Health Care & Insurance is Not a Free Market

As someone who purchases family health insurance not through my employer but as an individual consumer, I have carefully watched the Supreme Court hearings on the Affordable Care Act - pejoratively reviled by insurance holding members of the GOP as "Obamacare." As arguments about the "market" and the commerce clause applicability have been made to the insurance issue, many consumers have frustratedly tried to remind critics, this is not a free market issue. It's not an open market.

And, I have been baffled by the inability of the Obama administration to make this argument both in the public and in the actual court hearing. Now, finally, op-ed writer Donna Dubinsky has effectively and succinctly clarified these concerns:

As best as I can tell, the recent arguments at the Supreme Court did not touch on a critical part of the discussion about government’s role in health care: the broken market for private insurance. It was as if the court forgot that the private insurance market does not function as a normal market. If you are not employed and you want to purchase insurance in the private market, you cannot unilaterally decide to do so. An insurer has to accept you as a customer. And quite often, they don’t. Insurers prefer group plans, with lots of people enrolled to spread the risk. Can you blame them? The individual consumer is a lot of work, is a higher risk, and produces relatively little revenue.

The justices repeatedly asked: If the government can require you to purchase insurance, what else could it require you to do? What are the limiting conditions to this breadth of control?

The government muffed its response. To me, the answer is obvious. There are two simple limiting conditions, both of which must be present: (1) it must be a service or product that everybody must have at some point in their lives and (2) the market for that service or product does not function, meaning that sellers turn away buyers. In other words, you need something, but you may not be able to buy it.

Let’s test the examples presented to the high court: Can the government force you to eat broccoli? This proposition fails on both counts. Nobody must eat broccoli during their lives, and the market for broccoli is normal. If you want broccoli, go buy it. Nothing stops you.

Clearly, these are the issues which drove the move for universal coverage in the first place. And I have significant criticisms of the ACA - especially the mandates it requires for coverage to be provided for free. While I agree colonoscopies and well-visits should be covered - nothing should be for free. The consumer must contribute to the payment for all health services.

But, the private market is in serious trouble. It's not a free market, and no GOP alternatives to the ACA address that disparity.

Republican on Health Care

After visit to the Italian Fest in Denver - and watching people "enjoy" plenty of pizza and cannoli -I felt a slight philosophical shudder, a shift in my political center. All I need to do is go to a food festival or go to the mall or even go to the supermarket, and I feel an urgent need to "go Republican" on health care.

By that I mean, the issue of personal responsibility for health care is becoming more and more significant to me. Americans who give little thought to their diet, exercise, and health are literally costing me money. And, as cold as this may sound, I don't want to pay for their Medicare. And it may not even be about retirement - the poor eating and exercise habits of many Americans are clearly driving up my private sector premiums right now as well.

Obviously, increased demand and consumption - and advancements in technology/treatment - is what is driving up prices. And, on the national level with Medicare, it is only going to get worse. The biggest problem with our deficit is the millions of Baby Boomers who are retiring and signing up for their "all but free" health care for the next twenty or so years. And, let's face it, millions of these people are doing nothing to decrease their health care costs. They're not trying to get off their blood pressure medicine, they're not trying to decrease their risk of coronary hearth disease, they're not doing anything. And, we're going to be paying for it for decades and decades. And that really bothers me.

Now, of course, there is another side to this. I am under no illusion that this problem is entirely the fault of consumers - especially people like me and my family. Insurance companies are posting record profits, and they are jacking up premiums simply because they can. Some state governments are considering legislation that forces companies to spend a set percentage of medical services and lowering premiums. The insurance companies are certainly taking advantage of the fact that we are all terrified of getting cancer or getting in a car accident or tearing our ACL. And, so we could all get amazingly healthy, and the companies might still raise rates.

But, still. With the survival of Medicare in mind, I'm thinking, "Come on, people. Get a clue." Even conservative Bill O'Reilly has argued for years that we all have a interest in the health of others because their behavior directly affects our pocketbook. As much as a the libertarians want to whine when people seek to restrict and regulate consumption of "crap," one man's heart attack or high blood pressure or type II diabetes is certainly my business. So, lay off the fast food people. Period. Enough with the sodas. I'm serious. Stop plying your kids with processed versions of food, and get a clue about a little exercies.

Recently, after I criticized President Obama's jobs plan, I friend of mine said, "You're turning into a Republican." I laughed, knowing it's not about party for me. It's about money.

