Sunday, July 26, 2009

My Preview Of The Public Plan....


I spent some time this past week attempting to get my life back to "normal" after two weeks of running around the East Coast with relatives from England.  It was great fun, but some tasks did get backed up a bit.  Among tasks put off was my Driver's License renewal.  No problem....every thing needed was near at hand, including a recently renewed Passport.  In addition, I was running low on a medical prescription, and I need to re-order.  No problem, I'd just call in the prescription for refill, and it would be mailed in a day or two.

Funny how things work out......

About two years ago, at the recomendation of some family members, and despite being covered by private health insurance, I requested and was approved for enrollment in the Veterans Affairs Health Care.  I figured that I'd try it out and see if it was worthwhile to be involved with a governmental agency - and one tied to the military at that.

My initial reaction when I got to the local V.A. clinic was an immediate flashback, and not a good one, to my days in the Army. A rigid appointment, queuing for a couple of hours up with a number, a non-bedside manner lab tech, very loud nurse-clerks bellowing out instructions, coupled with a number of hurry-up and wait go-here, go-there directions.  Five hours later, the first day was over, but I still had to wait for my next appointment to see my assigned "Team" doctor.  At that point my view wasn't too enthusiastic about the experience so far, but I decided to at least take the next step, meet with the doctor, and then determine if I'd continue to participate.

The doctor that I was assigned to, although very young, was very thorough.  She asked all the right questions,  and answered all my questions in a very professional and patient-respectful way. I was impressed.  At that time I had two current prescriptions and she agreed that they should be continued, but not with exactly the same medications, as the VA would not prescribe them. We'd have to change to generics.  No problem, the V.A. generics were less expensive, and if they didn't work as well as my existing prescriptions, I'd just switch back.  Since I had private medical health insurance, as well annual income level above a threshold level, I would also be responsible for a co-pay on any visits, procedures and medications delivered by the V.A.  No problem....

So, over the past two years, I continued seeing my original private medical group as well as the V.A. as I evaluated the V.A.'s performance.  After two years, I felt comfortable with the capability of most of the people in the V.A who I dealt with, and their relative efficiency of operation.  My only negative evaluations had to do with the structural limitations placed on clinic operations and the bureaucratic layers of decision making that were apparent, not only in the lack of freedom that the doctors had in determining their course of action, but in their ability to prescribe alternate medications, even if they agreed that the medication might be superior and patient was willing to pay the differential.

Despite those dissatisfactions, and since I really don't have any significant medical issues to deal with, I decided a month ago to simplify my life, cease participation with my private clinic, and just focus on working with the V.A.

Like many others during the past year or so, and especially the past few months, I've been following the discussions and arguments regarding the Health Care Bills being pushed through Congress with great interest. The major issue has been the Democrats call for a "Public Plan", and the reality that despite their claims to the contrary, their "Public Plan" would become our only Health Care plan. The major fear factors around that scenario seem to be the control over options regarding medical care alternatives, rationing of care based on bureaucratic cost control, and forced "equality" of care under their misguided perceptions that our Constitution's basis of equal opportunity somehow equates to forced equal treatment and outcomes.

Getting back to my initial goals for the week, I called the V.A automated prescription ordering service but after inputting my request, was informed by the machine that my prescription was not renewable.  No problem.  I called my V.A. team to request a contact with my doctor and a renewal of my prescription.  A call came back the next day from my doctor's nurse.  Oh, oh......there's a eligibility for V.A. Health Care had been cancelled.  "Sorry".  She didn't know why, "but here's a couple of numbers" in two other Florida cities that  may able able to help me.  OK, No problem....I'll call.

I called one number, left a message and waited.  No return call.  An hour later, I called another number and spoke with Shelly.  She couldn't tell me what happened, but thought it might have to do with my income, and suggested that I fill out a new form, fax it back to her, and directed me to the V.A web site.  Found the form, downloaded it, filled it out, and faxed it to Shelly.  Along the way, I filled in the same form on an eligibility  calculator on their web site, and voilà, it computed that I was eligible.

