Life's Little Injustices (Take XVIII): Medicine As A Business (Sticker Shock Strikes Again)

<"Watch Out For Falling Bills...

Take I"/The Reckoner>

<i.>

You'd think I'd learned my lesson by now. Last spring, I'd been waiting on a procedure that I desperately needed, to make some "south of the border" improvements near my groin area. I'd reached the point where delay wasn't an option anymore. I was supposed to undergo it last November, only to have it KO'd twice -- once, due to COVID-19, the other, due to scheduling issues with the doctor. 

A freak ice storm pushed the date back yet again, from February 1, to April 22 (see my previous entry, "Life's Little Injustices (Take XVII): Medicine As A Business (You Gotta Love It)"). One more postponement followed, for scheduling reasons.

The May 26 date held, and I underwent the knife for an hour. The doctor only needed to numb the relevant body part, so I was awake the whole time, and didn't feel any pain. I took a couple days off, to ease the recovery process, and went back to work the following Monday.

A $200 bill soon landed on my doormat. I had the cash, so I promptly paid it, figuring it was my portion of the overall cost ($530 and some change). Come July, I received a second bill, for $180, and then, a third, for nearly $90. 

The former statement referenced Some Pathology Practice Or Other, in Toledo, OH. The latter bill contained info at all. 

Wait a minute, I told myself. I know you pay some of these costs for these things out of pocket, but...  I did some quick calculations to see where I stood. Taking these two bills into the equation, I'd end up paying 88 percent! Hmm, that doesn't seem right. What's up with that? I asked myself.

So I did what the pundits tell you. I called the various entities involved, and asked them what's going on, starting with our local hospital, which now owns the urology clinic that did my procedure. (They own everything else that matters here medically, too, but that's another discussion for another day.) 

I also rang up our so-called insurer, who ever returned any of my three calls. That matched what the hospital's customer support staff told me -- they reached out to them, too, but never heard back. Figures, right?

<"Watch Out For Falling Bills...

Take II"/The Reckoner>

<ii.>

July and August gradually faded into September, and now, October, as the big runaround continued. A couple of threatening notices from Some Pathology Practice Or Other landed on my doormat, too. Ironically, though, after months of runaround, I finally got the answer I needed.

Guess what? I'm on the hook for those other amounts, too -- the $90, due to that "out of network" thing. (Mind you, I've never received any info of who's in the network. But I digress. As for the $180? The Billing Department at Some Pathology Practice Or Other told me, "We did send that to your insurer, and they refused to pay it." 

So I'm still paying that 88 percent of the total, or $460. Oh, well, at least I didn't have to pay the entire cost upfront, something that you face constantly, as an uninsured IC (independent contractor). But still...

I'm not faulting any of the billing or customer support departments. They were pretty cordial and professional, and I had no problem getting them to accept the $30 per month I proposed to pay the $180 bill. I don't know how I'll handle the $90 bill yet, but I'm sure I can figure out something.

On one level, it's all good. And yet, on another level, it really isn't so good. Having to pay that 88 percent cost leaves a sour taste in my mouth. Fine, Herr Keaton, I get that it's a business, and you need another designer sweater to grace your already overstuffed hall closet. I'm sure your ex-hippie parents will love it!

Sure, Dr. Huxtable, I know you planned to buy a second Mercedes this year -- for your Roman numeral-entitled offspring. And yes, Mr. Ewing, I'm sure you can buy quite a few boots and 10 gallon hats, once we're all done shelling out 88 percent of your bills. 

<"Watch Out For Falling Medical Bills...

Take III"/The Reckoner>

<iii.>

But you know something? Sure, American medicine is definitely a business, but it's definitely the least efficient, least responsive business I've encountered. I shouldn't have had to burn up four months trying to figure what I was paying, or why.  

In contrast, I remember when Morgan Spurlock did a program on medical tourism. The Thai hospital he visited gave him an itemized bill for the hypothetical procedure that he outlined, down to the last baht. Wow! What a concept, right? Makes me wonder what else they've sussed out ahead of us.

