s a fictional comedy, but man, it can hit you right in the feels some times.
Last night, it really made me think.

It was an episode in early Season 8 (with Courtney Cox as a guest star) where JD and Elliott were treating a guy pretending to have MS so that he could get the prescription drugs for his daughter who ACTUALLY has MS, because she didn’t have health insurance. In the end, the doctors were convicted (by their consciences, not the law) and willing to put their careers on the line by knowingly prescribing a healthy patient with MS drugs. Happy Ending. 

This show originally aired before “Obama Care” came onto the scene; this was a fictional portrayal of a very real issue. Statistics show that about 129 million Americans (something like 50% of the US) have what the insurance world calls “pre-existing conditions.” These conditions include, but are not limited to: cancer, diabetes, heart disease, mental illness, arthritis and many, many others. 

This is not to say that half of America is uninsured—in fact about 85% of Americans were insured even before Obama Care came into effect—but it does mean that prior to 2014, insurance plans and insurers were routinely denying coverage and/or treatment to these people or charging them much higher rates to obtain and maintain coverage. 

Superficially, this makes sense. People with conditions that cost money are a bigger risk to companies insuring them, and thus, should be charged more for coverage. People with bad driving histories pay more for car insurance. People who drive expensive cars pay more for car insurance. Duh.

But, then again, we’re comparing apples to oranges. 

Comparing conscious choices: 

·         Which car do I want?
·         Do I want to pay attention to the rules of the road?
·         Do I allow myself to be a distracted driver or a cautious and respectful one?
·         Do I have a lead foot?
·         Do I want to drink and drive? (if so, you’re an asshole) 

With luck of the draw:

·         Does cancer, heart disease, mental illness, etc. run in my family?
·         Does my job put me under a lot of physical or mental stress?
·         Does my body just not want to cooperate with me?

Now before you start arguing with me in your own head (A La John Dorian, MD), I know some of the questions that come up:

·         But what about FAT people?! Can’t they just start living a healthier lifestyle? This would/could reduce so many instances of high blood pressure, heart disease and arthritis. 

·         If your job is so mentally/physically demanding, why not just QUIT and find a new one?!

I reply:

1.    Fat people need health insurance too. Just because they LOOK heavier than you think a healthy person should look, that doesn’t mean they aren’t eating well and exercising. There are people who don’t take care of themselves as well as they should, but there are also people who suffer from OTHER conditions that exacerbate weight issues, such as thyroid and other hormone issues, polycystic ovary syndrome, etc. There are slim people who appear fit, yet eat fast food every day. Genetic luck of the draw. There are also people who work 2 and 3 jobs to support their families and have little time or money to get in the shape society requires of them to be deemed healthy.

I’ll tell you right now that in college, I gained something like 30 pounds. I was not obese, but I was teetering on that fine BMI** line that tells you what your fat person health risks are. Suddenly I had gone from a thin, busy, college student who could eat whatever she wanted whenever she wanted and not gain a pound, to someone who’s metabolism stepped back and was like, I’m gonna let all that pizza catch up to you.

**I don’t hold much stock in the BMI index anyway, but that’s another story.

I have since gotten myself into a healthier lifestyle that includes lots of plant based foods, yoga, and walking, blah blah blah. I lost a lot of the weight and feel better, but I also won’t be turning down the occasional ice cream or bacon cheese burger.

However, had anyone presented me with the choice of putting down my pizza or paying more for health insurance because being overweight was riskier for my provider, I would have punched them in the throat with my fist that wasn’t holding pizza.  

2.    Please, continue to elaborate on how easy it is to find a good paying job these days that offers good benefits. For many people, it’s about sacrifice and survival. They work long hours, sometimes doing grueling or menial work to provide for their families. The end. 

I did a lot of research over the past year or two to better understand all of this. Most recently, this past winter when it was finally my turn to take on the task of figuring out what was the best insurance to purchase for my husband and I and what could we afford. 

Curious about the hot button topic that is “Obama Care”, I scoured for as much information I could find, on both liberal and conservative sides (trying to see different points of views and find pros and cons) as well as any sites that CLAIMED to be fact finders and truth checkers. 

