The Bureaucracy of Healthcare

My friend “George”, whom I have written about before, had a real eye opener this past week. George suffers from Membranous Nephropathy (MN), and has been told repeatedly by his nephrologist that he will ultimately die from the disorder. George’s kidneys are shutting down, and he is on peritoneal dialysis (PD). Due to complications from bariatric surgery and the placing of the PD tube in his abdomen, George has been prone to bouts of clostridium difficile (C. diff). Since he was diagnosed with MN, two years ago, I can recall at least four different occasions where George has had C. diff.

Each time he develops C. diff. he ends up in the hospital for several days, having become dehydrated, weak, and unable to keep any food down. The doctors and nurses load him up with IV antibodies, rehydrate him and send him on his way with a prescription for oral vancomycin. The vancomycin is the only antibiotic that cures his C. diff., and is one that the doctors have prescribed each time he has been hospitalized.  Ten days ago, he was back in the hospital with C. diff., and again sent home with his script for vancomycin.  Only this time there was a complication.

George’s prescription this time was written after January 1st.  That means that new rules are now in place on how medications will be prescribed and filled.  You see, George, since he is dying, and cannot work, is on Medicare and Medicaid, and while vancomycin is HIS doctor’s preferred drug of choice to treat George’s C. diff., it is not Medicare or Medicaid’s.  A fourteen-day course of treatment with vancomycin costs around $1,800.  When we took the script to have it filled, the pharmacy waited two days to let us know that vancomycin was no longer a Medicare/Medicaid approved drug.  It had been in 2012, but now with the new regulations that took effect in 2013, it was bumped from the list – too costly.  It took another two days, and a dozen phone calls between us, the doctor, and the unseen person at the Medicaid office to finally get approval.  The long and short of it is simple.  George had to go four days without his oral antibiotic, after having been dosed for three days with an IV course of the same medication.  If you read the medication bottles, or know anything about antibiotics, then you know you have to complete the course of treatment completely.  Otherwise, you are at risk of a rebound infection that may be worse.  We are hoping that will not be the case with George.

Another surprise that George got at the beginning of the year came when he went to get other medications refilled.  He has been on lorazepam and diazepam for the past several years.  One is longer acting, and the other is for when he gets acute panic attacks.  Several psychologists and psychiatrists have seen him, and they have all agreed that, given his current medical condition, it was prudent to keep him on both medications.  However, when he tried to get his prescription refilled, he was denied both prescriptions.  So round we went again between the doctors, the unseen voice at the Medicaid office and us.  The reason for the denial?  He must be drug seeking!  My question to the voice behind the curtain is simple.  How can he be drug seeking when all of his prescriptions are coming from the same doctors?  It is not as if he has a script written by Dr. Smith, and another by Dr. Jones.  Dr. Jones wrote both scripts.

Over the past year and a half, I have tried to document what I have gone through in dealing with public healthcare.  I have written about the weeks and months waiting for an appointment or test, the endless waits at clinic offices, the challenges of not seeing the same doctor more than a couple of times due to rotations.  These all occurred before the full implementation of the Patient Protection and Affordable Care Act (PPACA).  Now the PPACA is moving into its next phase, and things will get more complicated.  Medications that MY doctor and I have decided are best for me may not be available to me.  I was having a discussion on-line with a relative, and his comment was that these stories are anecdotal, and do not reflect how the PPACA will improve medical care in the U.S.  We will not know the true impact of the PPACA until it is fully implemented, but from what I have experienced over the past three years, and from what I saw firsthand so far this year, I am not hopeful.

There already was a long wait for treatments in the public healthcare system.  With the PPACA coming more on-line and 33 million more patients hitting the system, my question is simple.  How long before the medical system is so over loaded that it can no longer be sustained?  People want to tout the European system, or Cuba, or some other country with socialized medicine, but they forget to add one very important point.  The countries they are holding up as examples do not have the population that we have here in the United States.  The U.S. has approximately 350 million residents.  Cuba – 11 million.  Great Britain – 62 million.  Canada – 34 million.  Combined, these three counties have a third of the population that we have in the U.S.

Medical reform needs to be done, I will be the first to say that, and support comprehensive reform of the system.  However, I fear for those of us that are at the mercy of public healthcare and the way it is looking to shape up under the PPACA.  How many people will suffer or die because of the bureaucracy of healthcare?


About Joseph Ordower

I'm a middle aged, some would say curmudgeon, who is sick, tired and truly frustrated with the way things are going in a country (America) that he loves, honors and respects.
This entry was posted in Medical Profession, PPACA, Public healthcare and tagged , , , . Bookmark the permalink.

2 Responses to The Bureaucracy of Healthcare

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