Healthcare in America

An Opinion and Commentary


Let me start by noting that I have no background in the medical profession nor in the insurance arena. My background is in management methods and processes. My management experience has led me to the below overview and observations.

Executive Summary

Our Healthcare laws are focused on the wrong thing - Healthcare Insurance. Better that we should focus on Healthcare itself - truly affordable, real HEALTHCARE. And the government is not needed, not its help nor its control. The "Marketplace" can solve the problem - if we just let it.


First and foremost, NO ONE should be without proper, adequate healthcare. However, personal responsibility, at some point, has a role to play in that.

By now we all have heard - or should have heard - that The Patient Protection and Affordable Care Act (a.k.a. Obamacare), [i.e., the ACA], is not doing well - to put it mildly.

Obamacare and the 20,000+ pages of rules and regulations are, well, perhaps Eddie Izzard put it best. This article will shed some light on the issue.

As of late June 2017 the Republicans have (so far) put forth 2 bills, one in the House and one in the Senate, to try and - as they put it - "repeal and replace" Obamacare. What the Republicans are offering seems like putting band-aids on a massive wound from an axe blow.

From my perspective, both of these attempts, as well as Obamacare, do little to fix what ails America's healthcare system.

Let's go back a bit.

The ACA was offered as a solution to a problem. Some 30 million out of the around 300 million people living in the US were without health insurance. The ACA aimed at solving this issue, a 10% problem. Some of these 30 million folks could not afford insurance and others just didn't choose to buy any.

Now, any manager worth his or her "salt" knows one almost never tries to solve a 10% problem with a 100% solution - which is what the ACA tried to do. Further, absolutely no "proof of concept" trials or testing was done on the ACA nor any of its thousands of pages of rules prior to its implementation. Remember, virtually none of our representatives actually read the ACA bill prior to passing it and not one soul voted on any of the rules and regulations applied to the ACA.

It is my personal opinion that the crafting of the ACA was not truly done by inept management. I believe it was crafted to fail on purpose.

Why? Fairly simple, actually. The politically progressive have always only desired the "single payer" solution. However, 50% of voters were not seen as likely to support such a drastic change - and probably never will. So, a "stepping stone" approach was developed.

Create the ACA being designed to fail. With the 20,000+ pages of rules associated with the ACA, the entanglements in all of our daily lives would be too massive to change by a simple repeal and replace approach. Once the ACA crashed and burned, the only workable, saving solution would be "single payer".

This was working out according to plan; except... The Democrats lost the 2016 presidential election.

So, now the Republicans are trying to so something - anything - to keep people's health insurance in place. The ACA is too intertwined in everything for anybody to do much of anything effectively.

HOWEVER, . . .

The ACA and the Republican plans are both missing the REAL ISSUE.

The REAL ISSUE is actual healthcare - not insurance availability and cost.

In point of fact, all of the so-called health care bills existing and attempting to be into made law are misnamed. The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, should have been named the "Affordable Health Care INSURANCE Act". Why? Because that's the only thing it does; The ACA does NOT provide actual healthcare.

Yes, of course, insurance availability and associated costs are important. But, shouldn't we all try and solve the REAL ISSUE first? Only then can viable insurance plans and rates be identified.

I feel that the following actions are needed.

First, keep the ACA - as is - until a proven successor is defined and working - working such that actual healthcare availability is effected at a reasonable cost.


As an aside here to keep all the conservatives from jumping all over me (the progressives will anyway), I feel it important to mention this:

Congress, including the rest of the federal government, has no authority to be involved with issues of healthcare. Don't believe me? Check out the US Constitution, Article 1, Section 8 and see where it says anything about healthcare.

Yes, I am well aware of the typical response to this: "The Supreme Court ruled in favor of "Obamacare"; so, government sponsored healthcare must be constitutional". Well, yes the Supreme Court did and no, it doesn't mean that. (Click Here for an explanation.)

OH, by the way, if the American people would like the Constitution changed so that healthcare is added, they are more than welcomed to do that. Just go to Article V of our Constitution - it tells you exactly how to do that.

And, for you progressives who like to quote the first paragraph of Article 1, Section 8 having to do with providing for the "General Welfare" as evidence that the Constitution allows the government to provide for healthcare, this is bogus and terribly naive.

First, any simple look for what the Founding Fathers' meant by this clause will refute your notion. Second, if the "General Welfare" clause was as progressives would like to think, then the entire US Constitution would need only consist of one sentence: "The US government shall provide for the general welfare of the Nation as it sees fit."

