The Medical-Industrial Complex

I like medical professionals. I mean, most of them care, work long hours, and, you know, save us from our own recklessness. Doctors, nurses, and techs, the lot of them are just fine. All except for the two registered nurses I saw the other day. They were registered nightmares. Both ladies were in their mid-fifties, a bit round like me and pleasant, unlike me. My appointment was at eight AM, and the instructions said nothing to eat past midnight. I wasn’t in a good mood. If I don’t get coffee, I’m a bit off. I was at Saint John’s for a procedure to check my ability to swallow. I’ve had acid reflux for about six hundred years, and now it’s to the point where chicken soup tastes like somebody poured habanero sauce in it. I was led down a long hospital hallway and around a few corners, thus ensuring I’d never make it out alive on my own. The two women made small talk and tried to reassure me. They told Lillian the ‘procedure’ would be about thirty minutes—maybe less.

When I go to the doctor or have a ‘procedure,’ I ask them to knock me out. I never want them to explain what they are doing. I don’t need to know. I don’t like people touching me. When I’m at the dentist, the teeth cleaning gal is like Chatty Cathy, asking all sorts of personal questions. How in the world am I supposed to answer with a garden hose stuck in my mouth? Don’t even get me started on the sounds. You know, when the hygienist cranks up the polishing tool and casually talks about her cat. I hate going to the dentist.

Yesterday I had an esophageal manometry procedure to see how well I swallowed. I almost died. Apparently, the little flapper valve leading to my stomach doesn’t close all that well. The doctor called it the sphincter. But that’s not correct because I’ve worked with plenty of sphincters. So, these two evil sisters led me into a small torture chamber equipped with implements right out of the Spanish Inquisition. This time, a garden hose about twelve feet long would be shoved up my nose and into my stomach. The hose was long enough to see the headlight shining out my pant leg and onto my shoe. Where does discomfort end and pain begin?

With the alien probe inserted, I was instructed to swallow. One of the evil sisters looked at the monitor while the other put a large syringe to my lips and forced poisoned Gatorade into my mouth. Just swallow normally, the Gestapo guard said. They say most people enter the medical profession because caring for others is a calling. Medical professionals heal us. They dedicate their lives to our well-being. Everyone in the medical profession is a saint. Saints all, except for these two demons. Somehow, I survived. I escaped the torture chamber and applied an antiseptic gin-and-tonic to ease my pain. I just don’t like people touching me.

Many of you have medical calamities much greater than mine. You’re brave. I’m not.

Have you ever looked at a bill from a visit to the doctor? Do you understand it? I bet not. The doctor bills one billion dollars. Insurance pays five dollars. Do they write off the difference? Do they get a tax break? I really don’t know. I don’t understand medical billing. People have explained it to me over the years. It didn’t do any good. Do you know there are eighty-seven million medical billing codes? Everything a doctor, nurse, or torture specialist could do to you has a specific code or set of codes.

There are eighty-seven million medical billing codes, but your insurance covers only five. Sorry. Medical insurance companies run the world. You walk into the doctor’s office with a knife stuck in your eye. Sorry, we can’t pull that out. We’ve got to get a chest X-ray first. Doctors can’t do anything unless the insurance company says it’s ok. I’m going to have surgery to repair my esophagus. The doctor knows exactly what he wants to do. But I need six other procedures to prove I need the surgery. Somebody at the insurance companies should have a twelve-foot garden hose shoved up their nose. Insurance companies rule the world.

Lillian broke her foot a few years ago. She tripped over a curb. She’s a bit of a klutz. Not really. I just like to tell her that. I can find no other fault, so that’s my go-to. She was fine for the first few days, but then she started dragging her leg behind her, like Quasimodo. I took her to Urgent Care. We had the kind of insurance which required her to have a referral from her primary care physician. You know, a PPO. Or is that an HMO or an HBO Max? So, I took the gimp to Urgent Care.

Sitting in the waiting room, we saw the usual suspects. The kid with a runny nose, the guy with a knife in his eye. You know, everyday stuff. Finally, after a few hours, her number was called. Once in the exam room, the nurse took her vitals and ordered a chest X-ray. You know, insurance protocol. The nurse said she’d broken the metatarsal bone of her little toe. Now we needed an ortho guy. It just so happens he had an office upstairs. What a smart doctor. He had an office right next to Urgent Care. No need to chase the ambulance. They come to you. He looked at the X-ray and said exactly one word. Yup. His bill was $17,000. Next up was the young lady who put on the cast. She was twelve.

I’m reliving this story because of the absurdity of medical insurance. So, after several hours on the phone, I reached a so-called claims specialist. The one trained in insurance-speak.

‘There’s nothing I can do, sir. You didn’t have a referral from your Primary Care Provider.’

‘We weren’t planning on her breaking her foot.’

‘I’d be happy to send you the twelve million pages of your policy, sir.’

‘Oh, my supervisor?’ ‘She’s been dead for a year now but still taking phone calls.’

Luckily for our medical insurance company, they’d recorded the supervisor’s voice. She always said the same things anyway.

Finally, I got to someone who fixed everything. Apparently, there’s a clause on page 856 that says in case of emergency. . .

Claim approved. Next, we got the bills. Not just one bill but five separate ones. The facility sent us a bill, as did the nurse, doctor, x-ray technician, radiologist, and cast girl. All the folks we saw that day sent us a separate invoice. What do you mean the ortho guy wasn’t ‘in network?’ Well, that’s a different copay.

None of these people are really private contractors. They are indentured servants of the medical insurance complex. This is socialized medicine. Not socialized by the government. But something bigger and more powerful—Kaiser, Humana, Aetna, and Blue Cross Blue Shield. The list goes on and on.

We ran into this problem again when Lillian was due for a mammogram. She did her homework. She researched different X-ray joints and selected one that assured her they were in our network. The facility was, but the Pakistani radiologist who read her films was not. Lillian got a bill for seventy-three dollars. For several years we refused to pay the bill. We complained, wrote letters, and worked the phone harder than an NPR telethon. Nothing. Her credit score dropped to -645. Finally, we relented.

The medical-industrial complex rules the world.

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