How the Republican Party is losing me

I tend to lean to the right. For as long as I understood what it meant to be conservative or liberal, Republican or Democrat, I called myself a conservative Republican. In college, I wrote a newspaper column for 3 1/2 years brashly titled "No Left Turns."

In last year’s primary, I voted for Ron Paul for a couple of reasons. One, a lot of things he said made sense. Two, at least he sincerely believed in the things he said that didn’t make sense. And three, he’s a doctor. When Ron Paul predictably didn’t get the nomination, I voted against John McCain and for a Democrat, Barack Obama. The main reason was health care.I come from a long line of Republicans. My great great great grandfather, Dr. Edward Andrew Farquhar, helped the Republican Party get organized in the state of Ohio prior to the Civil War. My great grandfather, Ralph Farquhar, worked for the powerful Ohio Republican Marcus Alonzo Hanna. And my dad was three things: outspoken, Republican, and a doctor. Sometimes the order varied.

In 1992, Dad was very much against Hillary Clinton’s health care plan, but he was very much in favor of some kind of health care reform. The system desperately needed it, even then. Rarely did a week go by without Dad getting an angry letter from one of his patients. The story was always the same. Patient comes to Dad seeking treatment. Dad treats patient. Patient gets better. Dad bills insurance company. Insurance company denies claim. Patient can’t afford to pay.

The only variance was the patient’s understanding of what happened. Sometimes the patient was mad at Dad. Sometimes the patient wanted Dad’s help. All too frequently, what happened was Dad just didn’t get paid. The insurance provider–be it Medicare, Medicaid, or private insurance–wasn’t going to budge. The patient legitimately couldn’t pay the bill. Dad could press, but if the patient paid, the patient would go hungry. If Dad didn’t bill, Dad wouldn’t go hungry. Dad had a soul, so Dad would do what people who have souls do and just tear up the bill.

Someone had to give a crap about these people. Unfortunately sometimes Dad was the only one.

Dad told me once that if I decided to become a doctor, he would lock me away for seven years. Being a doctor is a family tradition. Dad thought there were better things for me to do than spend my life messing with computers, but being a doctor wasn’t one of them. He wanted me to have a better life than he had.

Dad died of a heart attack in 1994, aged 51. Had the health care system allowed him to practice medicine and stayed out of his way, I’m sure he would have lived longer. Maybe he would have been still been alive when my grandmother and father in law needed him.

Fast-forward to 2006. My wife was pregnant, but having a hard time of it. Extreme nausea was keeping her almost bedridden some days. Her doctor found one and only one anti-nausea drug that would work, a treatment normally given to cancer patients. Our insurance was willing to pay for it once. When her 30-day supply was exhausted, the doctor tried every treatment that the insurance company was willing to pay for, but none of them worked. She fell into a vicious cycle of dehydration and nausea. One built on the other, and she ended up hospitalized.

The drug cost about $80 a week to just buy outright. I bought a week’s supply to keep her out of the hospital for a week while I figured out what to do next. The doctor knew I was unhappy. I asked him if it would do any good to get a lawyer and sue the insurance company. I was serious and he knew it. He said he wished someone would do that, but if it was me, the only thing I’d accomplish would be getting some face time on CNN and meanwhile we still wouldn’t have the medicine we needed.

This is the free market compassion that Rush Limbaugh spouts about. I’ve yet to figure out what’s compassionate about cutting off a woman’s medicine so she has to go into the hospital. The insurance company will pay for part of her hospitalization, but not the medicine that keeps her out of the hospital. Oh, and while she’s in the hospital, she can’t work.

Writing some letters succeeded in getting her the medicine she needed. And my employer, to its credit, changed insurance plans the next year, to something that takes better care of people.

Unfortunately, this year I found myself working for a very large company that operated as its own insurer in order to keep the profits to itself. And that company quickly decided that my wife was using too much insulin and my son was using too many vaccines. Their doctors disagreed, but they’re only doctors. What do they know about profits?

One day, after getting yet another denial claim in the mail, I ran into a former coworker in a parking lot. He asked how things were going. I told him, then asked if my old company had any job openings. A month later, I was working for my old company again, with the only health coverage I’ve ever seen that actually covers what I need it to cover. When they offered me the job, I had to think for a whole two seconds before accepting.

Most people can’t do what I did. On paper, pretty much every health insurance plan I’ve ever had pretty much looked the same. But like I said, there’s only been one that ever covered much of anything.

