A story about our broken health care system.


We have a broken health care system. People can’t get the help they need, and the broken parts don’t communicate with each other – as witness this story.

A woman, married and with a child, got pregnant. Her family’s income was about the median for her county, which made her eligible for Medicaid as a result of her pregnancy. Unfortunately, she miscarried. There followed several months of unexplained abdominal pains. Doctors and specialists were unable to diagnose them. They told her if she was in pain, go to the ER, which she did about a dozen times over six months. The ER, of course, treated the pain but did no diagnostics. They told her to go back to her primary care doctor for diagnosis. But neither the primary care doctor nor the specialists were able to identify a cause for her pain.

Then one day, a PA in the ER flagged her as a possible drug seeker because of her frequent visits. As a result, Medicaid put her on restriction, which means that only her primary care doctor can prescribe for her, and she can’t see any other doctor without a referral, and she can only get her prescriptions filled at one pharmacy (Walmart).

Here’s the fun part: her doctor told her to get a flu shot. Medicaid covers flu shots. However, Walmart doesn’t offer them, and since she is restricted to one pharmacy, she was unable to get one that was covered by her insurance.

Then there’s even more fun: she got pregnant again. She’s allowed to see an OB/GYN, because her primary care doctor referred her. But the OB is not allowed to prescribe for her, nor refer her to any other specialists. For that, she has to go back to her primary care doctor. The average wait time for an appointment is ten days. Ten days, when a woman is pregnant, can make the difference between a healthy baby and a miscarriage.

Her nine-year-old son was also eligible for Medicaid, until the family bought a $2,000 car. Medicaid determined that the car was actually worth $4,000, which put the family over the $3,500 limit for personal assets. That disqualified the son from Medicaid. There is no appeal over the value of a vehicle – they use a table that overrules both actual and market price.

I think Medicaid is a great program. But our system is so flawed that it doesn’t work for many people.

Question doctors. Their advice isn’t always correct or safe


A few years ago I was gardening and got some dirt in my eye. It got infected so I went to a doctor and told him what happened. They said, “That’s impossible, we see no sign of it,” and wanted to put me on highly toxic IV antibiotics for a month for some rare and much more serious disease. I refused, took the eye drops that were appropriate for dirt in the eye, and got better quickly.

Another time I was eating a pill and it stuck halfway down and dissolved while stuck to the side of my esophagus. After a couple of weeks of esophagus pain I went to a doctor to see what he could do to help. He literally refused to consider the possibility that a pill had stuck to my esophagus, told me I had a serious chronic disease, and instructed me to take four times the recommended dose of a nasty med for the rest of my life. I thought about that for a few days and then gave him the heaviest verbal thrashing one human being can give another. So I refused the meds and got better in another week, which is normal for a pill stuck in the esophagus.

Then there was the time I was due for surgery. They said take a certain antibiotic the day before. When I got home from the pharmacy I noticed, at the top of the instruction sheet, in capital letters, “WARNING: THIS MEDICATION CAN CAUSE PERMANENT HEARING LOSS.” I called up the surgeon and said, “I’m a professional musician by avocation as well as vocation; I would rather die without surgery than live as a deaf musician.” He said, “No problem.” It turned out there was another perfectly safe antibiotic I could take but they hadn’t thought about that.

The obvious conclusion? Question all health care providers, especially the ones who do not listen to the patient! Many years ago I studied and then practiced acupuncture, and was an active part of the alternative healthcare community in both Vermont and California from about 1977 to 1990. But I met so many untrained incompetent egotistical under-educated anti-scientific quacks that I became ashamed to be an alternative medical practitioner, closed my clinical practice, and went back to full time music.

Fresh, local, organic vegetarian food and nonstop music is my health care now, and if I absolutely have to go to a doctor, you can be very sure I ask a lot of questions and argue with many of the answers. We are in the dark ages of health care; it is a science that has not really been discovered yet. Be careful, my friends.

We need comprehensive health care for all

Our health care system is so broken that people who desperately need medical help may not be able to get it.

My blogging here has bee a bit irregular lately. That’s because we’ve been preparing for my wife Sue to have cornea transplant surgery. She has Fuch’s Dystrophy, which clouds the cornea and eventually leads to blindness. They did her left eye yesterday and the operation is a success. Sue says she can see much better out of that eye now, just 24 hours later.

The operation is done by peeling the bottom two layers off the cornea, replacing it with the donor cornea, then holding it in place with an air bubble. Amazingly, this is an out patient procedure. Sue had to lie on her back for 18 hours afterwards to give the new cornea time to bind to the eye. Thus, we took turns watching her at night to insure she didn’t roll over.

Sue designed this foam pillow to insure she didn’t mover her head in the first 18 hours. Her retired engineer father assembled it!

Recuperation will take about two weeks. We are fortunate in that Sue works for the government so we have good insurance. But what’s happens to people who have no insurance? A friend of hers called last night to see how Sue was doing and mentioned she has scoliosis, is in terrible pain, and needs a custom brace. But Medicare doesn’t cover it and she can’t afford the several thousand it will cost.

It is just wrong that a prosperous nation like ours has such substandard health care that our friend must suffer in increasing pain.

Health care: sparrows and cardboard boxes

Birds. Sparrows feeding in a park, ca 1920-1950. Theodor Horydczak (Library of Congress Prints and Photographs Division Washington, D.C.)

Several years ago I sat next to a Frenchman on a flight from Paris to Washington DC. He stated that his country considered access to health care a human right and asked why my country didn’t provide it to its citizens.

Two years ago we got a watered-down version officially known as the Affordable Care Act (ACA).

Now we have people kneeling in the street in front of the Supreme Court Building praying that the ACA will be overturned.

Which reminds me of one of my very favorite quotes about the American polity from commenter Davis X Machina at Balloon Juice–it’s now enshrined in the Lexicon:

“The salient fact of American politics is that there are fifty to seventy million voters each of who will volunteer to live, with his family, in a cardboard box under an overpass, and cook sparrows on an old curtain rod, if someone would only guarantee that the black, gay, Hispanic, liberal, whatever, in the next box over doesn’t even have a curtain rod, or a sparrow to put on it.”

Or health care either.

Specialty MDs turn away most children with public insurance

Sixty-six percent of publicly-insured children were unable to get a doctor’s appointment for medical conditions requiring outpatient specialty care including diabetes and seizures, while children with identical symptoms and private insurance were turned away only 11 percent of the time, according to an audit study of specialty physician practices in Cook County, IL.

“We found disturbing disparities in specialty physicians’ willingness to provide outpatient care for children with public insurance — even those with urgent and severe health problems. This study shows a failure to care for our most vulnerable children” said a study author.

Reimbursement amounts, incentives, and the mission of the health care provider are major factors, with reimbursements being key. It takes a long time for the government to pay and it often doesn’t pay as much as private insurance, plus the paperwork can be onerous.

Many doctors now are getting squeezed by insurance companies and the government. I know of one MD who despite his best efforts to manage insurance and having one employee who did it full time, was recently forced to join a group practice where they have several people who do nothing but insurance. A while back, my obstetrician cousin shut down her practice when her malpractice insurance jumped from $60,000 to $200,000 a year.

Our medical system is broken. Private insurance is difficult enough for doctors to manage. Public insurance is even worse and it pays less. Thus it’s no surprise, if disheartening, that MDs don’t want to take public insurance patients. There may be a class issue here too. If a child is on public insurance then the parents are probably on welfare and doctors may not want to deal with them. What a mess.