Now, go take a walk. And ask someone to go with you.

Be Very Afraid of Dr. Watson

Here's food for (disturbing) thought:

WellPoint Insurance plans to use the IBM super-computer "Watson" to assist doctors in diagnosing illnesses. Watson, of course, is the computer known for beating the top Jeopardy! champions at the game of trivia. Now, a major insurance company is counting on the computer's vast resources and lightening speed to provide guidance to doctors as they seek diagnosis and treatment options.

The company spokesperson was quick to assure consumers that patients need not fear that WellPoint will deny care if in making a diagnosis of choosing a treatment option a doctor chooses to ignore the advice of the computer. In those cases, the insurer "will have a clinician review the case." A "clinician"? What the heck does that mean?

Is this an example of "trivializing" health care? Or is that just redundant at this point?

Be afraid people. Be very, very afraid.

Health Care Reform

While I was a little put off by the speed and scope of the Affordable Health Care Act, I am not on the bandwagon for repeal. There is too much good, and necessary, reform in that bill to be repealed. Modification is fine - though the arguments for how to provide access and make sure there is a large enough risk pool to keep costs down is complicated. Eugene Robinson of the Washington Post identifies the keys to the law that should not be compromised:

Already in effect are parts of the reform package that no self-interested politician is going to vote to take away.

No child can be denied insurance coverage because of a pre-existing condition. Coverage can no longer be canceled when the policyholder gets sick. Insurance companies can no longer impose annual or lifetime limits on payments for care. Adult children can remain on their parents' policies until they turn 26. Policyholders cannot be charged extra for seeking urgent care at an emergency room that is not in the insurance company's approved network of providers. Those measures took effect in September. Another set of provisions became law on Saturday: requirements that insurance companies spend a certain percentage of the premiums they collect on actual care; a discount on prescription drugs for some seniors covered by Medicare; a rule that gives seniors free screening for cancer and other diseases.

Republican leaders aren't dumb enough to explicitly propose taking all these benefits away. But Democrats can, and should, force them to have that debate.

Fix it, but stop this nonsense about the symbolic act of a "repeal vote."

Expensive Urgent Care

Several years ago, I took my family off my employer-sponsored health care because the premiums had become astronomical. Even with the district sponsored contribution, my out of pocket expenses for my wife and two was exceeding $12,000 out of pocket. And my family doesn't consume much health care - often not much more than our yearly check-up and immunizations. Thus, we pursued a catastrophic plan for them - with $7000 deductible. So, over the years we have saved a lot in premiums, though we haven't actually had "extra" money to put into the HSA that we qualified for.

It all came around this month when my wife sliced her finger while cutting vegetables. It was bare a half inch long, and not that deep, but it would not stop bleeding for nearly forty-five minutes. So, after a call to the doctor - it was a Sunday evening - we headed off to the urgent care clinic for five stitches. Initially, the clinic was deceptive, as always, about the cost, but we made our insurance situation clear. The clerk took our insurance and said it looked like we simply had a $100 co-pay for this procedure. That would have been nice.

The clinic's bill came this week - the bill is $1,500. For twenty minutes in a room and five stitches. And that doesn't even cover the doctor's bill - we're still waiting on that one. We haven't begun to negotiate, but conventional wisdom says they'll shave off 10-15%.

And that is the problem with American health care.

Limbaugh Prefers Costa Rica's National Health Insurance

Rush Limbaugh has offered this juicy tidbit: if the US Congress passes its health reform bill, he will leave the country. Really? Where will he go?

It's unclear if he'll leave for good, or just to get health care.

Incidentally, he says he'll go to Costa Rica. That's a country with a well respected blend of public and private care that is held together and fueled by national health insurance and national health care mandates.

Interesting.

Ridiculous Comments on Health Care

In the past couple days, conservative talk show host Rush Limbaugh and Colorado Republican Congressman Mike Coffman have been hospitalized - and both have used the incidents to make rather crass and ridiculous statements about the health care situation in America. Limbaugh was hospitalized for chest pains and Coffman broke his ankle. Both responded to the press that they have "tested" the American health care system and found it to be working perfectly.

How crass.

The only thing Limbaugh and Coffman have learned is that the health care system works for people worth $400 million dollars and for Congressmen who have government administered, taxpayer funded health insurance. That health care is available and high quality for the wealthy and upper middle class who have good - and untouchable - benefits has never been in doubt. Coffman, by the way, went on to note that he pursued a second opinion at a specialty clinic, for which he paid the additional $350 out of pocket, and it was "well worth it." That, of course, is not difficult for a man earning a salary of $175,000 of taxpayer-funded salary.

