“The doctor says he’s comin’, but you gotta pay in cash”

“Life in the Fast Lane

Eagles

None of my doctors take insurance.

Oh, if I’ve got to go into the hospital, if I need a major procedure, I’m covered, shy of that…

You don’t want to save money on your health care, no way. A friend in England was delineating a health problem, and he said he learned from living in the U.S. that you’ve got to have a physical every year. They don’t do this in the U.K. And he went and they found a progressive disease and if you’re waiting for symptoms to arrive, it’s oftentimes too late.

You’ve got to go to the doctor, just ask Warren Zevon.

And you’ve got to have insurance.

I was stopped at a light yesterday and I saw a mom with a sign asking for cash for her son with leukemia. I wondered what went on there, because this is something insurance covers, I know, I’ve got it. But maybe they had no insurance, maybe they’re here illegally. I mean can’t the system help this kid?

No, the system is…

Well, this is interesting. The self-reliant want to drown the government in the bathtub, leaving us all to buy private insurance, but if you can find someone who loves, even likes their insurance company…well, I’ve never found one. And the old days of lifetime employment are gone. So many are independent contractors, with no benefits, they need to buy their own health insurance. And those under 35 feel invulnerable, it can’t happen to them. And they’re right, odds are with them, but in truth they are susceptible to health crises, never mind an accident where they break a bone.

And, in truth, if you have an accident that requires immediate attention you can be seen at the emergency room at no cost. That’s the law. So if you’re dead broke, you’re covered, for the big things anyway, other than the emergency, you’re screwed.

So I believe in the big doctor. In every facet of medicine there’s an expert. In your town, in the United States and in the world. Chances are you don’t need to see that expert, but I have had to, more than once. You see everything can’t be easily diagnosed, everything can’t be easily treated, which is why you don’t want to see the generalist, but you want to see the expert who sees the condition all the time.

That’s another reason I won’t live in the hinterlands, why I’m never leaving Los Angeles…THE HEALTH CARE! I can recount the lousy health care I’ve gotten in the country, but instead of pointing at the pitfalls, let me focus on the opposite end, the zeitgeist, the best.

In truth practicing medicine is not the road to wealth it once was. Remember when the doctor was the richest person in your town? Those days are long gone. Back in the eighties we had a doctor friend making $225,000 a year. You know how much he makes today? $225,000 a year. No one works independently, they all work for the system, and the system has requirements. And usually that has to do with the number of patients you must see a day. It’s staggering. Fifty. The pressures are astounding. And the documentation! You have to satiate both the medical group and the insurance companies. You’ve got to hire people just to fill out the forms.

And if you’re a patient… You’d better front-load your questions, because unless you’re in an obvious crisis, you’re going to get a very short period of time. It’s positively hit and run.

For everybody other than those willing to pay.

My internist left the medical group, he wanted to practice medicine his way. He charges whatever he wants, and he’ll file the insurance forms, you might get a few cents on the dollar, but that’s your issue, not his. So the annual physical now costs around $2000. But this is the guy who diagnosed my aforementioned cancer. And the service? I usually don’t bother calling a doctor, what for? I’ve found oftentimes they don’t even get back to you at all. And if they do…it’s hours or days later and oftentimes you’re unavailable yourself. But my guy, you’re not only gonna hear from him the same day, but within hours, assuming it’s not an emergency…an emergency will get him to the phone right away. He answers his e-mail promptly and I want to reinforce, I’M PAYING FOR THIS SERVICE!

And he won’t take Medicare. Too many hoops to jump through, too much paperwork.

Nor will my heart doctor. I pay this heart doctor nearly two grand a year. And I’m not in crisis. And I’d rather not pay the money, but my friend Judd, who I grew up with, he keeled over from a heart attack two falls ago. He was 67. As was his father, who died of a heart attack at the same age. Do I think he saw a doctor? Sure. Did he see someone like my heart specialist? No way. Even my internist, he says if you come regularly and do what he says, you won’t die of a heart attack. But you’ve got to pay for that service.

And I went to this heart doctor and she said I was near heart attack. I didn’t believe it, but she did these special tests and created a medication program tailored to me. All that stuff you read in the newspaper? That’s general information, not specific to you. The people saying to forget an annual physical, that you don’t need a colonoscopy every five years? IGNORE THEM! And yes, after seeing this heart doctor my numbers aligned, they’re where they should be.

As for mental health… If your therapist takes insurance, fire them and get someone new. None of the psychiatrists in Los Angeles takes insurance. They’ll give you a form, that you can file, but you’re on your own.