Of course, medicine isn't the only driving force in the big squeeze most of us feel right now. The Squawker and I got a fresh reminder at the store yesterday, where we paid $4.29 for a dozen eggs (Ka-ching!), $7 for a pound of packaged lunch meat (Ka-ching!), and $7 for a package of organic sausages (Ka-ching!).  

Don't worry, though. I'm sure all the endless Biden-related investigations that the Republicans plan, if they retake Congress next month, should reduce all those prices in one fell swoop, right? 

And if you really believe that...I'll let you, Dear Reader, finish the sentence this time. Something's got to give, all right. I'm just tired of it always being me. --The Reckoner

Holidays In The Sun (Ecuador Named Top Retiree Destination)

"Ecuador Rising" (Commissioned Contribution)

A cheep holiday in other peoples misery
I don't wanna holiday in the sun
I wanna go to the new Belsen
I wanna see some history
'cause now I got a reasonable economy

Now I got a reason, now I got a reason
Now I got a reason and I'm still waiting
(The Sex Pistols: "Holidays In The Sun")

Some time ago, we at Ramen Noodle Nation announced nominees for The Cognitive Dissonance Hall of Fame -- specifically, to salute people who appeared to be adept at holding completely opposing views, even if it appeared to make them uncomfortable.  Or, as the gents at Wikipedia like to tell us: "The need to avoid cognitive dissonance may bias one toward a certain decision even though other factors favor an alternative." 

Our shortlist of nominees included a tie between the besieged WikiLeaks founder, Julian Assange, and his newest, hottest patron, President Rafael Correa, of Ecuador, who offered citizenship to the besieged Swede -- a grand gesture that struck us as a trifle odd, coming from a country that prides itself on bankrupting newspapers with defamation lawsuits, hauling journalists through the court process on arbitrary, trumped-up charges, and even breaking into opposing TV newscasts to push the government's version of things.

However, we're proud to inform you that our mock middle-fingered salute to our authoritarian friends in Quito hasn't been in vain.

Now I got a reason, now I got a reason
Now I got a reason and I'm still waiting

Recorded in October 1977, "Holiday In The Sun"'s thunderous broadside against those who watch the locals' misery from afar -- a theme that's memorably captured in the opening line, "A cheap holiday in other people's misery", yet sounds no less relevant today. (The lyrics took on a doubly ironic ring when drummer Paul Cook and guitarist Steve Jones split from their comrades, Johnny Rotten and Sid Vicious, to hang out with former train robber Ronnie Biggs, in Rio de Janeiro, and give him his short-lived bid at punk stardom).

Those lyrics may come back to haunt us in other ways, following International Living's release of its top U.S. retiree destinations.  For those who aren't familiar with the publication, the title does what it says on the tin: if you've ever dreamed of following the likes of Chet Baker, Jim Morrison and other A-listers to a seemingly more glamorous, less economically unforgiving lifestyle, this is the publication for you. Roll the credits, then, for the top five nations:

1. Ecuador: With dinner out costing a mere $2.50, and even potentially pricier propositions peaking at $25 (for a medical visit), it's no wonder that our favorite cognitively dissonant country captured first prize!  According to International Living (which we'll call "IL," for short) it's possible to live on roughly $900 per month -- which, in many places nationwide, is pretty close to what you'd cough up for the privilege of paying a landlord. Ecuador has held the top prize for five years running now.

In fact, IL's comments about Ecuador in general are worth reading, as this nugget from "Reasons To Retire In Ecuador" makes amply clear: ""This is one of the world’s cheapest places to live. Take $250 out of the ATM Monday morning, and your expenses are covered for the week." For the rest of the story, go here: http://internationalliving.com/countries/ecuador/retire/.

2. Panama: This ranking appears to be based mainly on the Pensionado (pensioner) visa, which apparently doesn't take much to get your hands on, and qualifies you for a raft of retiree discounts -- ranging from 10 to 15 percent for consultations and medications, to 50 percent for movies and theaters.  For those of us having to squeeze those Abe Lincoln coins until they scream, that might be an appealing option, no?

