A Tale of Two Cares: Over & Under

“The government is not making a conscious effort to counterbalance my overcare with my wife’s undercare. But that’s no comfort to me.”—Sanford Rose

Dolors & Sense

By Sanford Rose

KISSIMMEE Florida—(Weekly Hubris)—1/6/2014—I got a call from the office of my primary-care doctor the other day.

“You must come in for a visit.”

“Why? I’m not sick.”

“It’s compulsory. Your insurance requires one every six months.”

I think: This is counterintuitive. No insurance company on God’s green Earth would mandate doctor visits when they aren’t necessary. Not at $175 a visit.

Then I say to myself: Why not go? There is no co-pay for visits to a PCP in my Medicare plan. And my doctor is a very pleasant and unusually knowledgeable gent.

Besides, I’ve some impacted wax in my ears. He can clean it out.

I went.

The above is a microcosm of a basic cause of the country’s astronomical health bill: overcare for some, grounded in perverse incentives.

For the doctor, fee for services, even when such services are, to apply the kindest construction, peripheral to the patient’s general health.

For me, no need to monitor the bills I am rendering to the general taxpayer.

But not to worry, I said to myself, with heavy but bitter irony, my overcare is being counterbalanced by the undercare given my spouse.

She went for a routine check of her pacemaker recently.

“You must come in for a visit.”

“What’s the problem?”

“Your pacemaker recorded an episode of atrial fibrillation lasting six hours six months ago.”

When she tells me this, I think: Atrial fibrillation is not necessarily life threatening, but neither is it exactly benign. It carries a substantial risk of stroke (see last week’s posting). Yet this country does not underwrite or subsidize the transportation of data in real time from devices such as my wife’s pacemaker to a central processing facility, which then can alert her cardiologist, with luck, in slightly less than six months.

So off she goes, belatedly, to the cardiologist, who frightens the hell out of her by saying she is at substantial risk of stroke because she almost assuredly will have further episodes of Afib.

What does that worthy prescribe? Nothing, at least initially, besides blood thinners to reduce stroke risk. That is, nothing to prevent a recurrence of the fibrillation that the esteemed doctor said was probably inevitable.

Of course, my wife is currently on medications that may, and may not, control her crucial ventricular rate, if not her less important atrial rate. Still, there are other drugs that purport to fight Afib, as well as much more efficacious electrical methods of restoring the heart’s natural rhythm.

Maybe my wife is not a candidate for these therapies.

Or maybe she is one of millions of the aged who have been rationed out of costly therapies—those on whom the system has already in effect “pulled the plug.”

The government is not making a conscious effort to counterbalance my overcare with my wife’s undercare. But that’s no comfort to me.