Independent of proper constitutional authority or not, it seems "that ship has already sailed" and it may too late to "unring that bell".

Of course, the easiest way to solve this is to just flat out repeal Obamacare in its entirety. The marketplace (i.e., insurance companies) would jump in to cover the void. However, issues that could, and most likely would, arise between repeal and total replacement would be problematic and, to a large degree, unforeseeable at this juncture.

But, getting the government out of the healthcare business is doable and desirable - it will just take time and a lot of creativity. But it should be done. It seems to me that the current proposed changes to Obamacare aren't the way to go.

So, . . .


There are 2 basic approaches to solving a problem such as this one. First, there is "design to price"; and second, is "design to spec"; i.e., "design to a requirements specification".

In "design to price" you tell someone how much money you want to spend along with a set of requirements you generate. In this option you can afford the product but it may not be what you want. They will only build stuff up to the price you gave.

In the "design to spec" option you write a set of requirements and have someone tell you what the implementation will cost. In this option you get what you want but, possibly, it is beyond your financial reach.

If you're having a house built, it's fairly easy to come to an agreement with the builder as to what you get for the amount of money you have. With healthcare and all of its devilish details, it's a much harder "nut to crack".

Neither of these approaches will work in a standalone manner. There is always some "push and pull". The maximum cost of any solution should be defined. This maximum should be such that the country doesn't go broke and being such that everyone obtains adequate healthcare. A tough job to start with, for sure.

Then, as solutions are conceived, they need to be tested for both appropriateness and doability. The job of balancing cost with solution is iterative - and, it takes quite a while to get it right.

Detailed analyses need to be done to try and focus on the things that actually stand in the way of decent, affordable healthcare.

Let's see what some of these are:

(Below I'll offer problems as I see them combined with potential methods of solution. In no way are my "solutions" THE solutions. What I'll present are, by definition, greatly simplified approaches. They are but a way to describe what I feel is necessary; i.e., to think about problems in ways possibly not yet considered - or, let's try and "think outside the box").

The Cost of Malpractice Insurance

Many have been led to believe that malpractice insurance is a major factor in rising healthcare costs. Apparently, this perception is not exactly true, although such insurance is "a" factor.

Even though the total yearly cost of such insurance for the Nation is $54 Billion, the cost to an individual doctor doesn't seem too excessive - all things considered. A "GP" type of doctor can expect a bill of around $5K. An "OB/Gyn" around $35K. But, it is more complex than just different "skills" warranting different insurance costs. These costs vary, as one might imagine, based on location among other issues. For example, in the State of New York, malpractice insurance for a "specialist" can cost upwards of $190K per year.

An interesting aspect of medical costs result from what is called "defensive medicine". Defensive medicine involves a doctor scheduling tests, etc., when they aren't necessarily needed. No, they are not trying to drive up their bills; the lab, etc., that does the testing is what/who gets paid. Such "scheduling" is done to protect the doctor from being sued. The costs for defensive medicine runs at about $46+ Billion a year.

So, to put it in "easy speak", as it were, the patient is paying extra to help ensure the doctor's malpractice insurance doesn't go up. And, to add insult to possible injury, if this "defensive medicine" is to prescribe more drugs, the patient may suffer from an interaction between the "normal" drugs he or she is taking and the newly added drug(s). Note: as you may be aware MDs get little training in pharmaceuticals; the potential for inappropriate drug interactions is not small.

Solution Potential

The most obvious potential for a solution is radical tort reform. As it is now, anybody can sue anybody else for almost anything. A malpractice suit is rather easy to institute. There is always some lawyer somewhere willing to take a case on a contingency basis.

And, when one sues a doctor they are really suing an insurance company. Insurance companies have batteries of very high-priced lawyers. More likely than not, it is cheaper for an insurance company to settle a lawsuit rather than go to trial - even if it may look like the merit of the lawsuit does not lie with the person filing the suit. Such settling vs. fighting does little but drive up the cost of malpractice insurance.

The standard in the UK in the case of a civil suit is that the loser pays the majority of the costs of the suit. The United States is one of the few countries where this is not the case.

Were tort reform be instituted here in the US similar to the UK's approach, the number of malpractice suits would, in all probability, go way down. After all, a person with one lawyer who costs the person nothing if they lose would now be faced with the costs of many high-priced lawyers and their time at their "billable hour" rates for the same result. One better have a really, really strong case with lots of evidence rather than risk losing.