And pretty much any old insurance plan works for me, because I rarely use it. As long as I visit a chiropractor every six or seven weeks or so, I have no health issues. I could save a lot of money by declining coverage entirely and just paying the chiropractor out of pocket.

But my wife has to go to the doctor more often. So does my son. Me paying into the system and getting next to nothing out of it covers for them, who pay into the system and take back out a much higher percentage of what they paid in.

The only companies who aren’t jealous of health insurance companies’ profits are the oil companies. Since 2000, their profits are up more than 400 percent. But year after year, more and more people find it harder to get health coverage.

The system has a good racket going, frankly. Food companies sell poisonous food to the unwitting (or apathetic) masses. The masses get sick and have to go to the doctor more. Doctors give them pills for their problems, but the problems get worse because they keep eating poisonous food. Eventually they develop diabetes or cancer, at which point the insurance company can cut off coverage.

Everyone makes lots of money in the meantime. Except for the consumer-turned-patient, who pays out more and more every year, then eventually ends up with a chronic and painful disease.

I’m not saying it’s a conspiracy. Not at all. The free market just found something that works really well for the people in power. It’s a beautiful system–for those who benefit.

Unfortunately that same system hurts people. I live with two people it hurts. And the system killed my dad.

Sometimes the market needs a referee. That referee is called regulation. And since the Republican Party isn’t willing to regulate, I voted for a Democrat that I knew would press the issue.

Actually what I expected was for Obama and the Democrats to push some kind of socialized medicine, and Republicans to counter with something like the German system, which is all private but highly regulated. You don’t hear much about the German system, mostly because it works pretty well.

That’s what I favor.

Some people may wonder why I care, since I have good coverage now. But if you think the plan I have will last forever, you’re smoking crack. Eventually the plan will get too expensive. Or the company could get bought out, or it could lose the contract I’m on. There are any number of things that could put me right back where I was a couple of months ago.

I’d much rather fix the system. I might need it someday, but not only that, I actually have a soul, and I’m tired of seeing other people suffering.

If that makes me a moderate rather than a conservative, so be it. If it means I’m no longer a Republican, well, some things are more important than labels and party affiliations.

Why I quit my job

Today, some 10 years and 11 months since the last time I did it, I left a job on my own terms. I called my boss, asked to see him, and walked to his office with a single-page letter in hand.

It’s not something I’m especially good at, and, being a fixer by nature, it’s not something I’m usually inclined to do. And while there are several things about this job that I won’t miss at all, my main reason for leaving is health care.At first it was an annoyance. I went to the chiropractor. I go once every six weeks or so. I don’t have horrible problems, but a tuneup every few weeks makes everything work better. My old employer sent me a letter of encouragement when I started going.

My new employer and its insurer didn’t do that. They just denied the claims. Then they told the doctor’s office one thing and told me another. Way to keep the story straight. The insurer actually encouraged me to negotiate with the doctor and see if she would just take cash under the table instead of using insurance.

Nice.

Aside from that, I rarely go to the doctor. I don’t get sick very often. My cholesterol was off-the-charts good the last time I checked it, and I eat healthier now than I did then. I go when I have reason to go. It could be next month, but it could just as easily be years.

My wife and son go more often than I do. He goes because he’s a year and a half old. My wife goes due to a medical condition. It’s not her fault and she manages it well, but it’s something she has to deal with, and doing so requires regular medical attention.

So every time they go to the doctor, after paying the $30 copay, we get a bill a few weeks later for stuff the insurance company decided not to cover. Usually the bill was three figures. The most offensive thing they refused to cover was my son’s vaccinations.

My employer wanted my son to get polio?

Well, probably not, but that’s the message they sent. Message received.

Compare that to the actions of my previous employer. The insurance company was hassling us over an anti-nausea drug that my wife needed when she was pregnant. I complained to the employer. They made some phone calls and my wife got her medicine. Then, at the end of the year, they changed to an insurance company they’d used in the past, citing better coverage.

That sent a message too. A message I like better.

So when I heard of a job at the previous employer, I sent in a resume. The main reason I work in this field, as opposed to being self-employed, is to provide for my family. My job involves some fighting, mostly to get unwilling computers to do what they’re supposed to do, but sometimes there are political battles too.

