IF YOU WORK THE SYSTEM, THE SYSTEM WORKS

In the last post, I said I'd tell you about someone who found out the system isn't as broken as we might think. Here goes:

Several years ago, I had an acquaintance who had serious health problems, no education, no job, not much going for her. She was a severe diabetic and couldn't have held a steady job if she had found one. When she was feeling up to it, she cleaned motel rooms for minimum wage.

She would run out of her glucose monitoring strips, and out of insulin, and her blood sugar would rise to life-threatening levels. At that point, she would appear in the ED at the hospital where I work, and would usually go into ICU for a couple of days, then another week or so in general care. During the last phase, she would attend classes in our diabetic clinic and would be sent home with a supply of strips and insulin.

Since this hospital receives no government assistance, it does not provide ongoing free care. The care she was given during her admissions was not intended to be free, but she would be admitted nevertheless, because that's the law. She was ill, and could not be turned away. She was admitted, with the hospital knowing full well they would eat the bill. The end result of all this was a bill totaling over $200,000. She volunteered this information to me one day, so that's how I know.

I asked her if she had ever considered going to Parkland's free diabetic clinic. She replied that she called once, but they gave her an appointment about six months down the line, and she got sick and went to our hospital before that time arrived. She said she would like to get in the clinic, but just couldn't wait that long.

I suggested to her that she wait until she knew her sugar was rising, then pack a lunch and a good book and go to Parkland's ED. I told her she would have to wait, but it would be worth it, because that would put her on the fast track for their clinic. I could tell she wasn't buying it, so I dragged out some bigger guns. I told her that many hospitals were struggling financially because of unpaid bills like hers, and that if it continued, there might come a day when we would no longer be there for her! She said she'd think about it.

Well, just under a year later, I encountered her one day and she was just joyful, gave me a big hug and thanked me over and over. It seems she had followed my suggestion, and went to Parkland's ED one morning. She waited all day, but was finally seen in the late evening. They treated her rising sugar levels on the spot (not severe enough for hospitalization), gave her strips and insulin, and made an appointment for her for the next week with the diabetic clinic. Through the clinic, she was given strips and insulin as needed, she received laser surgery on her diabetes-damaged eyes which halted the advancing damage, her ulcerated feet were treated and healed, and she was put on medication to help her neuropathy. She had a hot-button number to call if she was in distress.

Naturally, she was just elated, and for the first time, had real hope. Because Parkland is tax-supported, they can offer these things. She just needed to position herself to receive them.

The point here is simple. Healthcare is available, if you do your part first. Someone just looking at her pre-Parkland situation might conclude that our health care system was letting this woman down, but that would not be true. It is true that she can't just waltz into a private endocrinologist's office at her convenience, and be given everything she needs, all the time, with no requirements on her. For that matter, neither can I. In order to do that, I have to do something first. I have to hold a job that provides insurance, or I must pay the premiums on private insurance. If I don't - or can't - do that, then I would need to go to Parkland. I am able to hold a job, so I have insurance. She was not able, so her responsibility was to play by the rules and make herself available to the Parkland system.

I'm sure there are people who, for whatever reason, don't fit in anywhere. Maybe their income is a little too high for one and a little too low for the other. I don't know, but I do know there are those who fall through the cracks. I believe it's in this area that some tweaking of the system is needed. Identify these folks, determine what the glitch is, and fix it.

Along with that, identify the wasteful spending and plug the leaks. These measures would, in my opinion, go a long way toward fixing our "broken" system. I really don't think it's broken nearly as badly as we're being told. Let's fix the obvious things first, and then we can see if it needs anything more.

HEALTHCARE REFORM REVISITED

Well, it has been about five months since I last posted here, and it would appear things haven't changed much. The battle still rages over that ridiculous monstrosity our President and his Socialist comrades are trying to shove on us. They are employing their usual tactics - throwing up smoke screens, making ridiculous charges, trying to confuse the issue any way they can.