Obviously, it sounds good to say that the Affordable Care Act (ACA) could potentially positively affect half of our countries population. As I mentioned earlier, about 85% of Americans currently have health insurance. Out of the remaining 15%, most conservative sites say that only about 1 million of them would truly be turned away because of a pre-existing condition if they were to try to acquire health insurance. 

I cite that “low ball” number (although liberals would say this number is much higher), because I know that seems insignificant. Personally, thinking that ONE MILLION PEOPLE in the most developed country in the world CAN’T GET MEDICAL HELP without the possibility of going bankrupt seems like a REALLY BIG DEAL. More significant. 

Concerning the rest of the already-insured people, if they contracted on of these aforementioned health conditions while they had coverage, they would get treated. However, if they lost coverage for some reason (loss of a job, divorce, etc.) and then had to try to get NEW insurance—TA DA—they now have a pre-existing condition.

The ACA also did away with Lifetime Benefit Caps. Many of us have never had to pay attention to these caps, because we’re fortunate enough not to get sick with some of the nastier, more expensive diseases out there, but it basically means, although you’re paying for an insurance plan and you are covered, the insurance company will only pay up to a set amount of money for LIFE. In many cases, this means if your treatments reach this max dollar amount, you are no longer covered and the rest of your treatment bills fall on you. 

This is how so many cancer patients end up having to decide if they can afford some of the newest or best treatments. This is why insured citizens still end up under mountains of debt— dealing with that stress on top of a debilitating illness. 

Even for people who don’t have cancer, but suffer from other chronic illnesses, the insurance co-pays alone can hurt. $15 per visit (for good plans) weekly or biweekly adds up. It’s like a whole new bill! 

Maybe, with serious reform, our health care system will stop allowing the pharmaceutical industry to reap OBSCENE amounts of profit from sick people—cancer patients in particular. Perhaps, if cancer stopped being such a cash cow for doctors and drug producers, it might actually incentivize a cure. 

This is one of my favorite John Oliver segments about big pharma:

And THIS is a disgusting story about a doctor who lied to his patients so that he could send them for cancer treatment in order to make more money off of them:

I’m sure this doctor is not the first or last to pull this sickening stunt. When the opportunity for doctors to profit from prescribing unnecessary treatment ceases to exist, then perhaps they will stop pandering to pharmaceutical reps, insurance companies, and lobbyists and focus on what’s best for their patients

For a country with so much (power, knowledge, wealth), it seems we can be seriously lacking in compassion, common sense, and moral compass.

The USA currently ranks 37th in the World Health Organization’s list of the World’s Health Systems:

USA can’t chant WE’RE NUMBER ONE about this. 

Even if these stats are not 100% accurate (bias is unavoidable and there are A LOT of factors to consider), we don’t even make the TOP 10. 

Here’s another list comparing the US to 11 similar countries:

We’re dead last. Shouldn’t be surprising, but it also costs the most here for some of the worst care among the top developed countries. 

If you want to drive fast in your big, fancy car—it’s on you if your insurance costs are through the roof. Take the bus; ride a bike; get a Prius! Those are all of your choices

No one chooses to get cancer. Don’t blame cigarettes or bad eating habits. 
 Yes—they’re not great for you. But I know too many healthy people who eat right, work out, never smoke and STILL get sick to let that argument stand in the way of reform. I don’t know why this stuff happens, and I probably never will, but it sucks. 

I have been fortunate to have health insurance for as much of my life as I remember. Before the full ACA mandatory enrollment period came up, I was in college and health care was the last thing on my mind. I didn’t even realize that the reason I was still able to mooch off of my mom’s health insurance for so long was because the ACA required plans and issuers that offered dependent coverage in their plans to make that coverage available until the dependent (child. me) reached the age of 26. 

A LOT of my friends took advantage of that new insurance requirement without even realizing how helpful it was! I stayed under my mom’s insurance until I got married (4 months before my 26th birthday) and that was a lifesaver. Often, with family insurance plans, it doesn’t cost any more if you’ve got one or 5 dependents on the plan. So, I was saving my own money by not having to buy insurance so soon after college, and my mom wasn’t financially affected by me staying on her plan (since I’m the oldest of 4 kids who were all still on it). It was funny to hear a lot of my very conservative friends rail against “Obama Care” while they were lucky enough to be reaping its early benefits. 

