inherit

For the Daily Prompt: inheritance.

Such soft colors. I am trying to capture the ferry wake color in the sunrise.

The news this morning and I am thinking of girls who are not believed and predators who are after them. And boys too. I am thinking of medical school, this essay.

I am thinking of the comment from a fellow male medical student, about the statistics of one girl in five sexually abused:  “I never believed it. I didn’t think women could be okay after that.”

There is still the idea in our culture of a woman “ruined”. Women are still not believed. Boys are assaulted, too. One in twenty. Here: http://victimsofcrime.org/media/reporting-on-child-sexual-abuse/child-sexual-abuse-statistics.

And in the end, I wonder, what are the adults thinking? It’s the woman’s fault for being pretty? It’s the girl’s fault for being vulnerable? The devil made me do it? I was tempted by evil? It isn’t my fault. I have money and power and therefore I can do whatever I want. Women and children aren’t people, I can buy and sell and use them.

I am so relieved to hear the news from Alabama this morning.

 

 

 

loyal

For the Daily Prompt: loyal.

I am thinking of the men working with the Weinstiens and the Cosbys. They might have heard a rumor, but they ignored it? Women are free to speak up if there is a problem?

No, gentlemen, actually women are only “free” to speak up if they are rich and in massive groups.

Otherwise, we are dismissed, silenced, disbelieved and ignored.

For me, it was at age 7. Are you going to say I was dressed wrong? I was too sexy? I should not have been alone with him? It’s my fault?

The water is beautiful and reflects the sky. What do you think is there beneath the surface in the depths?

 

the unwashed masses

I don’t have any of THEM as patients. The unwashed masses. All of my patients are smart.

There aren’t any unwashed masses.

I have a gentleman who is overweight, obese, diabetes. He is not stupid. He is not unwashed. He is not exercising or controlling his blood sugar right now because the temperature is below freezing. He has a hole in his trailer floor and no heat. So he huddles under the electric blanket.

I have a gentlewoman, also diabetic. She too is not stupid. She is not unwashed. She lost her husband to cancer and then everything else and then was homeless for a period. She has a small house but she has no heat. She stays in bed to stay warm. Her contractor quit before he put in the furnace and he’s gone bankrupt. She is cold.

I have veterans. They are not stupid. They are not unwashed. One was homeless for a long period and pooled his resources with another to rent a section 8 house. I am so proud of them. They are having trouble living together, each would rather live alone. Only sometimes they would rather not be alone. It is hard.

I have a massage therapist. She started to train as a counselor. To be a counselor, she needs a certain number of supervised hours and was getting this through the county mental health. “I didn’t know.” she says. “It is taking twice as long as I thought because half the time they don’t show up. They don’t show up because they don’t have gas, they don’t have food, they have been evicted, their son is in jail, they are in jail. I had no idea. My massage clientele is so different, they pay. I thought poverty was in third world countries, but it is here, in my county. I didn’t know.”

I know the people who live in the woods. A schizophrenic who comes once a month for his shot. He was losing weight. “Why are you losing weight?” I demand. “I am only eating once a day.” he says. I nag him to go to the community meals. He is shy, he is afraid of people and he is hungry. He is not stupid. He is not unwashed.

I have opiate addicts. Six years ago one expressed concern. He is 6 foot 5 and big. “I am afraid of some of the other people. You shouldn’t be doing this! It’s too scary and dangerous!” My opiate addicts are not stupid. My opiate addicts are not unwashed. Sometimes they relapse. Sometimes they die, in their 50s, 40s, 30s, 20s.

One in six people in the US is below the poverty level. They are not stupid. They are not unwashed.

And when someone talks about the masses, the people, the stupid people, most people are stupid, the sheep….

….I am beyond angry….

….my heart hurts….

Poverty in the US: http://www.census.gov/newsroom/press-releases/2016/cb16-tps153.html.

More: http://www.census.gov/topics/income-poverty/poverty.html.

The examples are taken from 25 years of practice, details changed for hipaa, but I can list dozens at any one time. The photograph is during the sunset after clinic, when I walked down town, the view across the sound.

