And Now For Something Completely Different...

[And Now For Something Completely Different...](#) Let's not talk about gold... the dollar... Janet Yellen... war... or the election. Let's instead turn our attention to a more important story: Health Garrett {NAME} OCT 22 [Icon]([Icon]([Icon]([Icon]( Dear Fellow Expat: “Mister {NAME}… are you still there?” The woman on the other line had me on hold for seven minutes. Now, she was coming back with results from Saturday’s chest X-ray. “So, we see a mass in your chest,” she said matter-of-factly. “This might be pneumonia, or it could be a tumor. We’d have to get you set up for radiology.” It was quiet for a good 20 seconds. “How long will that take?” I asked. “Well, I can schedule you for nine days out…” she said. “But your insurance requires pre-authorization. So, that would be October 30… or whenever it’s approved, the next available appoiontment.” Pre-approval… for a CT scan... for what could be pneumonia or something more serious. I asked what's the soonest this could get done. “If they approve it by tomorrow,” the nurse continued, “we can get you in by tomorrow. If it takes a week… then it takes a week.” I’ve been dealing with a nasty cough for three weeks. But I never developed a fever. My wife had pneumonia. My daughter had it, too. This pneumatic condition has taken over the Baltimore area with a viciousness I haven’t seen since the second wave of COVID-19. So, it would have been fitting if I was just knocked out for a week. But instead… a persistent cough, lousy sleep, and shortness of breath. Now, a mystery mass. It all sounds urgent? No? Well… not for the insurance company. Bureaucracy… I called my insurance company this morning. They hadn’t received faxes from the imaging clinic, which had received a referral from Patient First. The woman at the insurance company - no fault to her own - wasn’t in the United States. No one is picking up calls in Kentucky at 7 in the morning. I asked how long it would take to get a CT scan to assess the mass in my chest. “Well, we have two processes,” she said. “If it’s marked Urgent by the clinic, there is up to 48 hours to get pre-authorization. If it’s not marked Urgent, that can take up to 15 days.” “15 days? Well,” I laughed. “I could technically be dead by then. We’re talking about a mass in my lung, not a slipped disc.” “I know,” she said… And then, she explained the bureaucracy. It turns out that another person will receive the request and make a decision. Then, the decision is escalated to a committee, which decides if it fits the bill of necessity. Who knows when the committee meets and where? To be honest, I hope it’s at a TGI Friday’s. It seems like an ideal place to check X-rays and discuss radiology necessities over a plate of nachos and 2-for-1 Coors-Molson products. Do you know how we were all told there would be bureaucratic panels to decide who gets healthcare at what price and age? They’re already in place… and they’ve stayed there since the implementation of the “Affordable Healthcare Act.” Up to 15 days… with clear evidence of a problem on an X-ray. “Can I help you with anything else?” she asked. No. I hung up quickly. Then, I called the imaging facility back. “What’s the cost of out of pocket?” I asked the receptionist. She was very apologetic about the cost. It was the price of a fine dinner with my wife and two bottles of wine. I’m fortunate… I can afford to skip the insurance company’s bureaucracy - and just pay the damn CT scan bill tonight at 5:45 pm. By tomorrow, I’ll probably have four new medications to complement the antibiotic I received on Saturday after being diagnosed with an ear infection. That's assuming that it's just what we assume. I won't spend the day thinking about alternatives. Thank goodness the Patient First doctor cared enough to look at the X-ray again to notice the shadow in my chest. I’ll spare you the reflections on life, what matters, etc. These 24 hours speak to a broader breakdown. The Price of "What Matters" in Economics and Life I’ve commented repeatedly that the price of things that matter goes up when governments print too much money. Healthcare is a "double problem" because it’s constantly in demand on the drug and treatment side… but also, the number of quality doctors tightens due to too many patients (demand) and rising medical school costs (supply). Economics is a science of scarcity. And we don’t print CT experts on trees. As the number of specialists continues to dwindle and more Americans move onto the rolls of government-entrenched healthcare, costs will only continue heading higher while insurance companies seek ways to control them. That could mean more doctors dropped from networks - less choice by default - and longer wait times while the bean counters attempt to rein in costs. They won’t be able to… Today, word is that Cigna (CI) is again discussing purchasing insurance rival Humana (HUM). There will be plenty of testimonies on anti-competition, concerns about consumer choice, and more. They can always call me if they need someone to explain where this is going… and how it ends. But please wait until I get my voice back. Stay positive, Garrett {NAME} [Icon]([Icon]([Icon]([Icon]( [Logo Image](#) Postcards from the Republic 1125 N. Charles St. Baltimore, MD 21202 This email was sent to you because you subscribed to this publication via FinPub. To stop receiving these emails from Postcards from the Republic, Please click [unsubscribe](. © 2024 Postcards from the Republic, All Rights Reserved. Any reproduction, copying, or distribution, in whole or in part, is prohibited without permission from the publisher. Financial Disclaimer: Nothing in this email should be considered personalized financial advice. 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