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You’re Fired!

September 2, 2013

Weight LossFat HealthDiet Talk

This marks my third entry in the try-out.  I’d like to thank everyone for reading and Shannon for finding such great images to pair with my writing.  With that, we’re off…

Mitt Romney took a lot of flak when he said, “I like being able to fire people who provide services to me.” The full context from that speech can be found here. It wasn’t a one-off line where he gleefully expresses his desire to imitate Donald Trump. He was speaking about health insurance, a topic we all care about.

Trump and Romney

The Firing Squad

Romney pointed out that people tend to change jobs approximately every 3.5 years.  With health insurance tied to employment, you’re typically under any given policy for a few years. He argued that with health insurance coverage being short term, there wasn’t much incentive for the insurance company to keep you healthy.  Instead, they give you a few years’ grief and then you’re some other plan’s problem. Rand Paul and others have advocated for decoupling health insurance from employment, as it was prior to World War II, and selling it in a manner similar to life insurance. Instead of buying into a plan for the duration of your employment, you’d be buying into a plan on the order of decades. Romney’s argument was that insurance companies would have to work harder to get and keep your business. It also meant that you would be able to fire an unsatisfactory service provider.

Some of the worst medical care I’ve received has come when I had no choice, and no ability to fire the provider. During one three-year interval, I picked an HMO as my insurance provider. For reasons I still can’t figure out, they decided to assign me a primary care physician who was nowhere near me and definitely not my first choice. If I wanted to see a doctor closer to home, I’d get no say in who I saw. If I wanted to change primary care physicians, I’d have to go down to the office of the current one in person and fill out forms. They also kept very short hours, which made this an extremely impractical solution. Appointments often resulted in lectures about my impending death from high blood pressure and diabetes, the result of a failure to read my chart that showed risk of neither. Doctors’ offices make me nervous and my blood pressure reacts accordingly. It’s always lower at the end of the appointment than the beginning, but sometimes you’ve got to work really hard to convince the nurse to take a second reading when the fear and anger are diminished. And, of course, all ailments, whether pneumonia, dysmenorrhea, or a sinus infection, can be cured by weight loss.

At work, we’re required to undergo physicals every year. Once again, there is no choice in the doctor. He is a horrible person and a bad doctor. In his distorted eyes, everybody is fat. I could weigh 100 lbs. and he’d still tell me I’m verging on obesity. As an actual obese person, he has a field day with me. He must think my employers are blind because he feels the need to point out my appearance in every aspect of his report. Can I see in color? Fat. Is my hearing OK?  Fat. Did I contract tuberculosis? Fat. Mercifully, I still show no signs of high blood pressure, diabetes, or high cholesterol. I can only imagine the glee in his report if I did. In years past, he’s just shocked that I can touch my toes. This year, stretching that far makes my legs cramp. I’m sure he’ll enjoy mentioning that in his report. When I was showing classic symptoms of undertreated hypothyroidism, he failed to mention that I was taking thyroid medication, determined my thyroid was working fine by feeling up my lymph nodes and failing to correctly interpret the bloodwork, and suggested that my symptoms were actually the result of stress and/or depression… because of my fat. I can’t fire him and failure to comply will result in my firing.

The more bad providers I’ve encountered, the more I’ve been looking for ways to increase my choices and have the ability to fire bad providers faster. One alternative I’ve found was eHealthInsurance. I didn’t like the dental plan offerings through work because they offered coverage I didn’t need and the premiums were too high. An eHealthInsurance search matched me to a policy I’ve carried privately for the past several years at the price and coverage level I want. But what about cutting out the insurance company? Thanks to Walmart’s introduction of the $4 per month and $9 per 3 months generic drug pricing scheme, their competitors followed suit. When I needed antibiotics and painkillers after some dental procedures, I found I could do much better paying cash at an outside pharmacy than going through my HMO’s pharmacy. Lab work I’ve had done is valued at thousands of dollars, yet the negotiated rate with the insurance company is in the hundreds of dollars. How low can it go if the middle man is removed?

Another alternative I haven’t tried yet is the concierge medical model. Under that, you pay your physician an annual or monthly retainer for unlimited services. Without the time spent dealing with insurance companies, the doctor has more time to practice medicine. It also means not having to wait on authorization for treatment or a third party determining the amount of treatment you need. My endocrinologist utilizes a no-insurance practice model and he’s been one of the most accessible doctors I’ve seen and also one of the most thorough. Come to think of it, my dentist also utilizes a non-standard model in that you only pay for the first office visit. I suspect that he makes his money through cosmetic procedures. It’s been great to go in when I thought I broke a filling and I wasn’t charged to find out it’s still intact.