So, with appropriate tort reform the costs of malpractice insurance goes down, the need to do "defensive medicine" goes down, unnecessary tests are minimized, and the patient's costs are less. A side effect is that the doctors can spend more time with actual healthcare provision and less time worrying about being sued.

The Cost of Medical Equipment

The cost of medical equipment does, in fact, greatly increase the cost of healthcare. Take for example a refurbished dental chair - $6,000 - for basically a LOUNGE chair. Price ranges for portable UltraSound machines run from around $10K to over $45K. From India one can get the same/comparable machine for around $5K - with free shipping.

Take, again for example, a standard hospital bed. The average price for an electronically controlled one seems to be around $1,500. I did find one for about $600 and one for over $12K. AND, an ICU bed ranges from $35K to $40K per bed. Now, there are approximately 900,000 hospital beds (i.e., operational in actual hospitals) in the US. Taking the average cost of a bed (excluding ICU beds), that means that the Nation's hospitals have spent $1.35 Billion on beds alone. With the average "lifespan" of a hospital bed being 10 years, that means that hospitals in the US are spending $13.5 Million per year just on beds.

The unfamiliar (i.e., me) with medical equipment costs views these prices as way too high - especially if quantity buys are involved.

Solution Potential

Set up several, regionally dispersed non-profits, sharing information and products as needed, to procure medical equipment in bulk on an as-needed basis. One should never "single source" needed material.

Due to the high volume of "buys", these non-profits could entertain low cost buying. Hospitals would supply inventory needs to the non-profits. Shipments from the regional non-profit centers' suppliers could be made via JIT (i.e., "just-in-time"). Thus, minimum overhead is required - greatly reducing costs even further.

Consider: Perhaps any given hospital may need to replace only 2 or 3 beds a year. The regional non-profit might be buying for upwards of 1,000 hospitals. When buying 2,000 or 3,000 beds per year, the prices will be a lot per less per bed than buying 2 or 3.

Now, expand that concept for all the equipment a hospital might use and need. Millions and millions of dollars can be save across the entire medical profession nationwide. Further, include all doctor and dentist offices. HUGE savings.

The Cost and Availability of Pharmaceuticals

As most are aware the high cost of pharmaceuticals in this country is due to nothing more than, in many cases, overbearing regulations.

This article offers some insight into this.

But, there is more. Drug patent laws in this country do much to cause the high price of drugs. Current patent laws protect a drug's "inventor" for 20 years - but ONLY after the drug was invented. It can take a minimum of 8 to 10 years after invention to obtain approval by the FDA.

That leaves protection of only 10 to 12 years to recoup investments than can exceed $2.5 Billion on average. If a specific drug does not have a very high volume of need (i.e., low sales numbers), the cost per dose, by definition, skyrockets.

Other countries do not have the stringent rules of our FDA. Therefore, overseas the same drug may cost 1/6 or less of the cost here for the same thing.

Solution Potential

Two rather simple things can be done.

First, institute massive overhaul of the FDA's rules and regulations. Drugs must be safe, of course. But, 10 to 12 years to get approval? Unfathomable. And, increase the patent "life span" for developed drugs.

Greatly relaxing FDA rules will not only afford us all with newer drugs quicker but with longer patent life, the costs will be lower quicker and for a lot longer.

Next, as with medical equipment above, create regional non-profits to procure drugs. Buying in bulk saves money. The drug-centered non-profits would work exactly as the medical equipment approach described above.

Sounds too easy? Consider:

Through Walmart's buying power they are able to offer prescription drugs at a fraction of what your local pharmacy charges. And, drugs are not Walmart's prime business. Imagine what several regional centers for the entire nation could offer.

What about distribution? Netflix offers, right now, and unlimited number of DVDs to rent per month for $7.99. Now, effectively that's about 8 movies a month. So, for a dollar a movie you get your movie with shipping included.

It is not unreasonable that a similar shipping deal to the one Netflix has could be used to direct-ship drugs - at least certain ones - from the regional centers to your home for a minimal cost. Perhaps, for less money than the cost of gas to get you to the drug store and back.

Everybody wins.

The Practice of Over-prescribing Drugs

All of us have known cases where a patient was given multiple drugs to be taken daily. And, sometimes all the prescribed drugs were necessary and beneficial - and, sometimes not so much.

This issue is, in part, is that doctors must see so many patients to cover their costs of doing business that treating the symptom and not the root cause can lead to drugs being prescribed that are not designed to cure, but, rather, mask an issue.

