Preventative action cuts health care costs. Preventative medicine is the most economical form of health care. For all of us. But, there are a few reasons why preventative care is not as widely available as it should be.

1. The leading reason why people do not have diagnostic tests for early detection, vaccines and other medical care is because they HAVE NO HEALTH INSURANCE. That is roughly 30-50 million people in this country. 30 million (think about that number). Do you think that 30 million are not getting sick? They are. Many in ways that could have been prevented if they had a regular doctor and routine diagnostic tests. And when they get sick, who do you think pays for it. You and I. In one form or another.

2. Continuity of service. Again, this is a matter of switching health care insurers and then health care providers. It’s confusing. Even the best insurance companies are guilty of confusing patients with in-network, out of network and a host of other “stipulations” that you don’t know until you get a bill for it. When people are switching doctors, they don’t have the health care they need.

3. The medicine model in this country is on treatment, not on prevention. It’s a fact and it’s a horrible fact. It’s tied in, somewhat, to the medical profession but is more tied into insurance. Insurance companies simply don’t want to pay for diagnostic tests. And many who don’t have insurance can’t afford it. Again, INSURANCE issues.

Preventative care only becomes a priority when there is an explosion of a certain illness, then private fund raisers (usually cancer related illness) fund the research necessary to develop testing and prevention. And then insurance companies are pressured into getting on board. that is how ti works. They do NOT want to pay for preventative care.

Insurance companies count pennies. Penny wise and pound foolish. And they pass their foolishness onto their insured.

Yearly mammograms, pap smears, colonoscopys, prostrate exams etc are recent developments as more is understood about disease. And yet many insurance companies balk at these tests unless you meet certain criteria. So they don’t get done and the insurance company holds the keys to what you can and cannot have done.

When Michael was acting strangely and I was trying to get him to a doctor, there is most likely NO WAY that the insurance company would have paid for an MRI which would have revealed his tumors. Brain MRIs are not going to be approved unless there is a compelling reason like a brain injury. After a certain age people should be receiving many standard tests that would detect certain diseases that can be treated early and will not turn into catastrophic illness. There are people who are ticking time bombs, walking around with diseases that will be difficult to treat once they start to become symptomatic. There are many diseases that once you’re symptomatic, you’re basically done for. I’m not talking about full body scans which aren’t covered by insurance and are expensive (well over $1000) and do not detect many cancers and other ailments. I’m talking about the ability to receive a holistic “work up” when something is wrong but you’re not sure what. Or even when something isn’t wrong.

When I fractured my back last fall and have experienced a series of breaks over the past few years, my doctor was very concerned and asked if degenerative bone disease ran in my family. I had no idea. So my doctor ordered a genetic test to see if I suffered from degenerative bone disease which is hereditary. I’m adopted and don’t know the full medical history of my family. My doctor ordered the test which costs hundreds of dollars and the insurance company has denied it several times.

Since I cannot recount my medical history for the doctor, he really needs to know what we are dealing with. The insurance company denies the test and without THAT test the disability insurance refused to continue my disability payments. It’s a catch 22 that only benefits not one but two insurance companies. I’ve paid into Long Term Disability insurance all of my life and I have never used it. Now that I need it, I am denied it. Even though there is a lot going on with my bones and my joints, I can’t get all the tests or the procedures to diagnose it and to fix it correctly. I pay high premiums to my medical insurance and haven’t used a lot of it in the past few decades and now that I need a lot of tests to determine what is wrong with my bones and my joints, I am denied those tests. The denial of those tests leaves the diagnosis undetermined and the undetermined diagnosis leaves the disability company unsatisfied and when they are unsatisfied, they deny the disability.

All of my doctors complain about the amount of paperwork the insurance companies demand from them and then they claim to have lost it or never received it. My doctors are busy and the more time they spend filling out forms, the less time they devote to patient care and the more their costs go up. And despite all the time they spend, the insurance companies deny the patient’s claim. And that is how insurance companies reap profits and screw both doctors and patients at the same time.