The more choices we get in our healthcare, the better it will be. When the elements of choice are removed, there is no incentive to provide good service. If your insurance company knows you’re not going to fire them, then what motivation do they have to keep their costs down? If your physician knows you’re stuck with her, why does she need to listen to her patients?  I’m not famous enough to wind up on the evening news, but guess what? I like being able to fire people too.

21 Comments leave one →
  1. vesta44 permalink
    September 2, 2013 10:29 am

    This! Being able to fire someone who isn’t giving us the service we deserve is vital, especially in the medical realm. I’m lucky that I have TriCare and Medicare, and all of the doctors at the clinic I go to take both of them.
    Four years ago, when I was fighting with Dr W over my severely enlarged thyroid and the fact that her prescription of The Nightmare on ELMM Street was NOT going to make me weigh less, I was able to fire her. I sent her a letter telling her that she was no longer my physician, and spelling out the many reasons why (it was 2 pages long, typed and printed out in Word).
    I finally found another doctor at the same clinic (here in town) and after a couple of semi-heated exchanges, he’s left my weight out of the discussion when I come in with a problem or question. I told him up front that my weight was not a topic for discussion unless I gained or lost a large amount in a short period of time, and that I would have no problem firing him and looking for another doctor if I didn’t get the same treatment that a thinner person with my problems got. Dr D has actually been pretty good, and I’m satisfied with him, but I think being able to fire him and seek out a new doctor, and the fact that he knows I’m not afraid to do so, is a big factor in that.

    • gingeroid permalink
      September 2, 2013 10:48 am

      Diagnosing from the scale helps nobody. Fat people stop going to the doctor because it’s a waste of money to be told you’re a crazy, fat, liar any time you have a problem. Skinny people get screwed over because those awful fat people diseases like diabetes are overlooked. I don’t see these practices changing until more people are wiling and able to fire their physicians for such negligence.

  2. September 13, 2013 9:55 am

    I couldn’t disagree more about your central argument, that the private market leads to competition leads to lower costs. That’s the central argument of supply side economics, and perhaps it works in certain industries at first, but what we’ve witnessed in practice since deregulation came into fashion with Reagan is that markets tend to devour themselves in a Darwinian economic free-for-all. Mergers and acquisitions are the real game for major companies, and wiping out the competition and cornering the market to increase the profit share is the goal. A perfect example is airlines: once deregulated, was there more competition, more diversity, lower prices? No. It became Mergerfest and arilines couldn’t keep up with unregulated costs and began declaring bankruptcy.

    The United States is the only country with this kind of private healthcare system. And when it comes to obesity, countries like Canada are actually responding better to the situation than Americans are (as we’ve written here and here, although Brittain has certainly gone off the deep end. But with a private market where profits are the main motivator for all healthcare decisions, we see more partnering with weight loss companies, which becomes profitable for both the healthcare company and the weight loss company, and both promote weight loss as the cure-all for diseases.

    So, I’m not a fan of private healthcare in the least. I think the solution is a single-payer system because costs then become the main driver, the motivating factor for choosing treatments. The government is motivated to find evidence-based solutions, and if private markets weren’t interfering with public healthcare, they would find that paying for weight loss is not cost-effective and it doesn’t produce the outcomes desired, while promoting health and wellness to all Americans does. But if there’s one thing we’ve learned from the American healthcare system, it’s that healthcare profiteering leads to worse outcomes, not better.


    • Elizabeth permalink
      September 13, 2013 10:29 am

      Thank you, thank you, thank you! I compared this post to Jenincanada’s, and knew what system I would prefer to live under. As far as supply and demand does, I remember Robert Klein’s statement: We have all the supply so we can demand whatever the fuck we want.

      While we’re talking about Romney, the plan he foisted upon Massachusetts was the brainchild of the Heritage Foundation. This is the blueprint for Obama’s health insurance industry care plan; the Heritage Foundation has since reversed course on a plan of their own devising.

      Everyone I know who finally qualifies for Medicare has been so happy despite Medicare’s imperfections. MEDICARE FOR ALL!