Another issue, in part, is directly related to the above-described "defensive medicine". Rather than risk a malpractice lawsuit, doctors seem to favor just writing another "script" - it covers them "just in case".

The problem with this practice, of course, is that doctors have almost no training in pharmaceuticals and receive most of their drug information from the pharmaceutical sales representatives. Not the best way to learn, I feel.

Compounding this is that unless the doctor or pharmacist runs an incompatibility/interaction test on ALL the drugs a patient is taking - every time, bad things can happen.

A simple example:

Let's say you have a slight cold, or even a case of "hay fever", and also suffer from high blood pressure. The doctor has prescribed Lisinopril for your high blood pressure and you take it properly. Due to your cold-like symptoms you take an OTC drug, Benadryl. Since Benadryl is an over the counter drug you never mentioned this to your doctor. How important could a little "hay fever" be, after all?

The interactions with these two drugs can produce: headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. If you become dizzy or faint while driving or walking down a flight of stairs, obviously "this can be hazardous to your health".

That is a simple case. Chemicals, which drugs are, of course, will interact with each other in sometimes negative, unforeseen ways. As the types of drugs one takes become more complex, the less likely your doctor will be aware of ALL the interaction side effects.

Such bad reactions to drug interactions can run from the inconvenient to the deadly. But, each time such occurs it requires time of a doctor to assess and fix as well as additional costs for the patient.

This definitely does not help keep the cost of healthcare down nor advance the state of our health.

Solution Potential

Having doctors be able to take the time to find the actual root cause of our ailments is one obvious, partial solution. Solving this one will take many solutions to many issues all operating interactively until success is found. Of immediate concern is relieving doctors of the high cost of doing business. At the same time doctors should all remember what their job is - and that is NOT to make money, but to cure people. Today, unfortunately, this is a lot easier said than done.

The problem of potentially harmful drug interactions may be a bit easier to solve - at least in part.

The human body is a complex chemical-electric machine; and no two are alike. Drugs that may interact negatively for me may work just fine for you. Information, and lots of it, is the key.

Assume a national database is established of all drugs and their interactions. Currently the National Institute of Health (NIH) has an "API" [Application Program Interface] doing sort of what I am suggesting. There are, of course, other similar resources out there. But, I am suggesting something much larger and more detailed.

The databases I am suggesting would be resident in each of the non-profit regional drug centers and be exact duplicates - constantly refreshed with the latest status of the databases.

The basic storage would be a list of all known drugs. Algorithms would be developed and employed that check the interactions of all drugs with all other drugs. Not just one drug vs. another; but, combinations of drugs as prescribed combinations are known. The results would be available to all to peruse. This, obviously, would be an on-going, iterative process.

Although almost not needed to mention is the fact that both highly skilled diagnostic doctors and, perhaps more important, many, many Pharm.Ds/pharmacists would be required to staff these non-profit regional centers - not to mention highly skilled IT professionals as well.

Also, secure information on every prescription for every person would be entered. There would be no actual names or personal information submitted - just the list of drugs taken by each person. It is envisioned that each person have a unique "password" assigned vs. any personal data.

It would be required that pharmacists, upon filling a prescription, update the appropriate database. Upon update, the above-mentioned algorithms would run an analysis and furnish the results back to the patient, the pharmacist, and the prescribing doctor.

In so doing any potentially harmful drug interactions would be known before damage could be done - and, desirably before a prescription is even filled.

Thus, doctor visits would be reduced freeing up doctors to offer more attentive care, insurance rates would go down, and the cost and availability of healthcare would go down and up, respectively.

The Issue of Decreasing Doctor Availability

The number of doctors in the US is not keeping up with the growth of our population. From July 2010 to July 2015 doctors saw a rise in numbers of 2%; the population rose 3.8% - almost double the rate. By the year 2025 the projected shortage of doctors will approach 100,000.

Even worse, some, if not many, doctors are planning to leave the profession. The reasons, of course, vary. This article may shed some light on this: Click Here. Even Obamacare, itself, is being blamed for some of this.

Now, if the following, alone, isn't enough to make anybody want to leave a profession, I'm not sure what would. It would me!

The American Medical Association (AMA) sets forth what are called "CPT" Codes, or, "Current Procedural Terminology" Codes. And, the AMA makes anywhere from 400 to 700 changes to these codes every year.

If you go for an exam, there's a code for that; if you have acne, there's a code for that; if you have the flu, there's a code for that; if you have a splinter removed, there's a code for that, etc. No matter the ailment and treatment there is a mandatory code that must be used.