3. Malaysia: The only Asian country to make the upper rankings, IL cites its low cost of living ($22.50 for a dental filling and cleaning, versus $180 in the US), ease of integration (translation: you'll literally find hundreds of expats like yourself), and...tellingly...medical costs that are a fraction of those in the U.S.: "Penang and Kuala Lumpur are also medical centers of excellence and every day two planeloads of medical tourists arrive in Malaysia for various treatments. Not only is the health care amazing but it’s among the world’s cheapest. And prescriptions here cost a fifth of what you pay at home."

Now I got a reason, now I got a reason
Now I got a reason and I'm still waiting

4. Mexico: With so much ink being generated about people getting their heads cut off en masse, or wouldbe federale snitches having their knuckles massaged with bolt cutters, it's easy to forget that our southern neighbors are also one of the world's biggest destinations for retirees, and -- once again -- medical tourists, as this comment makes plain: "Across the board, health care—including doctor’s visits, hospital stays, lab tests, and devices—costs a quarter to a half of what you’d pay in the U.S. That’s assuming, of course, that you even pay out of pocket."

5. Costa Rica: Lest we forget, this was the nation that got mentioned in the same breath as the late River Phoenix ("The Vegan James Dean"), who bought 800 acres of endangered rain forest real estate in the Central American nation.  Evidently, his net worth wasn't the only factor, since IL specifically cites the country's low cost of living, large expat community, and -- mind you, this will sound like a broken record -- medical costs that don't approach the stratospheric heights of America's Disease Industrial Complex.

IL's entry mentions a couple who were paying $340 per month on prescriptions, and $1,000 per month for health insurance.  Guess what they're paying in Costa Rica?  As enrollees of the nation's universal healthcare system, Caja, Bob and his wife pay a whopping $49 per month, based on income.  Yet, with the onset of Obamacare, the best option that we get is --.the right to buy insurance, with government subsidies flowing to the people identified as "The Problem," not (ahem) "The Solution."

When you think about contradictions like these, sometimes, you're not sure whether to laugh, or to cry...and yet, the evidence is staring you in the face, regardless. For the rest of the list, and the story, go to this link, and scroll to the bottom: http://internationalliving.com/2012/12/the-worlds-top-retirement-havens-in-2013/.

"Ecuador Rising" (Alternate)

Now I got a reason, now I got a reason
Now I got a reason and I'm still waiting

Contrast the IL survey with the mood here at home, where the discussion primarily focuses on how much less we're going to have of everything, and whether we're ever going to be in a position to retire, as this despairing comment from "Brian" on a recent Yahoo News story on the topic might suggest:

"I think its sad how the media and the rich say to save "more" when I can not save enough to take my family to the movies. In all seriousness, whats the point? Lets say you can save $50 per month; without getting interest you would save a whopping $600 per year. Even with todays prices $600 might last 1-2 weeks; much less in the future where things will be more expencive; $600 wont even last a week. So lets say you save up for 30 years; congrats, you saved $18,000 in todays money. How much do you thing $18,000 will be worth in the year 2043? Unless we get paid more we will be dependant on government support."

And how about this comment, for a bit of historical perspective?:

"Actually myth number 1 should be - 'You will retire'. In a service sector economy retirement is only a dream for most workers.

"Along with competing in 'the global economy' comes living like 'the global economy'. Prepare for 3 and 4 generations of family members to share a small apartment. Prepare to take your children out of school so they can work to help support the family. Your standard of living is eroding and every time you have your wages, hours and benefits slashed the corporate CEO gets a huge bonus."

Funny, isn't it?  Remember when NAFTA passed, and how all its apologists dutifully poo-poohed what presidential candidate Ross Perot prophesied would become "the giant sucking sound" of American jobs headed south of the border?

The chickens have come home to roost, it seems.  Ecuador awaits, and President Correa thanks you for your patronage. Better keep your mouth shut, though, especially if you're planning on writing a letter to the editor...or you'll probably have a government agent kicking down your door in the middle of the night.  Some things never change...even in downtown Quito.  --The Reckoner