Anti-Vaxxers

One of the two people that died of measles in Pennsylvania was an infant.

All the anti-vaxxers who inquire (in bad faith) that if we have our measles vaccine, why do we care if others don't get it? Since we'll be protected by our magic shot, right?

This is why. Infants who are too young* for the vaccine can get the measles, and they are more likely to die of it than those of a more robust age. (Like six, which was when I got the measles. Not the shot. The actual disease. I lived before the vaccine was available, when children were still dying from the disease. About 200 kids died of it that year in America.)

“The real vulnerability is in infants between 6 and 11 months of age, as maternal antibody is waning and they haven’t gotten their first dose of the MMR vaccine,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Dallas.

In places where infants have a high risk of measles exposure, health authorities sometimes recommend an early dose of the vaccine for babies starting at 6 months old. That was the case during an outbreak in Texas last year, when two unvaccinated girls died of the disease.

Other people have immunological issues. They too can catch the measles. Some people, like me, lived before the measles vaccine was available and may never have caught the disease. Sure, they're likely to be old, so maybe anti-vaxxers don't care if they die. They didn't care during COVID, when "only" old people and people with immunological problems were likely to die of the virus. (Like my father, who was in his 80s, and had dementia. Who cares if he dies, right?)

These people have shrugged off the bonds of community. They aren't part of the community, they are declaring. Often they have their own insular (and whackaloon) community they have decided to belong to instead. That's their right, here in America.

But they're despicable all the same.

*12-15 months for the first shot, and a booster at ages 4-6

Medicare: A Review

Dr Skull and I are now on Medicare and for the most part it is great.

We have Part A, Part B, Part D and Part G. This last is a supplemental insurance that covers the Medicare "gap." Part B and Part G cost us $$ every month, as does Part D, though the part D is like $4/month, so that's not a big deal.

Part B and Part G cost us, together, a total of about $600/month. That's about what I paid for my insurance through the university, and it is indeed more than I really want to pay. 

On the other hand, with my university insurance, I paid that much, the university *also* paid that much, and when we saw a doctor, or bought medication, or spent a few days in the hospital, there was always a co-pay and there was always a deductible before insurance started paying anything (deductible of $7000/year in my last years on the job). 

Then once insurance *did* start paying, they only paid 80%, and only 80% of some things, not everything. Some things they would not pay for at all. This included my kid's top surgery, for example, and for a very long time, Dr Skull's CPAP or sleep studies. (They did start paying for those after Obamacare passed.)

Medicare costs us that $600/month every month, or $7200/year, but then everything is covered. No deductible. No co-pay. He spent four days in the hospital with cellulitis and now we have a home health nurse coming three times a week to deal with his wound and he's on three different antibiotics and yesterday we had to go to urgent care and the cost to us has been nothing. Not a penny.

In a sane society, this would be how health care would work. There would be a cost, yes, which ideally would be paid through taxes but whatever, let there be a cost. And then the medical system would cover everything. 

How does this change our medical experience? We're not afraid to go to the ER, for example. Usually I would have agreeded with Dr Skull that we should "wait and see" with his cellulitus. That's what we did when he had osteomyelitis in his foot. That resulted in a week-long stay and amputation of his toe. This time we had a four day stay, IV antibiotics, and he's healing well, whereas if we had waited, amputation or death by sepsis were possible outcomes.

In the long run, there is less cost to the end user and less cost to the system as well, not to mention a healthier population. This matters for everyone's health and pursuit of happiness, but it also matters for national defense, for example. And for our education system, and for our national prosperity. Sick and frightened people aren't able to be educated, aren't innovative, aren't good soldiers or good scientists or good artists.

Why don't we have this sort of medical system? Well, because the GOP has convinced bigots and the ignorant that if health care is available to everyone at a no cost at point of service, then black people and poor people and "those" people will get medical care, which currently is restricted to people "like us." You know, the way it should be.

That's why conservatives share those horror stories of people having to wait for medical care in Canada or England. Months! Months people have to wait for medical care! Or about doctors being rude to patients in places with nationalized health care. 