What are these codes used for? Billing of services, assuring a "standard of care" is offered, and ultimate payment to the doctor. AND, there are thousands of separate, distinct codes.

If the doctor or the doctor's office manager happens to make a small mistake in ascribing the correct code, you and/or your insurance company will be billed and you and/or your insurance company have to pay what costs are assigned to the code written.

As you might guess, medical billing errors is a significant issue.

So, rather than the doctor focusing 100% on the betterment of your health, he or she must also be a statistician, a billing expert, a financial manager, and many other things not dedicated to you health.

To be fair, with the advent of computers, CPTs are seen, actually, as a benefit to many. They help cut down on Medicare fraud and provide a "standard" for care in many cases. I, personally, feel that the number of these CPTs could be reduced to save administrative time, energy and money.

To add insult to injury, the AMA, itself, works to limit the number of doctors that could be available to us all. Not he very best of tactics, I feel.

Solution Potential

Better and less costly health care for us all is possible, of course; and, without government's help or control. A first step is to recognize the less-than-desirable access we all have to a doctor's care.

But, do we really need a doctor for everything that ails us? I don't think so. But, now seeing a doctor is the only way to get professional healthcare.

I am willing to wager that many, if not most, of the ailments for which we seek a doctor's advice are such that a Registered Nurse (RN), a Pharm.D, or a regular pharmacist could easily diagnose and treat - if only they were allowed to. Major issues, of course, need a trained doctor's advice. Now, Nurse Practioners (NPs) are required to have a Masters degree in order to have the title "NP". In every state they are allowed to write some prescriptions - some even for narcotics. With a bit of training can't RNs be granted some of the same privileges as NPs?

So, as a start, define a list of ailments and appropriate drugs that do not really call for the need of an MD.

Next, remove regulations that forbid a Registered Nurse, a Pharm.D, or a regular pharmacist from diagnosing and prescribing the meds re: the above resultant list of ailments. In some states pharmacists may write prescriptions; in other states they may not.

Now, consider that as of April 2017 there were 923,308 doctors practicing in the US. Next, there are approximately i.e., some 67,000) pharmacies in the United States.

By allowing just pharmacists to diagnose and treat (as appropriate) the vast number of things for which we now seek a doctor's advice, an increase of over 7% availability of health care is realized.

Now, add in Registered Nurses, for just one group. Currently there are 2,857,180 RNs in the US. Adding RNs to the mix would increase health care availability by a whopping 309% for what ails us the most frequently.

Just by removing (most likely) unnecessary rules and regulations, we have more than tripled the availability of healthcare professionals.

Doing so, of course, frees doctors to give maximum attention to those who really need their levels of skill.

And, another thing.

A new "industry" seems to have arisen in the country. This is the emergence of what may be called "Emergency" or "Urgent Care" Clinics.

We've all seen places such as pictured above. These exist due, primarily, to the shortage of available doctors. Currently there are approximately 7,100 such places in the US. And, as a rule, they not staffed by doctors; they are staffed by "physician assistants" (PAs). In some states PAs may write prescriptions and in other states they may not.

If you have the flu or something similar and just need "a little something" from your doctor, it is not unusual to be told that the next available appointment isn't for at least a week. These "Urgent Care" clinics, or what I call "Doc-In-The-Box" places, are there to fill the void.

Unfortunately, it costs well over $100 just to walk into such places. Actual treatment, of course, is "extra". And, if there is a REAL problem, they simply refer you to somewhere else - and are very happy to take your $100+ for the advice. Not a good "cost vs. benefit" situation.

With a restructuring of the CPT codes, as discussed above, along with relaxing of potential other bureaucratic rules, such places could become truly affordable.

And, I am certain there are plenty of Pharm.Ds and RNs out there who may be tired of their normal routine who might love to run one of these "Urgent Care" places. And, run them with greatly reduced costs. An expansion in the number of these places is also not unforeseeable. Yes, you may get the same "referral" as before when necessary, but at a much reduced cost.

Just consider, adding the 7,000+ "urgent care" centers to the number of drug stores (some 67,000), we wind up with over 70,000 additional centers where our most often needed medical help is offered - most often on a "walk-in-as-needed" basis.

Again, costs go down, the availability of doctors for more serious needs goes up, and the cost of insurance goes down. The "Trifecta".

Finally on this subject, the stranglehold of the AMA on the number of doctors must be curbed. Our population is growing and we, as a Nation, are growing older. This means that more doctors are needed and needed now.


