The Ineffable Unaffordability of Life

The accountant sent 19 pages of tax worksheets for me to fill out (I being, after all, way too innumerate to fill out a tax return competently). Slogging through all that unearthed the discovery that in 2011 I spent something over 25% of my income on health insurance, long-term care insurance (which I see as a species of health-care insurance), dental care, vision care, and medical bills that Medicare won’t cover.

Think of that: 27 percent of gross, not net, income.

Eight grand just happens to be exactly the amount I need to get through the four months a year in which no teaching income pours into my bottomless coffers.

What really frosts my cookies about this is that when I was working (and could have afforded to pay $8,700 a year for a modest amount of medical care—understand: nothing was wrong with me last year! My health is optimal, I take no medications, and the only times I’ve been to the doctor have been for minor injuries and a routine checkup), my EPO, which covered all my doctor’s bills with a $10/visit copay, cost all of $36 a month. Now that I’m unemployed and thrown out to try to live on reduced Social Security (because I was forced to start drawing benefits before “full” retirement age), the cost is through the freaking roof. On freaking Medicare!

Yes. I know I could get Medicare coverage a lot cheaper if I would join a Medicare Advantage HMO. Thanks, but no thanks: I watched my mother die of neglect in an HMO, and the lesson I took away from that nasty little episode is that no matter what it costs, you need to be able to choose your doctors and decide when to see them.

And no, dental insurance for the unemployed is not a cost-effective strategy, not by a long shot. If you have no major dental problems, you’re better off to pay out of pocket.

To be fully covered, you need to pay for Medicare B (for my cohort, that’s $111 a month, though it dropped a few dollars in 2012), Medigap (supplemental private insurance that covers the 20% that Medicare doesn’t cover, plus copays), and the required rip-off that is Medicare D (prescription drug coverage). Even then, you’re not covered.

Some doctors—usually the competent ones—do not accept what is called “Medicare Assignment.” This means they will charge you an amount above and beyond what Medicare and the tight-fisted Medigap providers regard as reasonable. Preventive care is often not covered: hence the astronomical bill from my doctor, who insisted that I just had to have a “regular checkup” (which I’ve managed to avoid for years) and thereby racked up charges for a variety of routine tests that Medicare and Medigap refuse to cover. Similarly, the shingles vaccine, which is absurdly expensive, is only partially covered by Part D—and believe me, folks, shingles is something you do not want to enjoy in your old age. I had to cough up $183 for that shot.

One thing that’s clear: I can’t continue to see my old, beloved doctor, who practices at the Mayo Clinic.

I go to the Mayo first because he moved his practice there when the Mayo opened a clinic on the far side of Scottsdale, and I never found another decent doctor anywhere else; second, because the overall quality of medical care in the Phoenix area is lukewarm, at best; and third because the Mayo Hospital saved my life one night when I couldn’t even get triaged at the ER of one of the two largest medical centers in the state.

Phoenix has a number of large hospitals whose PR departments sing their glories. You hear a different tune, alas, when you check out how they stack up in national hospital rankings, and that tune is especially dissonant when you attend the concert in person.

My late mother-in-sin checked into a branch of one our large regional chains for surgery on her aorta. This went more or less OK, though the care she got in the hospital was a little wanting. Then while she was laying there in the hospital bed, she had a heart attack. She pressed the button to call a nurse and no one came. What saved her life was a cleaning lady, who came into the room to pick up the trash, noticed she was in distress, and walked down to the nurses’ station to get their attention. Had the trash pick-up come few minutes later, and she would have died in that bed.

A couple of years later, I came down with acute appendicitis on Christmas Eve. My ex-husband drove me down to St. Joseph’s Regional Medical Center and dropped me off at the ER. Despite being in obvious distress and excruciating pain, I sat there for four hours without even being triaged. There was no place to sit in the waiting room, and the floor was so filthy I was afraid to hunker down on it. I ended up sitting just outside the door, in the winter cold, on a concrete bench next to a woman who herself had been there over four hours, in the throes of a miscarriage!

Finally along about one in the morning I called some friends and asked them to take me home—figured I’d rather die in my bed, thank you. At dawn another friend drove me to the Mayo, where surgeons instantly hauled me into the OR and performed the emergency surgery I should have had 20 hours sooner. If that care had been delayed much longer, the infected appendix would have burst and I could have died.

That, my friends, is medical care in Arizona. And that’s why one is inclined to pay top dollar to use the Mayo, which is the only hospital in Maricopa County that consistently, year after year, ranks among the top facilities nationally in clinical care and safety.

But unless a miracle happens and I find work that will pay the bills, I just don’t think I can continue to afford that level of care on what an adjunct earns.

Pretty clearly, I need to find a doctor who will take Medicare assignment, and pray to God she or he is at least halfway competent.

The Mayo doesn’t want to see Medicare patients at all. If you’re not already an established patient when you’re forced onto Medicare, the Mayo will not take you as a new patient. The only reason I can get in to see my doc at all is that I’ve been his patient for years. Decades, come to think of it. And the only way you can stay on the Mayo’s rolls of acceptable patients, once you’re on Medicare, is to make at least one appointment a year. Fall off their rolls, and you can’t get back on.

So what I’m thinking is, find a doctor for routine stuff but visit the Mayo for some minor this or that once a year. This will keep the hospital available to me the next time something big happens, but cut out most of the $2800 I’ve been paying for not very major medical care.

That may be quite a trick. According to HealthGrades, a doctor at a practice a friend highly recommended was suspended from practice in Connecticut and made to turn in his license there: drug abuse. UNbelievable. They defrock the guy in a civilized state, but here in the boondocks they put him back in practice.

Hmh. There you have it, folks: Teaching adjunct can be dangerous to your health.


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