Friday, January 10, 2020

With Medicare, required doctor visits for refills -- are they excessive and profit driven?


OK, I got the runaround getting a prescription refilled for arthritis medication.  I hadn’t kept up with their on-line app at the orthopedics specialist, and CVS told me refill was denied.

I call, get put on hold for 15 minutes, and I’m finally told I have to come in once a year now for refills.  Fortunately, they had a spot open for one of the assisting physicians.

So this is how Medicare works.  They want the appointments, the visits, the chance to charge $150 for fifteen minutes work. I try to be responsible, not overuse services, not go down the rabbit hole of doctors.

I have a feeling the same thing would happen with Medicare for All.  I suppose this is what happens in Canada’s single payer, too.

The warnings online for heart disease certainly set up cycles of visits.  Stress tests, catheritizations, maybe Holter monitors (maybe the Apple watch can do that now without the depilation). 

  
Seriously, especially in women, you can have advanced heart disease with relatively vague symptoms.  With a stent, you can usually be home and back to work pretty quickly.  But with a lower left coronary artery, or when there are many arteries compromised, or if they have become brittle, people can suddenly face “emergency coronary bypass surgery” (like David Letterman did in 2000).  That was pretty much happened with mother in 1999 at age 85 with severe angina.  There is usually a several week-long disruption including SNF care (the keyhole operation is possible).   As Regins Philbin said, they crack you open like a lobster (and that will please Jordan Peterson pr even Yorgos Lanthimos).  The Cleveland Clinic has a video noting at the end that patients didn’t realize how badly they felt before the radical surgery. But (except for mammary artery grafts) they don't last forever.

Princeton notes that the stress test only catches disease where plaque itself blocks most of the artery (where as many heart attacks occur when smaller blockages rupture suddenly). 

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