And it is to be expected that Limbaugh to comment this way. However, Coffman's comments are beneath the dignity of his office, and he should consider the many of his constituents who can't afford their premiums, or who have had their insurance eliminated by employers, or who can't get any policies, or who can't afford hundreds of dollars for second opinions.

I voted for Mike Coffman, but I am profoundly disappointed in his flippant, insensitive comments to the media, and I will be letting him know.

Actual Conservative Health Care Reform

Knowing that something happening is going to be better than nothing happening, I'll settle for some version of the Baucus health reform plan, though I'm not completely in favor of it. I'll side with heart surgeon and former senator Bill Frist on that. Ultimately, something as logical as the Healthy Americans Act isn't going to happen, and many provisions in the legislation - like preventing the insurance companies from dropping my family when they get sick - are good ideas. Beyond that, it's a good idea to provide a marketplace where Cigna or Kaiser or United have to offer a plan at a price - as opposed to charging me and my employer five times as much as they do for the same plan to a company across the street.

However, there are other ideas. And they don't have to come from the Democrats. I truly wish the GOP would actually start listening to the smart conservatives in their party and actually use some of the intelligent - not ideological - Republicans and conservatives to present an actual plan for health care reform. Not an idea or a theory or a ideology or a tweak. But an actual plan.

Like this one from conservative Harvard economist Martin Feldstein:

The simplest solution would be for the government to issue a health-care credit card to every family along with the insurance voucher. The credit card would allow the family to charge any medical expenses below the deductible limit, or 15 percent of adjusted gross income. (With its information on card holders, the government is in a good position to be repaid or garnish wages if necessary.) No one would be required to use such a credit card. Individuals could pay cash at the time of care, could use a personal credit card or could arrange credit directly from the provider. But the government-issued credit card would be a back-up to reassure patients and providers that they would always be able to pay.

The combination of the 15 percent of income cap on out-of-pocket health spending and the credit card would solve the three basic problems of America's health-care system. Today's 45 million uninsured would all have coverage. The risk of bankruptcy triggered by large medical bills would be eliminated. And the structure of insurance would no longer be the source of rising health-care costs. All of this would happen without involving the government in the delivery or rationing of health care. It would not increase the national debt or require a rise in tax rates. Now isn't that a better way?

That is market reform that would work, and it would actually accomplish the goal of many conservatives which is to encourage people to understand what their health care actually costs because they are paying for it - not $5 premiums for a high quality plan picked up by the wealthier companies and people in the country.

It's a thought. Any Republicans out there smart enough to run with this?

Senator Graham's Deceit on Health Care

While I generally like much of what Senator Lindsay Graham has to say, I was rather disappointed in his comment on ABC's This Week concerning the "public option" in any health care reform bill. While much debate is necessary, the country can do without truly disingenuous and ideological statements like this.

Graham criticized a proposed system where "the bureaucrat sits between the doctor and the patient" and "you'll wait longer to get treated and you'll get the treatment the government decides for you, not your doctor." How that is any different from a system where "the insurance adjuster or HMO executive or financial manager sits between you and your doctor"? How is that different from "the insurance company or HMO deciding what treatment you get and not your doctor"? How is that different from the current system where I wait seven weeks to see a specialists and a colleague waits a year for an MRI and another for the necessary back surgery?

Clearly, his opposition to the "public option" has validity, but his comments are simply dishonest, and that sort of ideological use of sound-bites doesn't contribute to the discussion. Perhaps the most disturbing aspect of Senator Graham's comments is that he has government-sponsored insurance. Is he having problems with bureaucrats (namely himself) getting between him and his doctor? Is he having his care rationed? Is he letting the government decide which of his treatments are covered? The FEHBP preserves the private sector by allowing providers to bid to a pool of nine million employees, including Congress. Satisfaction with the plan is extremely high - Senator Graham certainly isn't pushing to change his plan.

I hope the Senator will consider revisiting his position on the public option, and seek to build a comprehensive understanding of the issue. He might also consider the reality that polls show 70 - 75% of Americans support the "option" of a government plan, and those statistics include Republicans. Therefore, in the spirit of a democratic republic, I am opposed to Congress refusing to give voters "an option." That doesn't mean people will have to choose it or will want to. But fearing the giving of a choice to voters shows a real lack of faith in the American people.

