Some Thoughts on Medical Costs

I did something stupid at 3 AM on Sunday.  I heard a sound I could not identify and decided to get out of bed and explore the house.  In retrospect, I’m pretty sure the noise was coming from outside through the open bedroom window.  But, I wasn’t sufficiently convinced of that to stop my exploration.  Finding nothing amiss on the main floor, I decided to check out the lower level…we did just get a new furnace.

I must have stepped off the top step as I reached for the light switch, and the next thing I knew I had tumbled down two steps to the landing that goes into the garage.  Both of my ankles rolled, and I heard a snapping sound first in the left one and then in the right.  My husband heard me cry out and came running to pick me up.

First decision:  Do I go to the ER in the middle of the night or do I crawl back into bed?  Is this a life-threatening situation?  No…it is not.  Can I bear weight?  It is painful, but I can hobble back to bed.  Is anything to be gained by rushing to the ER now as opposed to evaluating the situation in the light of day?  Nothing…except a whole lot of expense!  Seeking care at an ER when you could receive the same care at a doctor’s office or urgent care is a bad financial decision.  You may argue, “But, I have insurance.”  Right, but you pay for that insurance, and choosing to use a more expensive type of care does effect what we pay in the long run.

So in the morning, I still had pain on weight-bearing and with flexion, extension and toe-curling.  But, it was Sunday.  Can I wait until tomorrow?  Sure.  I will take some naproxen and spend the day with my feet up.  Once again…this is not a life-threatening situation.  If you are having chest pain, for goodness sake, go to the ER!  In fact, call an ambulance to get there.

Today I went to an orthopedic doctor and had X-rays.  There wasn’t much choice about that.  The evaluation was necessary.  No fractures showed up on the X-rays, but the doctor said both ankles were sprained and ordered a brace.  She suggested that I could get one brace and alternate back and forth between the two ankles or get two braces.  I was told they would call my insurance company….it will only take a few minutes….and a nurse would come back with the brace. 

Several issues emerged.  They were short-staffed and unable to make the call right away.  Could I come back and get the brace later in the day.  In the process of trying to decide that, I asked how much the brace was going to cost.  I have seen ankle braces in drug stores for less than $30, and we would pass a drug store on the way home.  The answer:  $125.  What?!  Can I see the brace?  Sure.  It had quite a bit to it….laces, Velcro straps, plastic stays in the side to stabilize the ankle…but still….$125? 

The nurse then suggested she could give me a paper prescription and I could take it to a drug store or medical supply company.  That struck me as a good idea, because I could comparison shop.  When she gave me the paper prescription, it specified a left ankle brace.  So…if the right and left are different, how am I going to alternate back and forth?

We stopped at a drug store on the way home.  They did not have the specific brace prescribed but had one for $17.99.  I figured that was good enough for the ankle that was the least injured, so I got it.  My husband suggested that I wear it on the most injured side for a bit and see if it helped adequately.  If it did, he would go back and get a second one.  I decided it didn’t support well enough for the more injured ankle, but it was fine for the lesser injured ankle.  Then I started to make phone calls.

One orthopedic supply business had them in stock, but they would cost $94 and I would have to pay it and try to bill the insurance company myself.

Another medical supply business, had them in stock, but did not participate with my insurance.  However, I could buy one for $45.

A third place, a drug store, admitted that they bill insurance companies a bit over $100 for the brace, and would sell it to me for $95 dollars if I came in with a prescription, but have the identical thing on a rack out in the store for $45.  No prescription required.

I suppose most people would obtain this brace in some way that guarantees the insurance company is billed.  I paid the $45 because I can’t stand the rip-off of the same item being billed for as much as $125.  Of course, I wouldn’t have known any of this except that the doctor’s office was too short staffed to get the authorization immediately.  That is the only thing that caused me to start asking questions.

I am certain this sort of thing happens all the time.  Medical care costs way more than it needs to cost.  We are not wise consumers.  Why on earth would you pay $125 for anything you can get for $45?

The Cure for Anxiety

…no good thing will he withhold from them that walk uprightly…Psalm 84:11

I see so many people with anxiety over various things they think they desperately need….a car, a house, a different job, a smart phone, a game system, a drink, a romantic partner.  That desperation is a pathology.  It is not wrong to have goals in life and work toward them.  Some of those goals might very well be acquiring material things or a relationship with someone, but anything that is more important to us than our relationship with God is an idol, and it is wrong…W-R-O-N-G!  That sick attitude causes people to lie, cheat and attempt to manipulate outcomes to gain their purposes.  It causes poor decisions.  We humans never know all the factors with which we are dealing.  We don’t know what will happen tomorrow.  Our decision-making process is crippled by these limitations.

If we love God with all our heart, soul and mind, and we are developing our relationship with him, we don’t need a single thing, and we can rely on Him to plan our future.  He has promised us that if our focus is right, He will see to it that we have every GOOD thing.  That does not mean everything we desire, but it truly does mean everything that is actually good for us.

Those of us who have attempted to live this way can testify that we have wanted some things, NOT gotten them, and then later discovered that we ended up with something far better than what we thought was so important.  Sometimes putting God’s will first has saved us the trouble and sorrow our desire would have caused had we obtained it.