      • gingeroid permalink
        September 16, 2013 10:22 am

        Medicare is horrible. The government is behind on reimbursements, the amount being paid is getting less and less, and more and more physicians refuse to take Medicare patients for this reason. There’s only so much volunteer work they can do and stay open. In fact, some practitioners are advising that young people find cardiologists, oncologists, gerontologists, etc. now so that they’re a patient pre-Medicare. It’s no guarantee of treatment once on Medicare, but at least your odds are better. Some anecdotes:

        I watched the quality of my mother’s healthcare take a nosedive when she switched over to Medicare. She carried a very similar plan pre- and post- Medicare. Only now it’s a battle to get anyone to treat her. She goes to the dentist for a cleaning and they’ll floss her teeth and send her on her way. Apparently that’s the “cleaning” a Medicare patient is eligible to receive. Sure her doctor’s office will call here every week to demand a colonoscopy, but what she really needs is to have the integrity of her reconstructed foot checked out. For her to get an x-ray to check the placement of the screws, she had to see a physician’s assistant who couldn’t do anything, come back to see a physician who couldn’t do anything but could make the referral to a podiatrist, and then see the podiatrist who told her that the problem was her weight. Then she had to start over again to get a referral to a different podiatrist.

        One of the guys in my support group summed up my opposition to Medicare quite well. It cost him $70/year to manage his condition pre-Medicare. With Medicare, it costs him $760/year to manage his condition.

        I want to see an opt-out option at the very least. Quit taking my money now and let me manage my insurance in the future. I know how impossible it is to end entitlements so I would also be happy with a voucher system. If you feel the government run system is the best way to manage your coverage, then by all means apply your voucher to them. If not, you’ll have more options.

        • Elizabeth permalink
          September 16, 2013 1:15 pm

          Improve Medicare, don’t put it down. Medicare does not cover dental work of any sort; Medicare does not cover basic eyecare. IMPROVE MEDICARE. At least Canadians and Brits who bitch about their health care systems have the sense to see that going the American route is not the solution, IMPROVING their systems is the solution.

          • gingeroid permalink
            September 16, 2013 2:16 pm

            If a person chooses a Part C policy, some providers offer dental coverage. You’ve suggested improvement 3 times. My idea of improvement involves a voucher system, which I bet isn’t yours. What would you do to improve the system?

    • gingeroid permalink
      September 16, 2013 10:13 am

      Remember the state of “evidence-based” medicine right now. Most of us here are “proven” to be noncompliant (i.e. the doctor has told us for years to lose weight and we come in bigger and bigger), more expensive, and sicker. It’s hard enough finding a doctor who doesn’t follow that practice now. When you add in additional parties pushing that narrative, I predict it’ll get worse.

      Ultimately, it comes down to one question. Who do you think knows what’s best for you? Yourself? Yourself and your doctor? Yourself, your doctor, and your insurer? Yourself, your doctor, your insurer, and unelected bureaucrats? I like to keep the number of parties involved as small as possible.

  3. September 13, 2013 11:48 am

    In Canada, there’s also the option of purchasing additional private insurance if you wish to and can afford it. (Apparently private insurers still find it advantageous to do business there, despite their extreme hostility to public healthcare getting a foothold on U.S. soil.) But single-payer should be the first option available to all Americans, not that thing way down the road (ie- Modern day Medicare) that’s only doled out in certain very limited circumstances.

    • Elizabeth permalink
      September 14, 2013 1:30 pm

      I’m sorry, but I don’t understand your last sentence. All my friends who got to age 65 qualified for Medicare; I am disabled and have Medicare Plan A (hospitalization), but not Plan B, because I would have to pay for it and we’re already paying for insurance for me through my husband’s job. Medicare for All is extending Medicare to all Americans, not just those over 65 or disabled.

      • September 14, 2013 6:50 pm

        Elizabeth, I wasn’t talking about the desire to expand Medicare so that everyone receives coverage, I’m talking about Medicare as it exists now. I’m 47 years old. So while I approve of the program, I’m SOL so far as accessing it personally. 18 years is a long time and who knows what could happen between now and then.

        I did a little work locally several years ago to try and get single-payer passed in OR during a ballot measure drive. Of course it was pounded into the ground thanks to truckloads of money from private insurers and Big Pharma. Oh, and let’s not forget local labor unions (including the one I was in at the time) openly opposing it because… uh, because they were a bunch of short-sighted dicks, basically. Local Democrats are now making friendly noises about single-payer, despite their near-total lack of interest back when it was on the ballot. I guess it’s easy to stand up and look concerned when you know “the bill has no chance of passage this season.” [rolleyes]

        One major reason that I joined the Pacific Green Party was because I wanted to support a political party that actually had a demand for national health care in its platform.