And squeezing money from insurance companies is a game unto itself. They’re always denying claims based on codes. And then they deny stuff that is exorbitant relative to most people, but if you’re sick, you need it. And you can’t tweet or even e-mail them, to get the process going you really have to talk to someone, who has no ability to make a decision, it’s an endless ordeal, an endless time suck. The goal is to make you give up and pay for it yourself.

And then for the vaunted Medicare…

First and foremost, you should see what I pay. By time I pay for the government part, the supplemental plan and the drug plan, I’m at two-thirds of what I was paying in the old, pre-65 days, which was over four figures a year.

However, it’s not only my internist who doesn’t take Medicare, my dermatologist doesn’t either. Dermatologists have the quickest appointments extant. Five minutes frequently. Fifteen minutes is a rarity. Today I got an hour. But it cost me $490. No billing, I had to whip out my card before I left, and if I wanted to use credit, I’d pay another 3.5%, so I used my debit card. That’s the equivalent of cash these days. Nobody other than the super-rich carries a wad of cash today. You need at least a grand, a couple of thou in your wallet to cover expenses. And the people you do see with this amount of cash? Usually it’s undeclared. They got paid in cash, they’re paying in cash, the IRS is clueless. Another way the wealthy profit in our tax system. But the IRS, which has already been cut off at the knees, must continue to be held back, because… The rich should get away with it? You’re not even itemizing deductions, for the rich, tax forms are…LET THE GAMES BEGIN! Look at Trump, on trial right now!

As for my money…

I took a 30% haircut on my investments. On my cash I’m losing 10% a year. And I don’t see any low-hanging fruit to make more. I’m o.k., don’t worry about me. But what if someone has a family? How do they make it? MANY DON’T!

And the aged. You can’t live on Social Security. It’s going to get really ugly folks, many of those boomers who took Social Security early…they’re gonna outlive their money. You can’t get a job when you’re ninety, not even as a greeter at Walmart.

But no one likes to plan for the future, which inevitably comes, unless you off yourself. And people have been doing that on a regular basis recently, especially men, they call them “deaths of despair.”

And the men who refuse to see the doctor, believing they’re immune. Warren Zevon is the poster boy for this. Didn’t go to a doctor until too late, and then he died of cancer.

So you’re not going to live forever, that we know for sure, how are you going to navigate your health care?

BUY INSURANCE! For all the negative I’ve outlined above, you don’t want to go bare. It’s not only the aged who get cancer. Most people who go bankrupt do so as a result of health care debts. And many of them DO have insurance. Never cancel your car insurance, your health insurance… Don’t go out to eat, drive an old car. Believe me, when your number comes up, no one is going to jump out of the woods and make you whole. Odds are low that you lose the health care lottery, but it happens.

AND GO TO THE DOCTOR, EACH AND EVERY YEAR!

I’ve never ever had a precancerous cell. It seemed I was immune.

Until today.

My PSA, my prostate stuff is pretty good, I’m one of the rare men who can say this. But I’ve got a lot of other stuff wrong with me that almost no one else has, like my pemphigus foliaceus.

Which it took four doctors to diagnose. Most patients see five in a year, it took me eighteen months to be diagnosed. No one could get it right. And by time they did, I had to go into the hospital. But I live in Los Angeles, where I was referred to someone had studied at Johns Hopkins, the epicenter of pemphigus treatment. What are the odds I’m going to find this even in other cities?

So if you’ve got undiagnosable symptoms, keep seeing new people. Research. Go to see the big expert, even if you have to journey to another city. Money means nothing if you’re dead.

Sure, there are hypochondriacs, but for all the ink they get, proportionately they’re very few in number. The issue isn’t them clogging up the arteries of the health care system, but the people not utilizing it, or underutilizing it.

And the longer you live… You’re gonna get ill. You may not take any pills now, but you will, believe me. And if you don’t, you’ll pay the price. Like the woman I know who refused to take blood pressure medicine, who turned to alternatives, and then had a stroke.

That’s another thing. If you’re truly sick… GO TO SEE A WESTERN DOCTOR! Oh, I believe in acupuncture, but in truth I’ve had better success with physical therapy. But the distrusting elite hear you’re ill and tell you about all these cockamamie remedies. Like CBD. Every study shows no effect. I’ve tried it…nothing. But the dopers love it, it’s part of their religion, DON’T LISTEN TO THEM!

But CBD is painless. And muscle aches are usually a minor issue.

Oh, another thing, your body will tell you if you’ve got a problem. LISTEN TO IT!

Better to be ahead of the game, and capture it at the physical, like the rogue superbug in my urine.

But you don’t want to think about it, you’re squeamish, you’re healthy, it’ll never happen to you.

But it will.