WTF I’m A Doctor and I Can’t Afford Health Insurance

Today I went online to pay for COBRA, the program that will extend my health insurance from my last job for a monthly fee. That fee is $743.97

At my last job as a resident in a New York City hospital, my insurance came with the job, I had good coverage, and I didn’t have to worry about it, or even think about it.

Now because I’m a consultant, my job doesn’t pay for my health insurance. To keep the same insurance coverage I had before, the out of pocket insurance cost is, after I pay taxes, almost 20% of my income. Even if I never see a doctor. Even if I never fill a prescription.

WTF.

Let’s start here. I am 31, with no major medical problems. I take one medication, the pill, and I take it like you’re supposed to – I’ve never been pregnant.

My BMI is 18.5. My blood pressure is typically 100/60 and my resting heart rate is 60. By every basic metric that we in medicine track to be sure you are doing ok, I am beyond ok.

And that doesn’t even get into my blood work, which so far has been perfect. My HDL is twice as high as my LDL and my total cholesterol is at the very low end of normal. (Normal by the way, is warped in our society – our “normal” ranges are based on a very overfed group of people. No one checked your LDL in the year 1600… our norms have become exaggerated based on very recent steady states that in reality aren’t so steady.)

In addition to all of that, I am vegetarian, and I don’t eat fast foot or junk food or even processed food. I spend $150 or more a month on yoga classes – if you look at my bank statements, you see that I keep paying Kula Yoga Project, Strala Yoga, and Vira Yoga money, so I must be using them. I also do some sort of cardio every couple of weeks, and would join a gym, but between the yoga, and how much I dislike the gym vibe, it doesn’t make sense financially.

Yes I should pay something for health insurance. I should pay for catastrophic coverage in case an accident should happen or a prolonged hospitalization should be required. I should pay something for prescription drugs. Drugs for high cholesterol, a preventable disease, should I need them, should be covered, but covered less than drugs for say, Cystic Fibrosis, which is genetically inherited.

I should pay something for the ability to go to the doctor’s office for a reasonable co-pay if I need to, and something so that if I need a procedure of some kind that is covered in some part too.

Insurance should be what it’s meant to be. A shared cost in society. A benefit to me in that it creates a collective bargaining power amongst all of us who put into the pool. Yes I should pay up something in advance, so I can get a life saving procedure I could never afford otherwise.

But I should also be rewarded for how I live. For the chronic diseases I will never get that are upwards of 90% of our health care burden. I should not pay 20% of my salary for services I will never use.

And while the example I cite, COBRA, is not the cheapest out there, it, or something just as expensive, is the only way I can continue to see the doctors I have been seeing for the past year — the ones who know me, the ones with whom I have a relationship.

Trust me, as a doctor, when you know your patient, when they are NOT a stranger showing up out of the blue whose history, context, and personality are foreign entities and therefore important but unknown variables that will influence their care and their outcomes, you do your job so much better. You are happier, your patient is happier, and the process is infinitely less wasteful.

I don’t have all the answers. I do think people should be rewarded for good behavior. I do think what I pay to Kula Yoga should be deducted from my health insurance costs because yoga keeps me both fit, and sane. And the absence of any fast food on my credit card statement should factor in, too.

So should my stats, ie the basic metrics by which we judge anyone’s baseline health  in medicine – BMI, heart rate, blood pressure, and fasting blood sugar.

I believe when we start taking people seriously who take their health seriously, our overall health care costs will be lower, and we will stop the insane waste that is me paying 20% of my salary to an administrative system I don’t use, for care I generally never need.

Food for thought,

Robin Friedlander MD

Waist Matters

This is the reality. If your waist is wider than your shoulders, or creeping close, then you are in huge, huge trouble. The fat in your middle is a festering inflammatory stew spitting out cancer juice and artery-hardening, pancreas-killing, Alzheimer’s inducing, ragefull sludge.

You do not have to starve yourself. You do not have to be skinny. And I know, in some cases the genetic odds are stacked against you. But I don’t care. If you can do anything about it, get your waist circumference down and save yourself.

In the early days your pancreas may just protest a little and your low back and knees might only whine quietly, but to themselves they are saying, “I’ll show you sucker.” In time the diabetic foot infections, wheelchair-confining back and knee pain, and stroke inducing cardiovascular disease will have their way with you.

Note, the lack of a numerical inch limit for males/females here is deliberate. We are all individuals. You know whether you are emaciated and starving, nourished but trim, or if your belly is toppling over your waistband a little more each year. I don’t expect you to measure yourself. I give you more credit than that. Observe and be honest. 

No words minced,

Health Uncensored

Probiotics Live in Yoghurt & Were Born to Help You

Bacteria get a very bad rap, but actually you literally couldn’t live without them. There are many kinds living in and on us every day, as the Human Microbiome Project has recently discovered, but the best understood are the ones that live in your gut, help you digest food and absorb medicine, and keep your tummy happy in a very essential way.

You might have heard of probiotics? They are just bacteria that are known to be helpful for digestion, and they are packed by the billions into yoghurt and fermented drinks like Kombucha.

It turns out that Lactobacillus, a common strain, will reduce the chance of getting antibiotic-associated diarrhea by 42% according to a new review of 82 different studies published in JAMA (Journal of the American Medical Association).

The best part is you don’t need a prescription. Lactobacillus and usually a few other probiotic strains can be found in your average affordable cup of grocery-store yoghurt.

If you are not impressed know that people in hospitals all over America are. Antibiotics can be very problematic when it comes to causing certain kinds of intractable diarrhea.

But yet again medicine proves what the hippies already know. A healthy gut needs healthy, helpful bacteria in residence, whether it’s dealing with the daily grind of your diet, or the sudden impact of a disruptive antibiotic as it makes its way through your system in search of its prey, which could be something as un-intestinally domiciled as a skin infection or a UTI.

Full disclosure: No, I am not paid by Fage. It’s just the yoghurt my boyfriend and I have at home. But Fage, if you’re reading this, I’m open to talking about the possibility.

Love, 

Health Uncensored

WHAT TO EAT

Today I had to call a patient who had requested to see a nutritionist. She had been told by her doctor that she had pre-diabetes, and wanted to learn about what to eat.

Pre-diabetes means your poor besieged-by sugar-and-processed-junk pancreas is flagging a little on the insulin production, and your red blood cells (along with most of the rest of your body) are slowly being coated with sugar, or “glycosylated.”  Full blown diabetes is when your pancreas is shot or nearly so, and you need pills or insulin injections not to get really sick from the level of sugar in your blood. Insulin, by the way, is the hormone your body makes that, in a nut shell, gets your cells to move sugar out of your blood and into storage when there’s excess around.

I gave the patient the referral, but I also talked to her for a while. What to eat? Well, pre-diabetes is reversible, so literally, cut the crap, and eat what every one of us should be eating.

Lots of green veggies, whole grains like quinoa, millet, and unprocessed oats, nuts, plain yoghurt, olive oil, seeds, a little fresh fruit, fish, a little lean chicken and meat if you eat meat but not much. And, as I tell all my patients, “If it came wrapped in plastic, tin foil, Styrofoam, or tin, it didn’t come out of the ground that way and it wasn’t made by God so don’t eat it.” (I have no idea where I got the “God” thing but I think it sounds sort of final and fatalistic to say, and people seem to dig it – their eyes widen in fear or they laugh, so I know they are at least listening.)

There’s more to food than this of course, but if you start there you are in a good spot. 

Love, Health Uncensored