Summary

As stated at the beginning, the above is not intended to offer "THE" solutions to anything. But, it is meant to emphasize that a group of people who actually know what they are talking about could start to "think outside the box".

Whether any, or even one, of the above suggestions is workable is beside the point. These were just things that popped into my head. Imagine the result if hundreds of knowledgeable people started to come up with hundreds of potentials.

They would start with a small trial and work out the "kinks" of their approach. Then, they would expand their trial to a larger one. Keeping doing this and they would wind up with a workable, true solution to a problem.

What is stopping them now? The literally thousands upon thousands of government rules & regulations that stifle innovation. The only goals of such innovation would be to bring about better healthcare for less money. NOTE: Not ALL rules and regulations are bad. But, how many are actually beneficial to a better health care system for us all?

What is needed is the reduction of rules and regulations that: 1) make our healthcare costs too high for the ordinary person to afford, 2) make our available doctors in short supply, 3) make truly "affordable" healthcare in general not possible now; and 4) standardize across state lines the rules concerning who can write prescriptiona and who can not. To accomplish this we need innovation and thought processes beyond what seems to be in place at this time.

A rather simple example:

What drives down cost? The answer: competition. Just suppose doctors, etc., were to advertise their costs for specific treatments - averages, of course. A patient in need of care could peruse the varying, advertised costs for what they need. Combing this with an easy method of obtaining valid reviews on doctors, for example, choice could be made. Note: as with most things, lowest cost is not always the best solution.

For those who believe that the government IS the answer, take a look at the Veterans Administration's (i.e. run by the government) healthcare results - or even the current state of Obamacare. Not only do our veterans deserve better, but so do we all.


Post Script (no play on words intended)

At the beginning of this article I noted that, at some point, personal responsibility has a role to play in one's healthcare. Here is a personal story of my recognition of this assertion.

At about age 60 I suddenly felt lethargic. And, this feeling was all the time. This was not normal for me. I have always been reasonably active. I make sure I stay in fairly decent shape - not the shape I was in when competing in gymnastics in college to be sure. But, reasonably so.

I went to a doctor to see what was up. She told me that it was most likely my diet. Now, my diet is NOT something I would recommend for anyone; but, it had worked for me my entire adult life. No, I reasoned, that wasn't it.

So, I went to another doctor. He ordered some blood work - including a B12 test. A B12 test is not something normally done. Lucky for me the test was ordered and skillful of him to order it.

Turned out that I had Pernicious Anemia. This disorder is such that the body no longer absorbs B12 in the normal way. This condition can be quite serious; and my levels of B12 were at a critically low level.

After doing a bit of research on the topic, I learned that people of Scandinavian or Northern European heritage are prone to get this disorder. One look at me and I fit the bill very nicely, thank you very much.

Anyway, there is no cure. One needs to take an intramuscular shot (i.e., injection) of B12 on a periodic basis for the rest of one's life. Taking oral B12 vitamins will not do the trick.

So, for the next 3 months, once a month, I would trot off to the doctor's office and get a shot. OK, this entailed: Cost for the doctor visit, cost for a B12 test - again, (see "defensive medicine", above), and the cost of the actual shot. This was running about $300 every month. I was looking at this kind of bill for the rest of my life. Yes, back then insurance was paying 80%; but, still, for a simple shot...!

Therefore, at some point I made the observation that doing what I was doing seemed to be a waste of everybody's time and money - most especially mine. I asked whether I could administer my own shots. Of course, "YES" was the answer. So, I started doing just that.

Not knowing what I was really doing, I did some more research. What if I didn't take enough? Well, I would get lethargic again; if I went too long without a shot I could die. So, keep it regular, AYE!

But, what if I took too much? Well, I would just pee out any extra. OK on that end, as it were.

Now, regular shots are the key; but, if you miss a scheduled shot by a few days or a week or take more than one occasionally, there is no risk.

I get my injectable B12 from Canada now. With the cost of this plus the cost of syringes, I am spending about $20 a YEAR on my condition. That's a savings of over $3,500 every year. I've been doing so for the last 15 years - and, feel great all the time.

Yes, I took personal responsibility for my meds in this case. Was there a risk? There are risks to everything. But, I did the research necessary. In so doing, I saved myself time, aggravation, and money. While, at the same time, freeing up the doctor to do what doctors do best for others AND lessening the burden on some insurance company - which, hopefully, lessened rates for all.