A favorite ploy is to accuse the conservative right of being so stupid that we don't even realize that healthcare reform is needed. This, of course, is utter nonsense. Of course we realize that reform is needed. It's just that we don't believe this bill is the answer. It's too complicated, no one understands it, few on the left have even bothered to read it, and it gives with one hand while taking with the other.

The left always assumes that the right has made an all-encompassing judgment. They never seem to understand that we can acknowledge a problem, but not necessarily fall in love with their solution. Case in point - our president. I have said many times, as have thousands of others, that America had reached a point where we were ready for a black President, that such a choice would go a long way toward healing the hurts that still exist in this country. Silly me - I guess I thought that when such a man was found and elected, he would be an American black, a product of this country. He would naturally have African ancestors, as all American blacks do, just as most of us American whites have European ancestors, but he would be an American born and raised, and would have some sense of what it means to be an American.

As I said - silly me. What did we get? We got a half-blood Kenyan, who spent most of his formative years outside this country, who does not share much of the experiences we all had growing up here, and who apparently does not even share the Judeo-Christian religious beliefs of the majority of our citizens. He says he does, but his actions and words spoken in unguarded moments cast doubt on that.

So, I'm still waiting for that black American President. If the Republicans have any sense at all, they'll find such a man, vet him VERY carefully, be prepared to disclose everything about him down to his shoe size and a copy of his first-grade report card, check his closets for skeletons and shake his tree to see what falls out, then run him against the incumbent in 2012. That should be extremely interesting.

Now, as for the original intent of this entry, to point out some things about healthcare reform. I repeat, we conservatives do see that there's a problem, and we acknowledge that reform is needed. This bill just isn't the answer.

One problem is in wasteful spending. Money is spent where it shouldn't be, which makes it impossible to spend it where it should be spent. Example - when my dad had a knee replacement, Medicare dictated that he was to have a bracing device that would force his leg into straight-leg extension, to be worn for an hour three times a day. It cost $1600 and Medicare paid for it. My dad didn't want it, told the doctor he didn't want it and wouldn't use it. The doctor told him Medicare would consider his treatment incomplete and would pay nothing, if he didn't order the brace. So we brought the thing home and put it in a closet.

My ever-resourceful dad took a large dishtowel, tied a knot in two opposite corners, and tucked large heavy cans of pork-and-beans in the resulting pockets. Sometimes he used 5-lb bags of flour. He then sat in his chair, heel up on an ottoman and hung the dishtowel across his knee. Voila! Straight leg! He could hang the towel there in two seconds, vs the ten minutes it took to strap into the brace, which was very heavy and uncomfortable. If he needed to get up, he just dropped his foot off the ottoman, and his make-shift appliance settled to the floor.

Final note - when cleaning out his home at his death, I found the brace, carried it around in my car trunk for a while, and finally gave it away. I tried to give it back to the rehab center, but they refused, explaining that those braces are "custom-fitted." That's wasteful, any way you slice it, and I suspect something similar happens every day.

We need to examine things like that - cut out the waste, trim the fat, ask questions like "Is this necessary? Is it effective?" We should go through the Medicare regulations and look for words like "always" and "must", or "never." Words with absolute connotations are usually a red flag, and bear investigation. My mother taught me - and surely yours did too - to "never say never." Good advice. In my dad's case, you can bet there's a line somewhere that reads something like this: "Rehab following knee replacement surgery must include the use of a custom-fitted brace in order to achieve straight-leg extension. Failure to do so will result in incomplete rehab and therefore will not be reimbursed." There's that "must." Why couldn't it say "Rehab following knee replacement surgery will have as a goal a return to straight-leg extension, and the therapist should employ any reasonable means to achieve that goal. If an appliance is necessary, it will be reimbursed."

Of course, all of this makes too much sense, and therefore would just never work in Washington. In order to pass there, any document must be confusing, obscure, double-tongued, and must have many little loopholes and pockets where pork can be tucked in. I wouldn't be surprised if the brace-makers had a hand in engineering the little requirement that resulted in my dad receiving a brace he didn't want or need.

I just have to say this, though. While the system is broken, it is perhaps not as broken as we are led to believe. In another entry, I'll tell you about a friend who found that out, much to her surprise.