That said, I am not in favor of a public plan, but I think Senator Graham and the Republicans are missing a real opportunity to offer a comprehensive plan that legally "preserves" the private sector control of providing health care and insurance. This could be found in the bi-partisan Wyden-Bennett Plan, also known as The Healthy Americans Act (HAA). It is, in many ways, an extension of the FEHBP to all Americans where as many as 300 providers bid to serve a pool of 300 million Americans, and people purchase as much or as little as they need. It is a good plan, it resembles all the best parts of the American system, and it blends in the positive qualities of systems such as Switzerland or France.

If nothing else, I hope Senator Graham will answer the questions about his own health insurance and refrain from truly disingenuous and ideological malarky when discussing the issue - or just refrain from talking about it at all. I'd rather he be silent than actively deceiving people.

Health Care Wake-up Call

Congress is "utterly asleep" and "clueless" on the whole health care debate, and the members need a wake-up call about the realities of the system, according to Dr. Jeffrey Feldman, editor of political blog Frameshop, and contributor to the Huffington Post. Ultimately, there is a lot of blowing smoke and soundbites on the issue, as well as entrenched outrage and suspicion. Thus, I am with Dr. Feldman on the need to cut through the politics and solve the problem.

Supposedly, the health care debate is between one group of people who make fortunes via the insanely profitable insurance and pharmaceutical industries and another group of people who want to make sure everybody in American has access to 'affordable' health care. Consider this simple fact: The number of Americans without health care coverage is so big, and has been growing for such a long time, that we can now simply say that the United States is a country with a systemic lack of health care for its citizens.

This is a salient point that needs much honesty. The reality is that America has the best available health care in one of the worst possible systems. And that's just not right. So, how to maintain the quality care without sacrificing it for efficiency and universality.

In a nation with a systemic lack of health care, there is a radical divide between the haves and the have-nots. Those with health care live in a world that is radically different from those who live in a world without it. The haves are able to treat their health like any other good or service in the economy. Because health care is a privilege of income, the haves can go out and buy health care whenever they want, even to the point of excess. And so health care becomes not just a means to feeling better, but a luxury good to be consumed with lavish abandon.

As much as the tone of this can be disconcerting, and it invokes passionate ideological responses, there is much validity to the statement.

Those without health care, by contrast, live in a much different world. For the have-nots, appetite for procedures and pills in the health care market is replaced by constant concern about a future health crisis or incident. Life without health care becomes a constant game of odds making: I if I spend X dollars on this procedure, will I be able to afford Y and Z 18 months down the road? How long, at my age, would it be wise to go uninsured? Can I risk coverage for my children, but not for myself? Is 5 years too long to go without getting a full physical? How about 7? If the lump in my breast does not hurt, can it be that bad? And so on, and so forth. What happens when millions of people spend decades without health care is so shocking and so heartbreaking, that anyone who thinks about it would be instantly offended by the current Congressional debate.

Again, I understand the emotional and ideological hairs going up on the back of some necks. Yet, the only conclusion I can draw is this: It's just not right. This sort of discrepancy and systemic failure is just not right. What the answer is? Well, that's the problem. But the fact is we have a problem. And the realities of today are just not right.

Perspectives on Health Care and Politics

The Denver Post devoted the cover of its Sunday's opinion section to the controversy over plans for a public option on health insurance. Featured were a Canadian clinical psychologist named Rhonda Hackett who focused on "Debunking Canadian Health Care Myths" and a local citizen who asked "What Do We Pay for, Anyway?" Both of these pieces offered important insight and perspective, and simply reinforced the idea that reform is necessary and change is coming. What that is remains to be seen. Of course, there is plenty of evidence that many people who are still clueless about the current system and alternatives. I recently spoke with a man who lambasted national health care and said we should pay for ourselves, ignoring the fact that he has, has always had, and is very satisfied with his veterans benefits.

For some perspective on the public option, there is much debate and commentary going on in the papers and on the blogs, though sifting through it all could take hours, if not days. One notable piece recently featured on the Huffington Post argued "Fixing Health Care Does not Require a bi-partisan Bill - It Does Require a Public Health Insurance Option. Creamer offers some insight into the politics involved when he says, "it won't matter one whit to average Americans whether the bill passed by Congress is "bi-partisan." That's true. He goes on to explain that while the bill may not be bi-partisan, the feelings of country are. For example:

A poll conducted earlier this year by the highly respected Lake Research Partners found that voters overwhelmingly want everyone to have a choice of private health insurance or a public health insurance plan (73%), while just 15% prefer everyone having private health insurance.