        • Elizabeth permalink
          September 15, 2013 12:44 pm

          So sorry to hear about the failed single-payer effort in Oregon. We’re trying to get something going here in Maine, but we have to get rid of our horrifying governor (the one who makes the national news so everyone can laugh) first. That’s terrible that the unions opposed the measure, and like you I’m suspicious of Democrats. I’m glad the Pacific Greens support national health care because a number of years ago Green Party people here didn’t seem very enthusiastic (“Why should I have to pay for health care for people who eat too much ice cream?” Oh puh-leeeez).

          • gingeroid permalink
            September 16, 2013 10:37 am

            Third parties FTW! I’d love to see more of them gaining ground to further pressure the D’s and R’s. It always makes me smile to see the establishment politicians getting angry about alternative points of view.

            While single payer is definitely not my preference, I do support the right of each state to make the decision for themselves. Should my state go single-payer, I can always go to one that isn’t that way. Conversely, people could move to a state with a single-payer system if that’s what they desire. Good luck with your campaigns.

            • September 21, 2013 2:13 pm

              Ironic that my “big fat” response is going to end up crammed in a super-skinny column. :p Yes, thanks, gingeroid. I have my differences with libertarians, but I would support to my dying day the right to improved ballot access and media coverage for all of us on the so-called “fringe” of traditional politics.

          • September 21, 2013 2:10 pm

            Yup. I’m sorry to say that even the “sensitive” Lefty crowd is subject to the same anti-fat boorishness you can find pretty much everywhere else on the net. I recently took an, uh… hopefully extended hiatus from one such space for that very reason.

    • gingeroid permalink
      September 16, 2013 10:30 am

      There is also the option of medical tourism. When I was living in Alaska, I was surprised at the number of Canadians heading to Seattle for procedures. A big weakness of single-payer is the wait times. Free whatever does you no good if you can’t get it in a timely fashion. Sure you can have all the painkillers and cortisone shots at no cost while waiting for knee surgery, but wouldn’t you rather go directly to the knee surgery? Those who could afford it went outside the system.

      For me, the question is how many people I want involved in managing my health. I like to keep that number as small as possible and limited to people of my choosing. The more parties invited in (insurers, bureaucrats, etc.), the harder it is to maintain patient autonomy in my experience.

      • Elizabeth permalink
        September 16, 2013 1:19 pm

        gingeroid, I had two surgeries that were unnecessary but which I was advised to have at the time. When I told my disability lawyer that I had insurance both times, he wasn’t in the least surprised. I had knee surgery, and waiting is always the best option; I now have a nicely chopped-up knee, including problems where there were none. Over and over again, it has been shown that anyone with serious problems in Canada does not have to wait, but people with elective surgeries sometimes do. And, no, I am not going to move to another state because they have something I like and Maine doesn’t. I love where I live, for all its problems, I am attached to where I live, I do not subscribe to the corporate model that none of us should have any attachment to locality.

        • gingeroid permalink
          September 16, 2013 2:24 pm

          One of the great things about structuring our country with a heavy emphasis on states rights is that you could, theoretically, have 50 different ways of doing things. People can choose to go to the states whose laws best reflect them, to push for legislation in their home state that’s similar to legislation in the state they like, or to stay put. I am almost always an advocate of personal choice. Just because you can do something doesn’t mean you have to. I fail to see how that has anything to do with a corporate model. Personally, there are states I’ve lived in that I felt more attuned to and states that I felt less attuned to and the latter states I usually try to leave.

      • September 16, 2013 2:43 pm

        Medical tourism requires money.

        • September 21, 2013 2:22 pm

          As does a wholesale move from one state to another, often enough. :/

  4. Elizabeth permalink
    September 16, 2013 3:21 pm

    gingeroid, it was a policy of corporations, beginning in the postwar period, to move their personnel constantly so they would not become part of the communities they lived in, become committed to those communities.

    How would I improve Medicare? First, it should cover all parts of the body and it should cover women equally. Dental care and eye care — not just eye surgery — are absolutely necessary for good health. There should be prescription drug coverage, and not to benefit Big Pharma but to benefit Medicare recipients. I think 80 percent coverage is insufficient; I believe jenincanada saw not one single bill from her gallbladder surgery. Right now, many procedures overwhelmingly used by men are covered and services that women are more likely to need are not covered. I do not believe these things are not possible in a country spending over $1 trillion on a fighter jet that the Pentagon does not even want.

    Maybe it’s because I live in the state with the oldest population in the country, but I have yet to meet a doctor who does not take Medicare. And every single person I’ve known who has had health insurance at their jobs has been delighted to get Medicare when they turned 65. Why shouldn’t the United States, instead of being behind the rest of the industrialized world, be a world leader when it comes to national health care?

    And, thank you, Cara Mia, for your comment.

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