To do my job effectively, I need to save my fight for the computers. Ensuring that my son doesn’t get polio in 2009 ought to be a simple matter of making a deduction from my paycheck, taking him to the doctor and making a copayment. I shouldn’t have to fight the insurance company for basic, routine coverage.

I got the call today with an offer. They wanted me back. On top of good health care coverage, they also offered me a raise. That helped too, since I had several reasons to believe I wouldn’t be getting one of those next year.

So I turned in the resignation letter. My boss asked if it was just about money. I told him the health care was the clincher, and I told him about the large bills I was receiving for routine doctor visits. He seemed to understand. He even seemed a little offended.

It ran up the chain. I got a phone call from a high-ranking executive today. He wanted to know what would make me stay. He didn’t like my health care story either. I told him about what my previous and soon to be future employer had done in a similar situation.

He said I wasn’t the only one who had had issues. Now that I’ve thought about it, I’m not sure if that makes me feel better or worse.

He asked if I thought this problem might cause the company to lose other employees. I said I didn’t know, but it wouldn’t surprise me. The system works fine for people who don’t use it much, and most of my coworkers don’t use it much.

The problem is probably fixable, and he offered some solutions. But let’s face it: It’s a little late now. Had the coverage been adequate–it didn’t have to be good, just adequate–then chances are I wouldn’t have gone looking. But now that I have looked, someone’s dangling good, proven health care coverage and the biggest raise I’ve ever gotten in my life in front of me.

Why wouldn’t I take that offer?

He said he wanted me to stay, and I believe it. The only way to do my job well is to do it poorly for a time until you know the ropes. Then you get good, then something beyond your control changes and you say hello to mediocrity for a while, and eventually, hopefully, you adjust and get good at it again. And during those low periods, the phone rings a lot. It’s a painful process for the person doing the work, and it’s a painful process for everyone else directly or indirectly involved.

When I signed on earlier this year, I wanted to stay until retirement. The company put on a good show during in-processing, and, theoretically at least, offers a lot of opportunities to continue and advance your career. Having worked for a couple of different places where layoffs and cutbacks were a yearly tradition, I was looking forward to working for a company that was winning a lot of new business and seemed to have its best days still ahead of it.

It didn’t work out that way. I leave knowing I’m probably giving up some future opportunities. I leave a familiar situation for something different and new. And from the company’s perspective, they lose an experienced veteran who gained the bulk of his training on another company’s dime, and who will potentially be very expensive, and almost certainly very painful to replace.

But hey, they saved having to pay out a couple thousand bucks or so in health care expenses.

How I fought the insurance company and lived to tell about it

My dad was a doctor. Dad told me on several occasions that if I ever came home and said I wanted to follow in his footsteps and become a doctor too, he’d lock me in my room for seven years. One of the reasons for this was because he hated dealing with insurance companies. I vividly remember going out to the mailbox one day and finding a letter addressed to Dr. Farquhar, with a very angry note written on the front of the envelope: PLS LET THE DR READ THE LTR. I asked what this was about, and Dad said insurance was refusing to pay for a patient’s treatment. He said it happened a lot.

Now I’m 33, and my insurance was refusing to pay for treatment my wife needed. The best-case scenario without her medication would have involved numerous hospitalizations. The worst-case scenario? Coma or stroke if a lot of things went wrong. If everything went wrong, death wasn’t out of the question.

Here’s what I did about it.This isn’t exactly how I wanted to tell everyone, but my wife is pregnant. She’s also diabetic, and diabetes and pregnancy aren’t exactly the best combination. It wasn’t long before she was complaining about nausea. That wasn’t anything new; she can get bad nausea at times even when not pregnant. We try to keep a decent supply of Emetrol (or a generic version) on hand because of it. But we didn’t know if it was safe for her to take that while pregnant, so I suggested she ask her doctor. The doctor put her on a generic version of Zofran, a powerful anti-nausea drug.

The difference was like night and day. Without the drug, she couldn’t be up and around for more than 3-4 hours at a time. With the drug, she could function almost normally.

But after a month, the party was over. The insurance company refused to pay for the drug any longer. The doctor protested, but to no avail. So the doctor prescribed alternative anti-nausea drugs.

None of them worked.

She started a rapid decline. Within days, she couldn’t keep food down. Four days after that, she couldn’t even keep water down. She went to the doctor, and her doctor sent her straight to the hospital where she was admitted and treated for dehydration and severe morning sickness (I don’t remember the medical term). They kept her in the hospital overnight.