And the preference for a choice between public and private health insurance plans extends across all demographic and partisan groups, including Democrats (77%), Independents (79%) and Republicans (63%). So in fact, President Obama's proposal that creates a choice of a public health insurance option is a bi-partisan plan - whether is has "bi-partisan" support in Congress or not.

I'd say Creamer is right especially when he notes:

If private insurers can't compete with an efficient public health insurance plan, they have no business being in the market place. After all, they would be the first to argue that the "private sector" is always more "efficient" than government.

What they're really worried about is that in order to compete they would have to cut massive CEO salaries like the $26 million Cigna paid last year to its CEO - a figure that is 65 times higher than the salary paid to the CEO of the Federal Government - President Obama. Insurance companies are worried that they would have to become more efficient and cut their profit margins in order to compete. Of course from the point of view of the taxpayer, that is one of the major goals of health care reform: to control skyrocketing costs and incentiv-ize efficiency instead of waste.

Health Care Choice

According to the Denver Post, Howard Dean was in town on Friday stumping for health care reform:

Howard Dean, calling himself a "counterweight to the insurance industry," rallied a Denver crowd Wednesday to push for a public, government-subsidized insurance option for all ages. The former chairman of the Democratic National Committee, who is traveling the country to talk about health care reform, said Americans also should have the option of keeping their private insurance.

Of course, if Dean really wants to help the Obama administration's efforts, he didn't do them any favors when he says things like, "Republicans try to act like it's some kind of socialist, communist plot. Welcome to socialized medicine. It's called Medicare." People don't want to see socialized medicine - they want to see national health insurance. People want the doctors and the hospitals and the drug companies operating in the free market where the consumer has choices on who he sees and what he's willing to pay for. They perceive "socialized medicine" as single-payer systems in Canada and Britain where the doctors work for the government. That won't fly here. And Obama didn't help himself when he recently said of reform, "If we don't get it done this year, we're not going to get it done." Not a good idea to throw down ultimatums. We don't like being scared or threatened, and we want change, but not hasty change.

Thus, I am still baffled by the Administration's refusal to offer consumers another "choice" with a logical blend of public and private care. This is best exemplified by the Healthy Americans Act - also known as the Wyden-Bennett plan - or the extension of FEHBP - Federal Employee Health Benefits Plan - to all Americans. In these systems, the free market exists and health care providers bid to serve a pool of 300 million Americans. Each person can choose to purchase as much or as little as he needs or wants, but no one is denied access. No one is forced to give up his doctor - as I was in our current private employer-based system - and all medical decisions remain between the doctor and patient.

The problem for critics of Dean and Obama is that the country wants change, and it will come, and if conservatives are not careful, they could end up with single-payer simply because they provided no logical alternative that maintains the free market. HAA and FEHBP do this. Let's get on it.

Health Insurance Industry Cuts Costs, Too

WASHINGTON — A major health insurer says the government can save more than $500 billion in Medicare spending by sending patients to less expensive, more efficient doctors; reducing hospital visits by the elderly; and cutting unnecessary care.

Those are among 15 suggestions made Wednesday by UnitedHealth Group Inc., a Minnesota-based health-management company that is the biggest participant in the government's Medicare insurance program for the elderly.

So, when the government talks about cutting health care costs by avoiding wasteful and superfluous spending, it's "rationing," but when private industry does it, it's just efficient and good business?

Rational Health Care Reform

The health care debate continued to rage last week in Colorado when a sub-committee in the state house voted on a bill to move to a state-wide single-payer system. This is surprising in a traditionally libertarian place like Colorado, though it is understandable as the state turns more Democratic and voters continue to lose faith with the current system and the lack of a viable alternative. Vincent Carroll of the Denver Post's Editorial Board responded with a typical ideologically conservative commentary that was long of criticism and scare tactics, yet predictably short on alternative proposals. Though I was disappointed to see him immediately resort to the "red flag, talking-point" of rationing, I was pleased to see his concession that the current system already rations care based on ability to pay into the private system. Reform critics claim that single-payer would lead to rationing and prevent people from seeing their own doctors, as well as turn medical decisions over to a bureaucrat. However, that is already true. My employer-based coverage cost me my personal physician, and specialist care is limited. Decision are not simply left up to me and my physician; they are vetted through the administration of the insurance company. Conservative critics who cite those as effects of single-payer are fools. That situation is the essence of the private system as it exists. For, far worse than a cost-cutting bureaucrat (whose bosses are still responsible to voters) focused on budgets, is a cost-cutting executive focused on profits. Insurance companies are in the business of collecting premiums and denying claims.