How does one go about convincing someone else of that?

I can share that God has done this in my life, but I know I can’t talk anyone else into it.  This is where faith comes in.  By some miraculous combination of our faith and God’s grace, we step out into life believing that because He made us, He knows what we need and will provide it.  He is God and will keep His promises.  I have been relying on His promises for 65 years, 5 months and 18 days of my 73 years minus 4 days. 

If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him! 

Matthew 7:11

On a Dull Gray Day

The neutral banality of our days,

Lulls us into a monotonous routine.

We fall into habits which become ruts.

Time rolls along with little fluctuation.

We do not live in anticipation.

All unknown to us, change is taking place.

Behind the scenes, with only subtle clues,

Earth-shattering events are being planned.

Giant puzzle pieces are falling into place.

We are oblivious.

Until….

Lightning strikes.

The wall comes down.

The towers fall.

Cancer happens.

A loved one dies.

A volcano erupts.

The dam breaks.

Our world ends…or

The world ends.

The sky rips from east to west.

A trumpet sounds, and He returns to reign.

Unexpected on a routine day,

A gray nothing sort of day is electrified,

And bursts into a full spectrum of radiance.

Will we be caught off-guard….empty-handed?

To Infinity and Beyond

This morning, I was pondering the fact that every child is unique.  My father used to say that the trouble with parenting is that you are always an amateur.  Each child presents unique challenges, as well as times of joy and pride.  As I followed this rabbit trail in my mind, I ended up smiling over the following story.

One night when my son was about six years old, he called out to me shortly after he had gone to bed.

“Mom, would you come and lay down with me for a few minutes?”

As I laid down, I could feel the tension…the agitation…in his body.

He immediately began to talk.  “Now, Mom, I know that a thousand has three zeroes, a million has six, and a billion has nine, but what comes after that?”

“A trillion has twelve,” I replied.

“But, Mom, what comes after that?”

“A quadrillion has fifteen.”

“But, Mom, what comes after that?”

Ah, I thought…this poor child has figured out that no matter how big the number, you can always add another zero.  Numbers go on infinitely, but how could one possibly learn an infinite number of words to describe them?

I said, “Oh, sweetheart, please don’t worry about this.  There is something called the powers of ten that makes this easy.  Ten has one zero, so it is the first power of ten or we can say ‘ten to the first.’  One hundred has two zeroes, so that is ten to the second.  One thousand has three zeroes, so….”

He interrupted me, “And so on?”

“Yes, and so on.”

He sighed with relief, “Oh, thank you!”

I could feel his body relaxing as we lay there side by side.  Within sixty seconds, the deep breathing of sleep began.

I stayed there for a few minutes, smiling up at the ceiling, and thinking about what had just happened.

How does a child that age even think of such a thing?  What other concepts is he exploring?  

Twenty-five years have passed.  The child is now a senior software engineer at a major tech firm.  The project he works on is used by over a billion….yes, that is nine zeroes….people.  Sometimes he talks to me excitedly about what he is currently doing, and I am the one struggling.

“Oh….I wish I understood this well enough to just ask one intelligent question!”

Compared to my mind, his has gone to infinity and beyond.  Isn’t that what we hope for as parents?  That our children will surpass us?  That they will travel new roads….paths we may have never even imagined?

Short Term Pleasure-Long Term Misery

I don’t know his name, but I see him frequently standing on the same corner, and I know why he is there.

He is a maintenance worker for the school district, and no smoking is allowed on school property.  I don’t know how many times a day he does it, but he walks across the street from the maintenance facility and stands out in the cold smoking.  He is slender and past middle age, and he actually looks rather miserable shivering there with his cigarette.

I feel sorry for him.  I don’t know if he defiantly refuses to quit smoking, or if he is too addicted to escape the clutches of nicotine.  I wonder how far he is from emphysema or lung cancer.  As a nurse, I have seen people die of these diseases.  Some of them have insisted that it was not related to cigarettes.  I know of those who have quit smoking and a few years later died of lung cancer, because it was too late.  One of my own uncles always said he could quit any time and would if he ever needed to do so.  He developed lung cancer and did quit, but it was too late to save his life.  I had a neighbor whose COPD was so bad that he could no longer walk from the garage to the house without stopping to lean on the fence and rest, but he thought all those studies linking his condition to cigarettes were falsified.

I have never in my life smoked a single cigarette, but I do not feel self-righteous about this.  The idea of holding and manipulating a cigarette is actually attractive to me.  I grew up around it, and it seems like a perfectly normal thing.  I wish there was a type of cigarette that could be smoked that was beneficial.

I also recognize that I am not free from the risk of lung cancer.  Recent studies show an increased likelihood of lung cancer in those who have been exposed to cigarette smoke while their lungs were developing.  At one point in my life, I lived with five…yes, that is five…smokers who smoked in the house. 

I was born in 1945 and my Dad was in France fighting in World War II.  My mother and I lived with her parents.  When the war ended, it took men some time to find jobs and become reestablished, so we continued to live with my grandparents, as did all three of my mother’s brothers.  My three uncles, my Dad and my Grandfather all smoked. 

