I’m lucky I’m not dead

I’m about to make a big stink today. It’s about the abuse of the medical system by everyone at the expense of the patients. Insurance companies rip us off because they can and because the medical industry sees a free-for-all, grab-it-all while you can environment that’s only going to get better (for them) while Donald Trump is in office.

You may have already read my story about the Korean medical system where I ended up face down in the middle of a six-lane highway in Seoul South Korea and how my ambulance trip to the hospital and subsequent CAT scan, X-Rays and drugs cost me a whopping $328. Once I was home further x-rays, MRI’s, and other diagnostic tools together with a dozen doctors visits likely cost someone close to $10,000. In the end, of course, It’ll cost me in hiked premiums.

But I’m not here to complain about the cost of old injuries (they still hurt), I’m here to complain about something far more trivial, a fungal infection on my right thumb. It looks ugly. After a year of painting the nail with an over the counter potion whose only effect was to peel the nail down to bare skin without killing the fungus, I figured I should see a doctor. I called my doctor and asked if they could prescribe some drugs that might cure this ailment. 
For something as serious as this, I was told, drugs could not be prescribed over the phone. I would have to make an appointment a week hence. On the appointed day I drove the 45 minutes to the doctor’s office. Yes, 45 minutes. I live just outside of Boston Massachusetts, the medical capital of the world, so I’m told. How bad can it be elsewhere? I have to drive this distance because my insurance provider converted to a PPO, which means I am only allowed to go to doctors within the Partners Health Care system. I’ve had to abandon several perfectly good doctors in my neighborhood because of this. 
I arrive early but the doctor, or rather the nurse practitioner (In 3 years I’ve met “my doctor” exactly once) is running half an hour late, it’s only 10:00 AM. When she arrives, she takes a quick look at my nail and says, you’ll have to see a dermatologist, we can’t handle this. Luckily there is a dermatologist across the hall and, with luck, they might be able to see me immediately. I pay my $15 co-pay and walk across the hall. I’m sure the doctor’s office billed my insurance company around $500 for my 30-second visit.

It must be my lucky day, the dermatologist can see me in an hour. I pay my $15 co-pay there too. I’m sure the dermatologist also billed my insurance another $500. It seems that the pills that are able to kill nail fungus also kill ones’ liver. Not a good outcome so blood tests are required to be sure my liver is strong enough to handle these medications. I’ll need a blood test before I can proceed. So back across the hall I go for a blood test. I sit and wait then take the results back across the hall. (I’ll take a guess that this blood test cost another $500.)

It appears that my liver enzymes are a little elevated (I’ve got to buy more expensive Scotch so I’ll drink less) but not so high as to preclude the pills. There is a catch, however. Isn’t there always. A one months’ supply costs $2700 and the doctor doesn’t think my insurance will cover it. She leaves the room to check. They don’t. The other choice is a balm that can be liberally spread on the affected nail and in a couple of months it might cure the fungal infection and has no adverse effects on my liver. The balm only costs $600, my co-payment is a mere $240. I go to the pharmacy where I discover the doctor had ordered enough balm to cover my nail for the next fifteen years.

So what did all these doctors and the pharmacy charge my insurance carrier? Two doctors visits, ~$1000, a blood test, another $500 and a huge tube of white glop with only 1% active ingredient, $600 or a total cost for one fungus filled fingernail of about $2130. I’ll bet that in Korea (or Canada) it might cost $50. That balm better work or I’ll be back.