Next day, Shelly calls, tells me that I neglected to include my private health care costs, which should make my case even more positive, but then tells me that my net income from my business last year can't be a negative....she can't input that on her computer.  Meanwhile, I've been attempting to understand this model, where one year you're in, and the next year you're out.  I was a veteran, still a veteran, and I pay for any amounts not covered by my health care insurance.

Shelly can't figure out what to do next, so she provides me with a number to call in Virginia.  
"Good luck, and let me know what happens....."  

No problem.... I call the number in Virginia, turn on the speakerphone, and work on my PC.  A while later, I speak with David....a very nice guy.  We start from the beginning.  He looks up my records.  We talk about my income...he says based on the figures I provide to him, I'm not eligible. I tell him that he web site says I am...he says "can't be".  We both go to the web site...he fills the calculator in with my numbers....voilà, it computes that I'm eligible...he's the specialist....he's now confused.  We chat a little more....  Hmmm....  He's got to speak with some other people, he'll get back to me.

I don't wait for his call. I have a feeling this will take some time.  I leave for my appointment at my local Florida Motor Vehicle office to renew my license.  I'm feeling all my documents; passport, Social Security Card, V.A. picture identity card, utility bills, insurance card, vehicle registration card.....No Problem.

Get to Motor Vehicle office a little early and start the process with two people....the ofice manager and a new hire  he's training on their system.  No problem...  She gets my information, locates me in their system, starts me on the eye exam....the usual minor issue crops up.  I can't see out of one eye.  No problem.  Next step.....problem.  The manager informs me that I have a suspension existing on my license from NY State....??????  The National Records data base that was initiated after 9/11 by Homeland Security has gone live, so all the State Motor Vehicle Dept's are now linked.  Since I'm not aware of ever having any license suspension,in any State, I ask "What reason does the system give for saying I had a license suspension?"
"Can't tell you.  It doesn't give one.  You'll have to straighten this out and then come back. Sorry".  

The Florida DMV manager can't help me.  The system only tells him that I've got a standing license suspension in NY State.  But, he does give me a number to call in NY, and say's he'll put me to the head of the line when I come back, if I can get it straightened out.  

"Thanks.... No problem...I'll call them."

Hmmm....  Problem.  I remember what NY's DMV was like to deal with in person.  I can't imagine that it's become easier to do business with, especially via the phone.

I left NY State in 1993 to live in Europe, and terminated my residence in NY State in 1998 when I returned and moved to Florida.  I did register a new car in NY that I purchased in June of '98 when I returned, but re-registerd the car and exchanged my license for a Florida one in October of '98.  

It's only 4:20 PM when I get outside to my car.  I call NY....I'm in queue.... I hear the firm and distinctively New York voice of "Reggie"....NY State DMV.  I tell him that I'm trying to find out why NY has a suspension on my license.  He says with the tired disdain of someone who's heard this story before, "Don' worry...we'll tell you 'zactly why it was suspended....  Hold on".... silence.....I wait and watch the clock. Seems like hours, but it's only four minutes. Next contact comes on but I miss her name.  I start my story...she cuts me off..."Name?.....DOB?.....Last four of your Social?"  Wait.........

"You owe us $25 for having to send a notice of insurance suspension to you."  WHAT?......  I'll cut to the chase.  When I moved to Florida and re-registered my car, notified my insurance carrier of the change in residence, they notified NY State that my insurance in NY had been terminated.  Since I didn't mail my license plates back to NY (who knew?), they mailed a notice to me (at my old address in NY which the US Post Office was to have forwarded to my new address but evidently never did). 

"OK, OK.......I'll pay the $25....."  
"Hold on...I'll transfer you...."   Wait.........

"Hello NYS DMV"
"I liked to pay for an insurance suspension notification"
"That's $25"
"OK, can I pay it over the phone?"
"Yes, but it will cost you $5 additional, and it won't get processed until Monday anyway, and won't hit the National database for a few days after that.  Might as well do it online.  Got a PC?"  
"How many days will it take to update the National database?"
"Can't tell.....a's the website address, pay it on'l be better".

By now it's 5PM...the day's over...government offices on the East coast are closed.  Time to head home to a quiet, no-surprise dinner with my wife.  An hour and a half later, all has gone as wife and I are just finishing dinner.  My phone's David from the V.A. he's actually been working the 12PM to 8PM shift so he's still on duty.  He's got "Good News, bad news, and good news". 