People shouldn't have to wait for the health care they need or want, that's the moral to all their fables. What they mean, of course, is people like us shouldn't have to wait.  Doctors shouldn't speak sharply to people like us. People like us shouldn't have to sit in waiting rooms as if we were people like that.

Those poor people or those brown people or those immigrants, well, that's different. If they have to wait for health care, or do without health care because they can't afford it, they should have been born rich. Or married rich. Whichever.

The reason our medicare experience is so good, by the way, is because we can afford that $600/month. If we could not, if we weren't people like us, if we had only Medicare Part A (the part that is free) things would be very different. After Part B is taken out of our Social Security, we're getting $2771/month, both of us, together.  There would be no way we could afford Medicare Part G at $278/month, which covers the gap, on $2771/month, if we didn't have our TIAA pension and my father's money to keep us middle-class.

So great health care system, for people who can afford it. 

Argh American Healthcare

I chipped a tooth, so I needed a dental appointment. Getting one turned out to be surprisingly easy -- I got in a noon today.

Riding that high, I decided to set up an appointment for Dr. Skull with a PCP. 

That turned out to be a nightmare. It took me three hours and calls to several local doctors before I found one who would just make me a damn appointment (which is a month away). Everyone else wanted me to fill out reams of paperwork, so that they could decide whether to accept him as a patient, and warned me that even if they did accept him, the first appointment would be at least a couple months out.

Oddly, I've been told only places with universal health care/single-payer systems have this sort of problem. How strange!

The Final Bill (Maybe)

So I was sick in December, as all y'all who read regularly know. It was a kidney stone, or actually several kidney stones. This is not an unusual medical event. Most of us can count on having some minor medical emergency like this at some point in our lives.

I have insurance. I get it through my university, and along with the extra fee for dental insurance, it costs me about $600/month. That's a little over $7000/year, or about ten percent of my pre-tax income.

I had to be hospitalized twice, and I had four separate "procedures," as they're called. Twice the stones were pulverized with sonic rays (or however they did it) and twice I had stents put in, and during the last procedure, the stent was removed. Multiple X-Rays, a CT-Scan, drugs.

After a $1200/deductible, the insurance covered 80% of the costs. Since part of the treatment happened in 2019 and part in 2020, I paid the deductible twice.

I made payments going into the hospital, and some coming out -- these were small payments, maybe $300 total.

Today I just finished setting up all the payment plans to pay off the rest of what I owe.

The hospital: I will pay $137/month over the next 18 months.
The urologist: I will pay $75/month over the next 18 months.
Anesthesiologists, etc: I will pay $50/month for the next 18 months.

Also, I had an abscessed tooth a few months ago. I am paying $100/month for the next 12 months on that.

This means, for the next year, I will be paying $362/month in medical payments, plus the $600/insurance. (For six months after that, I will be paying $262/month.)

That's almost 20 percent of my income in medical payments.

Good thing we don't have single-payer health care. Think how poor I would be then!





(Oh -- and here's a twist. In Arkansas, it's illegal for healthcare providers to charge interest on the debt you owe them. In the past, that meant someone like me could pay off the debt at a relatively reasonable rate -- I could pay maybe $50/month to the hospital, and $50 to the urologist, and so on. But now if you can't pay the debt off in under 18 months, hospitals and doctors just sell your debt to collection agencies, who sue you, and charge you high interest rates, plus "fees" -- or else garnish your wages. USA! We're NUmber One!)

The Greatest Healthcare System in the WORLD

So obviously I have terrible health insurance. We all know that.

For the past six or eight years, our administration had been giving us a $1000 discount on our health insurance if we complete a "wellness check" in November. (Basically a check on our BP and other details.)

In the past, doctors came to the university and did the check there. The last two years, we've been told to see our primary care physicians for the check.

You can imagine the paperwork this generates, as well as the opportunity for errors.

This year, I get to be one of the errors! I went to my PCP in November for a wellness check, but somehow the insurance company has decided that my visit didn't count as a wellness check. No discount for me!

There's a way to appeal, but I'm not optimistic, since the insurance company is the final arbiter, and I can see them letting go of $1000. Not likely.

Also: the sheer amount of paperwork that this nonsense generates has to cost a ton of money. That's why American health care costs so much -- administrative costs.

