Luxury Beach Lifestyle Information

Is is any wonder that people are leaving the country to retire?  If I retired tomorrow (or the first day I was eligible for Social Security income), my health insurance (before Medicare was available) would cost me more than half my Social Security check, every month.  If I moved to Costa Rica, my health care insurance would cost me about 1 tenth of one month’s Social Security check for the entire year!  I could also build a two story all concrete construction house for about US$50,000 with 3 bedrooms, add a second bathroom and some upgrades, plus a double garage for about another US$10,000, and taxes would cost me a whopping $45 a year on such a property.

Now, it is true, I’ve been thinking a lot about moving to Costa Rica, or Roatan (in Honduras) or possibly the beautiful little island country of St. Kitts and Nevis (2 islands, 1 country).  But the oppressive heat of Arizona summers are not the only thing hastening my departure.  The medical system in this country is full of amazingly good doctors (not that there are not good doctors in most countries), but the way in which medicine is “practiced” is anything but healthy.

This week alone, I have seen two glaring examples of what makes healthcare cost ten times what it does in other countries, well, three if you count the cost of brand name drugs (versus generic drugs).  The most recent was in trying to get a prescription of my own re-filled.  Notice that is RE-filled, not a new prescription, but one I have been taking for some time, and for which the “supply chain” has been working for something close to a year without major incident.  Suddenly on of several prescriptions in an order reaches the end of the authorized refills.  As they say in Britain, that’s when it looked as if someone threw a spanner in the works.

Actually, I suppose it was reasonable caution on the part of a doctor who said, “Okay, we’ll give him one more 90 day refill, but then he has to come in for a checkup. ”  Not so unreasonable generally speaking.  Everyone should have some kind of checkin or check-up with their physician at least once a year.  However in my case, I am seeing a specialist for one condition, as well as my primary care physician, and then an gastroenterologist for an annual checkup due to some minor surgery a couple of years ago.  How much “doctoring” does one man need (who still walks around without falling down, getting lost [not too often, anyway], or bleeding from his wounds)?

Of course, it didn’t help this situation, in my case, that my usual primary care physician was away for a couple of weeks, so my prior primary care physician, a highly accredited doctor with a Canadian education and a cautious nature too boot, was the one responsible.  That is not to say, “to blame,” necessarily.  The wheels really fell off the wagon when the fax hit the pharmacy after I had placed my refill request in the highly efficient manner of a web form, that actually got 2 of the three medicines winging their way to me with all due haste.

But the pharmacy “interpreted” the PCP’s (that’s Primary Care Physician in “pharmacy speak”) as being a denial, so they sent me an email saying, we can’t fulfill that order, the other drugs are on the way, but call us to find out what happened.  I might as well have called a blind person for a description of the collision of the cars on the nearest major intersection.  He or she could probably have been more succinct, and more accurate.

So the point is, that after 4 calls to the (mail-order) pharmacy, and 3 calls to my primary care physician’s offices to speak to the assist (of no particular acceditation or status, other than pleasant and trying to be helpful, and it was actually 3 different people) they say they’ll send it again, but I have to come in for an appoinment AND the soonest that can happen is not until next Monday, at which time I will be seeing my former PCP’s Physician’s Assistant, also a lovely helpful, even thoughtful and kind man, but several most days of delay until a resolution comes.  Ah, but my story isn’t over yet (and I don’t just mean, wait for a Monday update) because there is a whole other, even greater example of how marvelously (malevolently?) inefficient healthcare can get in this country.

You see my mother-in-law has been quite ill lately.  A couple of hospital visits, in which x-rays, ct-scans (more than one) and at least one MRI, have revealed that a slip and fall cracked a vertebra in her spine (L4, to be exact).  So after 2 hospital visits the first an emergency room only cursory look, (but with x-rays and CT-scan), the second with MRI and 3 days stay, she arrives at a licensed care facility (which at 99 seems a reasonable choice) (although she’s been through 2 rounds of “hospice care” in the expectation that she had less than 90 days left to live both 4 and 3 years ago, I believe it was).  The licensed care facility is not only depressing and a little scary, but not well suited to her needs which include being legally blind, and nearly deaf in both ears (I think she exaggerates that, she hears me pretty well, it’s her daughters she seems to need to have repeat themselves).  So in the second licensed care facility, they arrange for PT (physical therapy) which only aggravate the spine, the compression fracture and the woman attached thereto.

So, they send her off to a “pain clinic” where the doctor seems disinclined to waste his time on someone so old, at least according to my wife’s report of her observations of the visit.  The next day, it is off to an osteopathic doctor, who also turns out to be a Physician’s Assistant (which, by the way, is nearly equivalent to a doctor in this state, although he/she practices under the supervision an approval of the doctor to whom he/she is attached, a good feature of Arizona medical practice in my opinion).  She, in this case, is a magnificent woman who exudes confidence and recommends a “camp corset” to relieve back pain, along with a bone growth nasal spray (yes, really, legitimate, mainstream medicine for bones in a nasal spray) and “home” she goes to the care facility again.  (Actually there is a prolonged procedure of waiting to be “seen” at a durable medical goods dealer without an appointment to get her the “camp corset”, on the way back to her temporary quarters.)

No sooner do we arrive there, than a Licensed Nurse Practitioner (again, a partner of a doctor, like a PA) suggests transdermal pain patches for the patient’s spine.  This is after 5 doctors or equivalents (or more) because the narcotic pain reliever is insufficient to allow her to even sleep comfortably.  The next day, the patient (my mother-in-law, remember, even I tend to dissociate from the personal when discussing medical information) is in such pain she is hysterical and yelling at the staff.  The staff agree to call the LNP to get her a calming prescription.  They call.

They leave a message with the answering service.

The answering service calls the LNP with this “urgent” message, and they leave another message on her home answering machine.

The daughter calls the care facility.  ”Oh yes, we called that in.”  Hours later “mother” confirms she has had no additional pill.  Another call to the care facility, another call to the LNP, intercepted by the answering service to say that they left a message previously, but if it is urgent they will try to contact her directly.  Finally word gets through to the LNP, and she calls to confirm that she has ordered the pill for “mother”.   Another hour passes and …

The licensed care desk says yes the pill was ordered, but the order was faxed to a pharmacy 52 miles from the facility and will be DELIVERED BY MESSENGER from there.  That is pill: Quantity One (1) hand delivered because it is “urgently” needed (from about 6 hours earlier).

And that, ladies and gentlemen of the jury, is why, in Arizona I pay nearly US$600 per MONTH for health insurance for one person, age 60, when I could instead pay US$130 per YEAR for a family of 4 with a view of the Caribbean thrown in.