As Colorado attempts a move to single-payer, I am hoping they will take a more pragmatic approach and blend the public-private system as many countries do, and as we currently do for nine million federal employees. Thus, I hope Mr. Carroll will consider researching and writing about options that would do this, and alleviate the need for states to push for a single-payer system. A good place to start is the Healthy Americans Act, also known as the Wyden-Bennett plan. It is an adaptation and extension of the logical move of extending FEHBP (Federal Employees Plan) to all Americans. In FEHBP, there are more than 250 providers that competitively bid to cover federal employees. Employees are given the choice to purchase as much or as little coverage as they need, but all are guaranteed some basic coverage. Obviously, large pools lower cost, and if a pool of nine million employees works, then a pool of 300 million would work even better. An extension of FEHBP to all Americans is the best and most logical reform, the the HAA is a good second-best.

As Mr. Carroll notes, reform is necessary, and it will come. As the private sector eliminates more people from coverage, the masses will eventually take what they can get. And having lived under it for five years, I can say with all honesty that national health care is far better than being un-insured in this county. Thus, I urge the Denver Post to research and write extensively about plans, such as the HAA or the FEHBP, that blend public and private. I have contacted my congressional candidates and representatives about this, and I hope more people will as they become aware of it. Otherwise, we will be stuck with a system that the masses begrudgingly accept.

Health Care; Health Care

As the dawning of the Obama administration nears, there is much hope for systemic change, not the least among it being health care reform. Not since 1993 has there been such hope for developments in this perplexing industry that accounts for 16% of the nation's GDP. Morton Kondracke weighed in today with a comprehensive op-ed piece which attempts to address all the variables. However, I'm not entirely sure what to make of the piece other than noting the habitual scare-tactic ranting about the evils of the Canadian system. That aspect of the commentary saddens me, as it implies that any nationalized system would inherently mimic the style and the problems of Canadian or British health care systems. This ignores the possibility that the United States could do something better, or even emulate systems that blend public and private health care, as they do in Germany, Sweden, Switzerland, etc. I also suspect that this is one more case of a pundit criticizing something about which he has no personal experience. I have rarely met critics of foreign health care systems who have actually lived under those systems. More likely, they are wealthy individuals who have yet to feel the pain of increasing premiums and decreasing benefits. I am still holding out for a blended system that offers all Americans a base health insurance while allowing for the purchase of additional private coverage. At this point, I see the Wyden-Bennett plan as being the most feasible, and I hope it will continue to generate support.

Health Care Debacle

It's the health care system, Stupid.

Currently, I carry a low-premium (not really that low) high deductible, catastrophic health care plan for my family because the family coverage through my employer is not only cost-prohibitive, but it would require that my children give up the pediatrician they've always known.  I remembering hearing that as a major criticism of the Clinton nationalized health care system, yet, alas, here it is in the same old system we're stuck with.  And, considering that my children are incredibly healthy - that is, in six years they have only seen the doctor for their yearly well visits - my wife and I concluded this is the best plan.  Though it's far from optimum, and here's why.

On vacation this summer, my daughter developed an ear infection (first time for any serious sickness) and we were faced with the issue of finding a doctor.  Normally, for ear infections there is little that can be done, and we weren't going to go with any antibiotics.  However, we had been out in rural Wisconsin, where the kids were playing in the woods which are known for ticks, and we were a little worried that something had crawled in her ear.  All we wanted was a nurse or doctor to take a look, so we visited the Urgent Care Clinic of Anderson Hospital in Maryville, Illinois.  After a quick look from a physician's assistant, followed by an even quicker look from the doctor, our fears of a tick were relieved, and we left.  The ear cleared up in a couple days.

Fast forward to a couple weeks ago when we received a bill from the hospital for $200, which is not covered by our insurance.  We negotiated that down to $160, though we were still livid, having expected it to be half that.  However, the situation got worse when we received an additional bill for another $150 from the doctor who is apparently represented by Midwest Emergency Management, Inc.  Needless to say, we are completely baffled by this ridiculous billing, and our negative opinion of health care continues to grow.  For me, at this point, future elections may be all about health care.