I’m not saying the Affordable Care Act is perfect, but it really is a step in the right direction—even if you think everything proposed sucks—it’s a conversation starter and an acknowledgement that our system is in need of serious improvement. 

I’m aware that this is not news. It wasn’t news to me last night…but for some reason, it was never in the forefront of my brain—most likely because I had insurance for most of my awareness years. (Although before I remember understanding co-pays and coverage, I know we did go through a time where we were at the mercy of charity care organizations and Medicaid. My mom got a job working for the county, which opened up a door for good health benefit options. Many people aren’t that fortunate, and while some would call it a blessing, my mom still works really hard for a modest salary, because of the health insurance benefit.) 

I don’t know why Scrubs was the final straw or why it hit me so hard. The light bulb went off, and I laid awake for much of the night thinking how horrible it must be for the people who have to find “illegal” ways to get the medical care and drugs they need because insurance won’t help them. How could health care and quality of life not be a basic human right in a country like ours? I thought about hard-working people I know who have to buy their antibiotics from Canada, because they don’t have insurance and can’t afford to go to the doctor. 

Change seems to be so difficult in our country. So many bureaucratic hoops to jump through. And almost ALL of the officials, politicians, lobbyists, presidents, and CEOs in power are privileged and wealthy. You can’t even get to hire levels of government without millions of dollars to spend on a campaign behind you. All this money, and yet there are citizens who can’t get quality health care. 

Here are some articles that give you an idea of what the average congress-person’s benefits and salary package looks like. And yes—they all have the option to obtain federal insurance.

Scrubs made me realize that this situation can be as serious and ridiculous as it comes across on screen. 

It also got me thinking about how infinitesimal I am. Although sometimes I get discouraged thinking that my vote has to get through a political swamp of money and power and lobbyists to matter, I still have to do it. This is the first step to having an opinion and hoping to effect change. Vote. Vote. Vote.

And for heaven’s sake. BE INFORMED. And I don’t mean turn on your one favorite news channel every day or share some stupid bumper stickers on social media. 

I have made it my mission to cast a completely thoughtful and thoroughly informed vote for the upcoming Presidential election. I appreciate any advice on quality news sources or political forums. I am determined to learn about every single candidate and weigh the options as well as the outcomes that could accompany them. 

Although I work in government, I’m not nearly as politically savvy as I could or should be. I had to Google the pros and cons of free vs. fair trade and research off-shore drilling. I swing back and forth on some issues, because sometimes I feel like I could be a VERY liberal Republican or a conservative Democrat. (Don’t get me started on the ridiculousness of the 2 parties in general or the fact that everyone on social media seems to LOOOOOVE the independents, and yet they never get voted in.) 

Growing up, almost everyone I associated with voted for the same party. It was not even a question. It almost seemed like it didn’t matter WHO was running, as long as you check the right box. My first few voting experiences followed suit. Then I got really cynical and stopped voting for a bit altogether. 

Whoever you vote for, please do so with conviction. Not because your friends or parents or pastor or media tell you to vote that way. 

This year, I’ve decided to vote for the candidate who is serious about addressing the health care system, equality for women, and the environment. I decided that right now they are most important issues to me (and in my opinion, very important for everyone living here in our country and, in regards to the environment, on earth).

I Googled “Quizzes to help you figure out who to vote for” at one point, and took a few. My results surprised me because they were all very similar to each other and contrary to my prior voting habits. 

With so many candidates right now, it helps to get a better understanding of who’s who. 

If you’re interested, this one was my favorite, and seemed to be one of the most in depth and easiest to use (best website set up):

Although I really dislike Fox news and laugh at the thought that some people consider Megan Kelly to be a trusted news source, I will be watching the Republican debate tonight. If anything, it will be a conversation starter for the rest of the week with friends and coworkers, and conversations (if respectful) can often lead to new perspectives.

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