So when these two insurance companies do their default dance of denial, and things get bad enough and I’m on Social Security Disability and paying for this test (which has to be done sooner or later), the tax payers will be paying for this test. And I could have been treated for this all along if only my insurance company would pay for this test. But they won’t. They prefer to shift the burden to me or to the taxpayers sometime in the future. They deem it an unnecessary test. Perhaps for someone with a full medical history but not for me. There is no box to check “Patient does not know her family’s medical history and she’s breaking bones all over the place.” which would make sense for this test to be done. No, the insurance company finds it “unnecessary.”

Many say that doctors order unnecessary tests all the time. The actual reality is that many do not order enough or cannot get insurance authorizations for the ones they need.

Preventative medicine is one of the most important things in keeping health care costs low. And people without insurance and others with insurance don’t get it because it costs too much. You have to fit a certain “criteria” to be approved for certain testing and many of the things that would cause you to need a test aren’t in the frame work of the insurance companies. So you don’t get them and there is NOTHING you can do about it.

2. Using the Emergency Room as your primary doctor. Everyone loses on this one.

The other issue is that people without insurance do not go for preventative care and oftentimes use the ER as their doctor when some medical issue comes up. So if you are suffering from something, either a one-time or reoccurring thing, you don’t go to your doctor who is going to charge you $250 for an office visit, you go to the ER where you get it for free. If you wake up with a rash, you don’t call your primary care physician because if you don’t have insurance you don’t have one, you go to the ER. If you have a pounding headache or blurry vision, you go to the ER. Many uninsured people use the ER for things they could easily go to a regular doctor for but they don’t have one or can’t afford one. They go to the ER, where it’s free and they can’t turn you away.

But it’s not really free. The hospital eats the cost by not hiring more staff and the next time you’ve waited in an ER for 3 hours, think about it. When we keep those who have regular medical care and primary doctors out of the ER, the hospitals can afford more staff and more machinery and get to you quickly. I have waited in an ER for hours waiting for an xray because there were too many people and not enough xray machines or xray technicians. If those who use the ER as their primary doctors weren’t there, not only would your wait time be less because they’re not there, but the hospitals will have more resources to treat their patients who are actual emergencies.

If these uninsured had a regular doctor and preventative care, most of these things would not occur. If you suffer from migraines, you go to your doctor who gives you a prescription for migraine headaches and perhaps a note for work that you need to work in a dark area when you have a headache or something to that effect. An ER is not going to give you a reoccurring script. They can’t. So every single time you have a migraine, you go to the ER. And take up time and space that can be used for people with actual emergencies.

3. Young people do not get preventative care once they outgrow their pediatrician. Most cannot afford insurance after they turn 21 and elect to not get it. If they go to the ER chances are they can’t afford that either and for some, ERs will send bills they cannot pay and the bill will go to collections and the collection will wreck their very young credit for many years to come.

With the ACA, your parents can keep you on their insurance until 26 without additional premiums.

The funny thing is that New York, a liberal state where most are in favor of the ACA, has a similar (actually better) provision and Texas, a conservative state where most are opposed to the ACA, also has this provision (again, actually better). If affordable health care wasn’t a priority for all citizens, why do states, both conservative and liberal, take such steps to insure their populace?

The ACA allows all parents to insure their children until 26 and that helps young people get the regular checkups they need, pay for any emergency visits they need and keep costs down and their young credit from not being wrecked. Everyone wins.

New York and Texas both provide better options and coverage than the ACA will and will still be allowed to cover people better. I’m not saying health care is great in either New York or Texas and as states like Texas opt out just to spite the President, it will be much worse, but right now the ACA provides things that some states have seen as a necessity for years.

If a liberal state like New York and a conservative state like Texas have both passed health care laws that benefit their constituents, don’t you think it HAS to be a good idea?

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