 

Your health care dollar

I have been writing posts about fraud in medicine: but I think I am using the wrong title. Instead it should be your health care dollar: how the US medical corporate system wastes your health care dollar.

Think about it. What do you want to spend that dollar on?

Do you want it to go to 1300 different insurance companies and their web sites, their advertising, their competition and their profit? Do you want your healthcare dollar to go to complex coverage rules and contracts, to forms for prior authorization, for the weekly postcards and emails that they send me telling me that they have changed your coverage? Is it any surprise that I have no idea if your insurance company covers a test? They may have last week and not this week. The overhead for medicare is 2-3% administrative costs. Now why would we privatize that when the overhead for the health insurance companies is 20-30%?

How much of your health care dollar do you want to go to corporate competition?

I don’t want ANY of my health care dollar going to corporate competition and profit. I want my health care dollar going to my HEALTH. We spend the most per person in the world, almost twice as much per person per year as the next most expensive: and we don’t guarantee care. Hello, the next most expensive and all of the other nearly 40 countries, first and second world, have universal care for all their citizens. So is our care twice as good?

No, no, no, and no.

Hello, new administration. Let’s put the health care dollar where it is paying for health…. in medicare for all and in a single payer system. We have guideline after guideline on how we should treat illnesses, here:

US Preventative Task Force

The guidelines are regularly updated. If we have medicare for ALL then I will KNOW whether a test is covered or not. I have memorized the entire list of medicare covered screening tests and all the details: screen for abdominal aortic aneurysm is covered in male patients age 65-75 who have smoked more than 100 cigarettes in their life and any patient who has a family history. I have the whole list in my brain.

You CAN make a difference. Write to your congresspeople, state and national. Call them. Email them. They all have websites. Tell them YOUR health care story or the story of a friend or family member.

Join Health Care Now and Physicians for a National Health Program.

I want my health care dollar to go to HEALTH CARE.

For the Daily Post Prompts: gone and interior. Interior because I am so angry at the poor spotty costly health care for my fellow people in the US. And gone: your health care dollars is GONE: let’s use the next one wisely.

Doctors don’t charge for phone calls

Doctors don’t charge for phone calls.

Attorneys do: they charge in fifteen minute increments.

Doctors don’t charge for phone calls: oh, but actually that is a myth. And it’s raising the cost of health care in the US because the insurance companies are using this myth to their advantage. Not only is this costing every one of us more money, but it is driving doctors out of practice. And it’s making patients bitter and angry at the doctor, when it is the insurance that should bear the blame…

Why do I say this?

A patient calls their health insurance. “I need x.”

The health insurance says, “Have your doctor’s office call for a prior authorization.” Now, we are definitely paying the health insurance to have someone say that to the patient.

The patient calls the doctor’s office and requests the prior authorization. There, a second person is being paid to get that phone call.

The doctor’s staff runs it by the doctor. The doctor says, yes, the patient needs that or no, I would like a visit to discuss this. More time that we pay for.

If the doctor says yes, the doctor’s office contacts the insurance by phone or on line to do a prior authorization. This means a different website for every one of 1300 insurance companies in the US. We are paying the doctor’s office staff to be on the phone and on the computer to fill out prior authorization forms to get permission from the insurance if your doctor agreed that you need x or that x would be helpful. We also are paying for all of those websites that the insurance companies have to slow down giving the patient care.

I don’t have an office staff to do this. I have a bare bones clinic so that I can spend more time with patients. I call the insurance myself with the patient in the room.

More than half the time the insurance company says that x is not covered under the patient’s plan.

But wait. The patient already called the insurance to ask if they could get x. And the insurance said have your doctor get prior authorization. So in the usual office, the patient is called and told that x is not covered. The patient is angry, because they think that the doctor’s office has messed up the prior authorization. The insurance does not want to tell the patient it is not covered. So our costs spiral up and up and up, because the insurance has realized that they would rather have the patient angry at the doctor’s office, not the insurance.

And we all are paying for it with our health care dollars…..