"Lisa, Line One"

It's always bad news. "Lisa, line one," means I'm in trouble. I'm about to get yelled at. I got a bill from the lab. You used the wrong code. My drugs aren't covered. My insurance sucks. Fix it. Fix it. Fix it. 
But today I picked up and I could hear the patient smiling. Hi Lisa! She wanted to tell me all about her new insurance plan. One of the Medicare Advantage plans. Zero premium. Zero copay. Good drug coverage. I kept waiting for the complaint, but it never came. I thought about how we've helped this lady over the years, spending hours hunting down deals on procedures and meds, just to get her through to the next month, weaving her though the health care maze and how hard it must have been for her to ask for help. On my way out tonight I ran into some more patients, an older couple handing over their new 2012 cards for us to scan. They were happy, too. Less expensive. More coverage. Smiling as they spoke about insurance. Unheard of for the past decade. Little by little, we're seeing some changes this year. I got a free Mammogram instead of dipping into my massive deductible. Seniors saved an average of $500 this year on medication costs. Patients got physicals without a copay. This week the Department of Health and Human Services ruled that insurance companies need to spend 80% of the premiums they bring in on actual patient care. Not on marketing. Not on lobbyists. Not on some twenty-year-old in Bangalore denying an MRI while playing Angry Birds. Actual patient care. Imagine that.

I may start answering the phone more often.

219-212

Wow, those lawyers can talk! Health Care Reform finally passed. No more pre-existing conditions. No more excessive rate hikes. No more doughnut holes. More preventative care. Sounds good to me. 

Nancy, you go, girl!

From everything I read, after the heartbreaking loss in Massachusetts, everybody was ready to give up. Scrap it. Start over later. Someday. Maybe next year. But not Nancy. She's a fighter. She marched right in to the Oval Office and said, "No way. We're doing this." Who knows what went on behind closed doors, but she did it. They all did it. Thanks.

Here's a calm explanation of how the Republicans did todayfrumforum.com/waterloo, shows how this health care reform legislation looks a lot like Mitt Romney's health care plan and the conservative Heritage Foundation's health care plan and the Republican's plan put forward after Clinton's fell through. Amazing. Could have saved us a lot time if they all just played a little nicer together in the sandbox.

Health Care Reform

There's a vote on Health Care Reform coming up this week and it's close. Really close. Looks like Dennis Kucinich just switched his vote to "Yes" - nothing like a little trip on Air Force One with Obama to convince a guy. Here's an amazing graph - take a look at all the money flowing from the health care industry into our representatives pockets, then take a look at the percentage of people uninsured - then what's with all the undecideds from Arizona? I'm going to make some calls...


http://www.washingtonpost.com/wp-srv/special/politics/votes/house/finalhealthcare/?hpid=topnews

What's Up, Doc?

Health care reform seems dead out there in Washington, leaving the rest of us in the medical world to try to sort out the mess. It's not fair. Almost half of the phone calls we get at the office every day are about the price of drugs. This one's not covered. There's no generic on that one. My coupon expired. Can you write it it my  husband's name, he has better insurance (no, sorry, we can't). Last Friday one of our patients, an old family friend, waltzed in. He can do that. He knows us. He's retired and once the tennis game is over, the rest of the day is pretty free. He just received a letter from his insurance company. They are requiring him to switch to a cheaper medication for one month to see if it works for him. If not, then he can return to the higher cost brand. He said, "you ever see anything like this before?" Yep, everyday. "Does Shawn like the alternative drug?" No. But we jumped through the hoops, handed over the new script, even gave him some samples of the good stuff to get him through the next month, biding his time until he can get back with the old program. He told me he's above average (and he is - in so many ways, his stand-up comic abilities alone are way above average!). What he meant was that he has above average access to us and it's not fair for the rest of the average Joes who can't waltz in on a Friday afternoon. He's right. I like to think we treat all of our patients like they're above average. But he's right, it's not fair.

Health Care Reform

When Shawn started practicing medicine, he and the patients were in charge of health care. Over the years, however, the insurance and drug companies seemed to take over. Back then our patients had good health care insurance that was provided by their employers and our older patients had Medicare. Drugs were available at a reasonable cost. Things have changed. Not a day goes by that we don't deal with some sort of financial issue - somebody's co-pay is too high and they can't come to see us, or they lost their insurance or their insurance didn't cover their lab test or their office visit or the medicine that Shawn prescribed. We are constantly taking our eyes off of patient care and running decisions through other filters - what will insurance cover? And it's a good thing you don't know how often I have to send them copies of your "private" medical records so they can "review" your medical problems. We now deal with HMOs and Medicare-replacement plans and "donut-holes" and waiting on the phone with insurance companies forever to discuss Shawn's plans based on his 20 years of education and experience with some 20-year old in Delhi begging for a prior authorization. We have at least ten drugs reps a day come through the office, selling their wares. I remember a time when they would come in and actually talk about their products, the research, the benefits. These days, it's all about coupons and vouchers and websites and giving away "free" drugs, at least until the formularies change. And then there's the cost of insurance. Some employers have stopped providing it and individuals now have to choose between insurance and food, often choosing a plan that promises everything, then changes a month or so after signing up. Something has to change and tonight is the first step. The House, after almost a century of trying, has passed a health care reform bill. Now it's up to the Senate. Come on, people, it's about time.