Capitalism is Great—Until You Try to Apply it to Health Care TLWH 7.24.26

One of the promised benefits of old age is that life gets easier. The calendar and the clock would have far less impact on daily life. Social Security keeps groceries on the table. Medicare and an apple a day keep the doctor away. In reality, those promises are no different than the one a delinquent customer makes when he says, “The check is in the mail.”

Since moving to metro Duluth a year ago, we have needed to find primary care doctors because we both rely on medication to keep the grim reaper at bay. Or so we’ve been told. Last March, the Bohunk had an appointment with the clinic on the other side of US 2 to get her prescription regimen renewed. She also had scheduled her “free” annual Medicare wellness visit. 

Even though we’ve been insured under Medicare for eight years, and even though our clinic in Grand Marais included the “annual wellness visit (AWV)” in our annual physical/drug renewal visits, we really didn’t understand what it was all about. In April, after the big-name clinic bills arrived (yep, two bills), the Bohunk questioned why two bills and why the amount charged was over $500 before Medicare processed the claim. The written response from the Patient Financial Services department of the big-name corporate health system was enlightening, to say the least. 

Turns out that when Congress created the AWV with the Affordable Care Act in 2011, they specifically outlawed a head-to-toe physical. They meant it to be an hour of dedicated time for a nurse to review all the answers you gave on the lengthy questionnaire you fill out at the front desk to find out if you are depressed, taking your medications, still smoking, drinking too much, or having balance issues. A “health risk assessment.”  

When the doc comes in, listens to your breathing, pokes a light in your ear, palpates your abdomen, and writes your prescriptions, your visit moves to the “evaluation and management” level, which requires a second invoice, surprisingly enough almost twice the amount of what was paid for an “hour” of lectures by a nurse. 

My mama needed a lot of doctoring in the last 30 years of her long life. Trying to understand all the doctor and hospital bills she had was an obsession of hers. And I think it drove her nuts. It drove me nuts, too, as she faithfully shared her frustration with me about each pile of paperwork. I foolishly thought my generation would have a much easier time of it, what with technology and corporate efficiencies, when we became dependent on the ever-expanding corporate medical industrial complex.

Another year has passed since a doctor wrote a 90-day prescription, with three allowed refills, for drugs that for more than 25 years have kept my blood pressure and cholesterol low enough to prevent my death. Other medical conditions have tried to put me six feet under, but at least my LDL and BP stayed in a somewhat normal range. One of those homicidal medical conditions left me with a surgical alteration which needs something that is euphemistically called Durable Medical Equipment (DME, not to be confused with DEI). Since that alteration is permanent, so will be the need for the DME. Yet the corporate insurance-dominated health care system requires that the prescription for the DME I use every day, and will until the end, be prescribed for 90 days with three renewals allowed. 

So the other day I called the other large corporate medical care business in the area for my annual physical. The first available appointment at its clinic close to us is August 28. I’ll be there that afternoon to go through the aggravating hoops.

Having spent my entire life as a small business owner and advocate, I am a fierce defender of the capitalist engine. Competitive markets are an incredible tool for driving innovation, job creation, and the pricing of necessities. But a tool is only as good as the job it’s designed for. While the free market is the perfect engine for many things, it is a failure when applied to human health.  

For too long we’ve been sold a myth that if we just treat health care like any other capitalistic enterprise, the markets will fix it. A patient in the ER or urgent care is NOT a consumer with a choice.

To paraphrase a favorite Jimmy Buffett song, sometimes I feel like I’ve lived too long because of the frustrations of a life dominated by ever-encroaching large corporate entities. If you need me, I’ll be pacing the cage.