Good news #1 seems to be that they figured out what was wrong with the web site that showed I was eligible, and they fixed it.  It will no longer compute I'm eligible. But he thanks me very much for pointing out the system error to them so that no one else would be confused.

Bad news is that I'm no longer eligible, despite the fact that the V.A. just recently upped the income eligibility levels by 10%.

Good News #2 is that I'm really still eligible because I had been enrolled previously under different eligibility factors.  He's got me back in the system.  I thank him warmly for his consideration in following this through for me, and request that he send me a letter attesting to that, he agrees.  We both part amiably and satisfied on a late Friday evening.

OK.......if you're still reading this narrative, let's see how my story relates to "Obamacare".  

It would be great hubris on my part if I were to attempt to pronounce a solution for improving our nation's health care system.  It's huge....American's spend about $2 Trillion on health care each year.  It's complex....with hundreds of thousands of suppliers, and hundreds of million participants.  Similarly, it's hubris on the part of the Democrats (and some Republicans) to think that they can re-architect this baby in mid flight and not have it crash.  No one experienced in any type of system change methodology would even contemplate such an act...unless they were an imbecile, or had another agenda.  So it's not my intention here to address what change should, or shouldn't be made to the system, but my past few days dealing with what could be considered a micro-model of government managed health care is very telling.

Everything in the story involves my interaction with Government agencies, the bureaucrats who staff them and make arbitrary and capricious decisions, as well as the hard working people (in many cases), who assiduously attempt to provide some measure of quality service for their customers (us) while maintaining some semblance of self-respect and dignity despite working in severely disfunctional bureaucracies.  

Regarding Health Care, fortunately at  this time, I still have a private health plan option where I can choose my doctor, my medications, and assert my individual preferences for treatment.  How long that freedom of choice will remain viable once a "Public Plan" is put in place is highly questionable.  The basic unequal playing field created by government subsidized health care is obvious; it's inevitable share of market size and focus on cost reduction will destroy the private health insurance options by causing health care providers to shift their losses from the lower paying government Public Plan to the private insurance carriers (as Medicaid currently does), and in doing so, it will cause ever increasing cost increases to be passed on to private insurance plans and individuals. 

As that happens and costs increase, employers will shift their health insurance for employees to the lower cost Public Plan in an attempt to maintain cost equity with their competitors.  When that happens, the profitability that fuels the innovation in U.S. medicine will cease, and the ramifications of that will be even more severe for the rest of the world, as they depend on the research, inventions, and innovation that is fueled by the medical industry's profitability in the U.S.  No advancement in health care.

The part of my story regarding my license suspension in NY causing my inability to renew my license in Florida, demonstrates how an advanced national information system designed to protect Americans from foriegn terrorists, has easily been transformed by cash strapped State governments into a system to hold hostage, and extract cash out of, even long-gone residents.  

Think about the power over your lives that bureaucrats will have when there's a National Health Database that includes everything about your health history, linked to a database of the IRS, linked to a database of State DMV's, linked to....well you can just imagine....  Your records, like mine, could be flagged by some unknown, unseen minion in a department far, far away from you, that will prevent you from being authorized a treatment, a medication, or even access to the system.  I was lucky. I was able to navigate through the system and straighten things out (maybe....we still haven't received the letter, or the renewed drivers license),  but we may not be so lucky down the road.  That's why it's important to stop this headlong rush to pass a Health Care won't be healthy for us.

It's interesting that many Democratic Socialist Party's of the world use a fist clutching a rose as an emblem.  It's supposed to symbolize labor and their struggle against material and spiritual poverty, but in reality it always becomes the iron-fisted hand of despotic Socialist governments squeezing the life out of it's citizens.  They don't start out with that intention.....but human nature being what it is, they just evolve that way.  The same result will face us if the Democrats and Obama are allowed to transform the most advanced medical system in the world, into their vision of equal medical care for all (Well almost all.  Like all apparatchiks, members of Congress keep themselves separate from the rest of the people they control). 


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