The Story of my Illness

I probably ought to wait a week or so to write this, given that I'm not yet out of the dark woods. But I'm so much better than I was.

Kidney stones, as I said earlier, started all this.

I have two massive stones, and they jammed up in my urethra, which just for the record I do not recommend. Not only does this cause pain beyond comprehension, it also will cause urine to back up into the kidney, causing it to swell (and also hurt amazingly) and sooner or later begin to die.

This is why when you go to the ER with kidney stones, they get you in right away, organ death being nothing to fuck with. (The people at the ER were great, by the way, even the second time, when I went in on Saturday night, when they were swamped.)

The first time, they kept me two days, putting in a stent (bypassing the stones, as they thought) while also giving me IV morphine and fluids. I went home and was better for maybe three days, though still very sick.

Then very rapidly I deteriorated, with non-stop vomiting, more pain, and a general feeling I can't even describe to you. I've never felt that bad. As it turned out, this was because my kidneys were, in fact, shutting down. (Again, do not recommend.)

Back to the ER, where they admitted me once again. The urologist guy I'd seen while I was out came by at four a.m. (everything in hospitals happens at night) to tell me the CT and ultrasound showed the stones jammed up against the top of the stent, blocking it. They had to put a new stent in.

"I thought they did lithotripsy," I said. "I thought they broke up the stones."

"Not yet," he said grimly. Apparently the entire state of Arkansas has one lithotripsy machine and it won't be at this hospital until December 27th (when I'm scheduled to have it done). Good thing we don't have socialized medicine, huh? Some people might have to risk their lives waiting for proper care.

Anyway, they gave me more morphine and fluids, put in a new stent, threading it past the stones this time, and sent me home to wait until the machine is available. Since the stent isn't blocked by the stones now, my kidney function is improving, and I'm feeling much better.

On the other hand, I spent the past two weeks either vomiting or queasy, unable to eat anything at all (literally -- I tried to eat a cracker and couldn't manage), so I'm down 12 pounds and so weak I can barely walk out to the mailbox.

Looking back (1) I should have gone to the ER much sooner, except I was still hoping I would pass the stone on my own and (B) I should have gone back to the ER much, much sooner.

But given how much all this is going to cost (the hospital $$$ person has nicely set us up with a payment plan, as they will), yeah.

My Big Question...

...is how are these people getting such cheap health insurance?

Ours costs nearly $7000/year with dental and vision, and that's subsidized by the UA system. That's for the family plan. And that is with a serious yearly deductible (nearly $6000 a year) and co-pays on almost everything. As I've noted before, that deductible means, in practice, that we can't really use the health insurance, since we can't afford the co-pays for anything at all.

Apparently we've got really crappy health insurance.

ETA: Or apparently those numbers are bullshit

The Kid and Single-Payer Heath Care

So over on Twitter, that place, some clever fiscal conservative made a crack about single-payer health care not being a workable solution because Americans are so fat and lazy.

Meanwhile, about ten days ago, the kid got what we thought was the flu. Well, at first we thought it was a cold. When they* tweeted me asking was it normal for their fingernails to be blue and their hands to be numb, I made them go to the clinic. At this point, I was mostly worried about it being a really bad flu or even pneumonia.

There, the PA ran tests, several of which came back with disquieting results. She sent the kid for a CT. The CT came back showing a "nodule" in the lower right lobe of the kid's lung.

More CT scan, a full chest this time. More blood tests. The kid's ANA is slightly off. Her liver readings are slightly off. Does she have an autoimmune disease? Is it something worse? Who knows?**

We're seeing an autoimmune guy next week.

Meanwhile, because we don't have single payer, and because the American healthcare system is useless and horrible, not only do we get to live through days and weeks of anxiety, we also get charged thousands of dollars. (Our deductible, before the insurance kicks in, is $3000 per person. This is after we pay on the order of $7000/year for health insurance, plus a $35/co-pay every time we visit our PCP -- God forbid we need to see a specialist.)

But yeah. Americans are fat and lazy. That's the problem with our healthcare system.


*The kid is, as many of your know, genderfluid, and has asked for they/them pronouns. I know y'all will support them!