When her doctor visited, I asked him what to do. He said insurance companies do this all the time.

"Let me get this straight. This guy with no education, who’s never seen her, knows better than you do what’s best for my wife?" I asked.

He said he sees this every day, and he’s sick of it.

"So do I need to look into getting a lawyer and suing this company for malpractice?" I asked. After all, there was at least one time when Dad said a patient needed one treatment, and a different doctor decided to do a different treatment and the patient died. The patient’s family, based on what Dad said, sued the other doctor for malpractice. If a doctor can be sued for practicing medicine badly, why can’t an insurance company be sued when it practices medicine badly?

He said if I did that I’d probably end up on CNN and he’d love to see the public pay that kind of attention to the insurance industry, but it wouldn’t help my wife any.

So I asked about buying the drug outright, without insurance. It was going to cost more than $400 a month. That’s outside of most budgets. I probably could have made it work, by making some cutbacks on food purchases, taking on some extra work, and if all else failed, borrowing some money, but it shouldn’t be necessary. This is why we get insurance in the first place–to cover these kinds of expenses.

So I looked into what it would cost to import the drug from Canada. The best price I found was $330–not much help.

I called my boss and told him what was going on, originally for no reason other than to provide justification for why I wouldn’t be at work the next day. But the more I told him, the more apparent it became that the situation offended him too–and not just because I was missing work over it. And that gave me an idea.

If the situation offended him, then it probably would offend the decision-makers at the company too. I decided I needed to talk to my boss and ask if I would be going over his head by talking to the higher-ups about the situation.

He gave me the OK, so I wrote a letter to my employer’s upper management. It wasn’t very long. In point by point fashion, I described my wife’s medical needs, what the doctor had done about it, what happened after the insurance company stopped paying for the drug, and what risks were involved with my wife not getting the treatment that she needed. I spelled it all out in lay terms. I also tried to be very matter-of-fact about it. They didn’t need my opinions on the matter–the facts spoke for themselves. Nobody would want their wife or daughter to have to go through what my wife was going through. And that was what I was counting on.

My letter climbed up the corporate ladder and over to HR very quickly. Not long after that, the HR director had the insurance company’s representative on the phone. Before the day was over, my wife had her medicine, and by the next day, she had a case manager assigned to her.

I believe this is the only approach that would have worked, and this is why:

1. I have an acquaintance who once worked for an insurance company, in the IT shop. He told me the majority of insurance adjustors who make decisions about what the insurance company will and won’t pay for are frustrated people with minimal education (sometimes just a GED) and they get their jollies by overruling doctors. It’s a power trip, and it’s what gives their lives meaning. Calling up the 800 number on the back of the card and complaining doesn’t do any good because it just proves to them how much power they hold. And calling the number and treating whoever answers the phone to a profanity-laced tirade (or even just asking the person where he or she went to med school) really drives home how much power they hold.

2. I’m just one customer and I have no control. The insurance company doesn’t care if I leave, because all they lose is a bad customer. Remember, customers who pay into the system and don’t take anything back out cause profits to rise. Customers who take money out of the system cause profits to fall. And besides that, I have no say in where my company buys its insurance anyway. The only way for me to change insurance providers is to change jobs, and that’s not only impracticel, it’s also very difficult.

What I had to do was to take my case to the people who do make that decision, and appeal to them. Working from the assumption that none of them would want the same thing to happen to their wives and daughters, I just presented the facts and let them come to the conclusion that the insurance company would do the same thing to anyone else in that situation too–including them. After all, they’re covered under the same plan I am. And of course they wouldn’t want that. What I basically did was raise the stakes. The insurance company wouldn’t be sorry to see me go, but what insurance company wants to risk losing a whole company’s business?

3. I kept my cool. By my own admission, to call me a loose cannon is an understatement. If I don’t like something, everyone around me knows it. But I wasn’t going to make any friends by saying "You guys are idiots for choosing to buy insurance from [company x] because they’re trying to kill my wife and unborn child." My emotions and opinions were more likely to make them get mad at me, and I needed them to be mad at the insurance company, not me. So I trusted them to be reasonable, rational people and come to the same conclusion I would when presented with the same seven basic facts.

So that’s how I got an insurance company to let my wife have a drug they decided they didn’t want to pay for.

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