If you know me, you know I fight a few health battles. I’m an asthmatic with some major allergies. I take medications for that and other things. But for me, the biggest cost of my health care ALWAYS comes down to my knees.
(And before friends and family ask: This post comes out of the need to pass a health care reform bill. Not out of knee pain. Luckily I am reasonably pain free these days. I pray daily that continues to be the case.)
I grew fast when in middle school, so I have had a lifetime of knee problems. Because of that, I have taken medicines that don’t exist anymore, visited more surgeons than I can count, and (the biggie) have had a total of 8 knee surgeries so far.
Some of the surgeries were done because the doctor thought it best. I don’t mind surviving those surgeries. But two of the surgeries happened because insurance said “Take it slow. Do this first and then try the next step.”
In these two cases, surgeries were done on one knee because insurance defined them as “the thing to do.” When “the thing to do” didn’t work on one knee, the surgeon and I knew that it wouldn’t work on the other knee either. BUT, he couldn’t just move on to the next level for both knees. He had to do “the thing to do” on the second knee, wait for it to fail, then get approval to do the next step for both knees.
Another side to this: He wasn’t ever allowed to do surgery on both knees at once. Insurance said, “Let’s see if fixing one fixes the problem enough for her to not need surgery on the other.” That wasn’t ever going to be the case, but… That’s the insurance industry.
All of that is well and good. It happened, it will happen again. Surviving the surgeries isn’t the only cost here, though.
A decade later, I still know I need replacements. When? Who knows. Research now says that doing them earlier may be better. (See this Johns Hopkins piece for some of the research results.) But now, the replacements I need are risky surgeries. Because of the work done to my knees already, I can’t have standard replacements.
And therein lies the hidden cost:
Because of the way insurance required my knees to be worked on in the past, I have to pay for a more experienced surgeon any time I need my knees looked at.
Most surgeon’s won’t even look at my knees. I am too great of a risk. The last time I needed to find an orthopedist, it took multiple referrals before my primary care doc could even find someone who would look at the knees.
When one does look at them, they can’t just do what they think is best. They have to prove to insurance that “everything has been done” to fix the problem. So, another round of PT gets added to my regular exercises. Another new round of drugs gets added to see if that will slow the degeneration and the pain. Another round of x-rays, MRIs, , scopes, etc. are done to make sure that “Yup, the problems are still there. And, yup, they are still there in both knees.”
All of that costs me money and time. Costs you money too. Because I am the kind of patient that raises your insurance rates. If insurance companies took a longer term view of patient care, the costs would be lower. The steps insurance companies take are usually done to keep short therm costs down and delay long term costs in the hope that the patient will be under someone else’s plan before the condition gets critical again.
Before you all jump on me for recommending doctor’s jump medically necessary tests, therapy, etc., please know: I am not against medically necessary treatment. BUT I want my doctor and I to decide, not my insurance company. It’s my body. I know how bad the pain is or isn’t. I don’t even mention the pain level until it is off the charts. I don’t ask for a referral until it is beyond medically necessary. If I go, it is because there is a problem. And it shouldn’t have to be that way.
Insurance should be there to help cover the costs of things that the doctor says are needed. Not there to tell the doctor how to treat me or when to treat me.
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Bruce
March 21, 2010 at 2:59 pm (UTC -7) Link to this comment
Rusty,
Socialism is only a word. Both purely Socialistic and capitalistic societies are unworkable. We need to have a balance between them.
Pure Socialism removes any incentive or opportunity for advancement.
Pure Capitalism eventually results in feudalism. Those with the money and control make slaves of everyone else. There are many examples of this in history. But people stop it either gradually or abruptly.
Your link just states that we are becoming socialistic and that this is the ultimate badness. There are also lots of unfounded claims and predictions of doom.
The US swings back and forth between capitalism and socialism. There is no reason to panic. We need more government for some things and less for others. Yes, some policies have become more socialistic since FDR, but many things have also been privatized. Just look at the current level of freedom on the internet.
I would rather have the government involved with how my health care is paid for than corporations who have an incentive to simply not pay. I have personal experience with insurance companies acting irrationally.
CallKathy
March 21, 2010 at 2:06 pm (UTC -7) Link to this comment
Thanks for the link, Rusty. While you and I disagree on the politics of this issue, I appreciate that you stopped by and took the time to express your view.
rusty
March 21, 2010 at 2:00 pm (UTC -7) Link to this comment
http://unitedstatesofscamerica.blogspot.com/2010/03/distress.html
what medicine can help an osteo-arthritis patient specially suffering from knee pains? | Treating Arthritis
March 21, 2010 at 7:49 pm (UTC -7) Link to this comment
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March 21, 2010 at 5:59 pm (UTC -7) Link to this comment
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