**It may well be nothing at all. This is what we are hoping for, and my friends in the healthcare profession have given me good reason to hope for this outcome. But of course we must follow up on it -- and despite what these free market conservatives would have you believe, it is not like we can fucking shop around, looking for a clinic that will charge us just a little less for a CT scan, maybe over there in Oklahoma?

So, This Happened (TW: medical procedure)

I may have mentioned my ulcer.

I've got this ulcer, caused by my hiatal hernia, caused by having a baby -- well, by being pregnant.

What's This Good News WUT?

Just back from the Endodonist, who tells me he is fairly sure I do not need a root canal after all.

"Let's put a temporary crown on it for four to six weeks," he says.

"Keep an eye on it," he says.

"But I think it's going to be fine.  Then we'll put on the permanent crown," he says. "Eighty percent chance everything will be straight from there.  How's that sound?"

"Wut?" I said. "Yes!" I said.

"You look like you just got a reprieve from the Governor," he said.

American Medicine: Best In the World

So I have to get this root canal, right?

Luckily I have dental insurance. Right?

Except in July my kid had her wisdom teeth taken out.  Which I paid for with my Health Savings Account.

Ai.

American health insurance being what it is, when you use it, you're fucked.  (Apparently you're supposed to have it, not use it.)  I used the benefit card that came with my HSA, which triggered this audit function, and froze the card.  Since July, y'all, I've been fighting with the HSA company about the $625.00 co-pay which was our share of having the kid's wisdom teeth removed.

The HSA benefit card is still frozen.  Oh, and our deductible is still not yet met.  (Yes, even after paying $625 in July.) So Tuesday I have to go in for this root canal and pay $258.00 (my share of the root canal) out of pocket.  I have it in the HSA, but I can't access it, because the benefits card is still frozen.

(Why is it still frozen?  Because the insurance company -- yes, the same insurance company that controls the benefits card -- had not, until about a week ago, issued the EOB on the wisdom tooth question.  Now it has, but it will take four to six weeks to unfreeze the benefits card.  Explain to me one time why socialized medicine is worse than this?)

Then next week, I will have to pay out $421 dollars for my ulcer procedure.

Did I mention we owe almost $2000 in back taxes?

MURICA!

Toxic Ignorance

So a town not far from my town has finally -- finally -- made the decision to add fluoride to its water supply.

This is a big deal for Arkansas.  In 2011, our governor made it a law that all cities and towns with populations over 5,000 people had to add fluoride to their water. (A great many did not, up to then, including my charming city of residence: we're supposed to have it starting in November 2015.)

Giving the appalling lack of dental care in Arkansas -- this is partly due to poverty, and partly due to a serious lack of dentists -- you'd think anything that improved people's teeth would be welcome.

But that just shows you don't know Arkansasans.

This Post Comes To Y9o From The Stratosphere

Good news, y'all.

I saw the surgeon today! And wow. Did he give me some good drugs or what.

No, wait. That's not how I meant to start this.

But yeah! Give it up for doctors who do give sufficient pain medication.

Also: I have to say this was the best clinic experience I've ever had.

Listen to this: I walked in there with a 9:00 a.m. appointment and, bitches, not only was I back with doctor by 9:00 a.m., I had already -- by then -- had an X-Ray done, talked to two nurses, and been whisked through receiving and insurance. I mean, yowza.

Every step of the way, also, each nurse and tech led me directly to the next step; and each one was very kind about doing so. And when I got to the examination room, the tech that led me there brought up the X-Rays I had done (about three minutes before) on the computer in that examine room. It was like medicine as art, I have to say.

Or, you know, like seeing medicine done the way it ought to be done in the 21st century.

Then the surgeon appeared, maybe three minutes after the nurse had left me, and talked to me about being an English professor, and then he showed me the X-Rays and told me what they might mean, and what they might not, and then he outlined what we could do, and then he asked what I wanted to do.

Then he scheduled an arthroscopy --what we decided to do -- for (get this) six days from now.

And told me he'd call in script for pain meds, no problem.

I left the clinic thinking I must have fallen into a alternate universe.

This can't be American medicine?