For the first 7 years of my life, we moved in and out of my grandparents’ home.  My mother was bedridden during a pregnancy, and we moved back in with them, so Grandma could care for my Mother.  Grandma had some illnesses, and we moved back in, so Mom could take care of her.  We lived with them when we were between homes.  We moved out for good when I was six, and my Dad smoked until about the time of my seventh birthday.  My developing lungs were exposed to a cloud of carcinogens for the first seven years of my life.

All of these smokers in my life professed great love for me, and I don’t doubt that love.  The dangers of smoking were not clearly understood in the 1940s and 50s.  Although they are understood now, many people are trapped.  Some don’t care.  Some shiver in the cold clutching the nail to their own coffin or their child’s.

Cigarettes= short term pleasure and long term misery.

Role Reversal

I often think of my Mom this time of year.  Specifically, she comes to mind in connection with Easter, because of the year she was in the hospital at Easter time.  She had had a heart attack with symptoms beginning on Palm Sunday, and so, as Easter approached she was in a Progressive Care Unit.  Most of my family is musically inclined, so on the evening before Easter we gathered in her room to “Easter Carol.”  It was like Christmas caroling, but with Easter hymns.  After we had sung several songs to her with various family members harmonizing and sounding very like a choir, a nurse came in and asked us if we would consider singing for another patient on the unit who would appreciate a concert….so we did.  This is one of the more pleasant memories I have of times my Mom was hospitalized.

This morning I was also thinking of some of the other times.

When I was twenty and came home from college for Christmas vacation, my mother was in the hospital having had a pulmonary embolism.  She survived, but she was very ill.  This was the first occasion when my mother’s needs and concerns took precedence over mine in our conversations.  Growing up, I had gotten used to my Mom asking questions and being interesting in my life.  This time, she didn’t ask much about my life and concerns and talked in detail about what had happened to her.  It wasn’t inappropriate for her to do so, but it was a wake-up call to me.  My mother was going to age, and someday I might end up as her care-taker.

Decades later, this became a reality.  In her seventies, she fell and broke her arm in four places.  She was terribly uncomfortable in the ER.  No position seemed to give her any ease.  Finally, I stood next to the ER stretcher and said, “Mom, lean against me.”  I supported her against my chest and shoulder.

She said, “You don’t want to have to stand here for hours holding me.”

I replied with a sassy smile, “Don’t tell me what I want to do!”

I thought to myself about all the nights she had probably held me as a child when I was sick.  I thought of how I had held my own children all night long, if they were ill, and it was the only way they could sleep.  I imagined she had done the same for me.  If I had to stand there supporting her for hours, I was going to do it.  Payback….I thought.

A few years later, she had a massive stroke and could do nothing for herself.  We moved her into our home for the last five months of her life.  This necessitated round the clock care.  We did eventually hire someone to come in at night, but near the end, one person could not turn her by themselves, so a family member was always sleeping nearby ready to be awakened when needed.  She could not be left alone, so even running out to get groceries had to be planned ahead.  She had to be fed soft foods.  I even bought some baby foods to give her in addition to yogurt and meals I put in the blender.  I had to do everything for her….as she had once done for me.

No parent wants his or her child to experience this role reversal.  We all wish to be independent.  Most of us would wish not to be any “trouble” to anyone else.  I knew that my Mom felt that way.  Her ability to communicate was greatly compromised in those last few months, but she tried to express her concern for me and our family.  She repeatedly begged my Dad to take her home…. “We can manage,” she would tell him, but he knew they couldn’t.

For my Mom’s sake, I would wish those last five months had not happened.  Sometimes people say that offering such care is a “privilege.”  I hesitate to use that word, because I wish my Mom had been spared that time.  However, from my perspective, there is no resentment or regret.

I owed her every minute of that care…..every backrub, every spoon of tomato soup, every linen change, every minute of lost sleep, the “tennis elbow” I got from lifting her, the restrictions on my comings and goings….I owed her every bit of it.

Perhaps these thoughts are more appropriate for Mother’s Day, but they are happening today.

The Rock

One of my daughters is taking a college course and had to write a paper on “The Stranger” by Camus.  I have been discussing it with her.  The main premise of the book is the meaninglessness of life.  This is tied to the main character’s atheism.  Whether or not one can find meaning in life without God is a topic that appears in many books on both atheism and theism.  As a teenager, I might well have committed suicide out of intellectual despair, if I had not believed that there was a God who had a plan for my life.  If there is no God and no plan, then why bother?  In any event, it reminded me of a poem I wrote nearly 40 years ago.

Sifting, drifting, so elusive,

Time runs through my hands.

Ever-changing, mist and cloudlike,

All my grandest plans.

Let me catch you, flitting, floating,

Butterfly of dreams.

Grasping, clasping, cannot hold you.

Life is only sunbeams.

Panting, puffing, running after,

Cannot catch my youth.

Puzzle, ponder and still wonder,

Where and what is truth?

Is there meaning?  Are there answers?

A key to fit the lock?

Tell me, is there something solid?

Is God Himself the Rock?