Journal of November 2015 Trip to Israel on Walk the Jesus Trail (includes all days and more pictures, but large file)
During the first few months of every year, everyone is used to dreading the tax season of preparing those wretched returns, but now physicians and other providers of primary care can also look dreadfully forward to the yearly change of the formulary with its compulsory deluge of forms requesting medication changes. What is accomplished with this fruit basket turnover of medications is nothing that usually improves anyone’s health, but solely serves to help the financial bottom line of the insurance companies who send them while they continue to raise yearly premiums and co-pays to levels hardly imaginable. Physicians loathe these forms because little is accomplished that is worth our time and training. We want to improve our patients’ health and get to care for them, not just serve as liaisons to enforce insurance company policies for their own financial benefit. It leaves one feeling thoroughly unfulfilled and used like a pawn.
Requiring us to change within classes of medications, as if all of them are the same chemical compound with just different names, reveals the naivete of the people who are making the decisions for us now. Any physician can give loads of examples. What is worse are the physicians who work for these companies who actually are aware of what they are doing and have pushed aside their conscience for mammon while foisting this charade upon us underlings, the grunts who toil among the patient masses, while they sit in their ivory towers thinking of what their next cost-saving measure, labeled as a quality measure, will be.
In the past, most of this rigmarole was confined to forcing us to choose a generic medication instead of a brand name medication. It was not that difficult to accomplish and most of us were able to go along with it without too much of a problem. Nowadays, however, this has morphed into an out-of-control prior authorization (PA) scheme designed to prevent patient care, not just alter it, while it is done in such a way where the physician can be blamed for the lack of supply of the medication to the patient; we simply do not have the time to complete all of the forms the insurance companies want done. They know that and have learned to keep those road blocks in the way so that they can keep their costs down. The number of these PA requests continues to escalate and take our precious time away from doing what we were trained to do, just to help the insurance companies have a better profit.
In addition to the PA system they have shifted to full tilt, their strategy for more control and more profit has started pushing into full throttle the forced acceptance by patients of mail order pharmacies. Most patients like their local pharmacy and want to continue to use them for their medications because they know them and trust them. Patients are now being forced to pay outrageous prices if they try to use a local pharmacy and it is not the local pharmacies’ choice, but is arranged this way by the insurance companies who now have their own centralized pharmacy chains. If physicians were behaving in this manner, we would be hauled into court on felony charges, but not so for the large insurance companies who can pay for lobbyists and campaign contributions to keep this legal.
How can we fix such broken system? First, if insurance companies want to force medication changes through financial pressure, require them to accept the liability for their decisions if the physician opts to disagree with them. Second, require the insurance companies to pay a fee to physicians to cover the cost of these forms being completed and submitted, which is not reimbursed, and costs us all a lot of payroll expense. If they have to start paying something for this to be done and share in the liability for their decisions, I think they will start thinking twice about continuing this game where they seem to be able to make all of rules as they see fit. Patients and physicians need our leaders to help us reclaim our health care, not help these profit-driven insurance companies take further advantage of us all.
With the recent news of Christians, including children, being beheaded by Islamic jihadists, there comes to mind questions of why the God we serve is allowing this to occur. To acknowledge that God is allowing children to be beheaded in front of their Christian parents in Iraq brings a certain level of discomfort dependent upon our worldview. To those who have not acknowledged God, the horrific actions of these people are explained only as being cruel actions by cruel people. However, for those of us who do recognize that we have a Creator who is the God of the Bible, thinking about these actions in the context of the God we know from His Word brings more to mind than these being plainly cruel actions. We must acknowledge that God had foreknowledge of this happening to His children and did not choose to intervene. Our questions inevitably lead to us wondering why and the answers are not easy to find, if they can be found.
Scriptures that relate to God rescuing us are the first that come to mind when we are in trouble. “He trusted in the LORD, let Him rescue Him; Let Him deliver Him, since He delights in Him!” (Psalm 22:8). Psalm 144 speaks of God prospering and preserving His people, “Rescue me and deliver me from the hand of foreigners, whose mouth speaks lying words, and whose right hand is a right hand of falsehood– That our sons may be as plants grown up in their youth;That our daughters may be as pillars, Sculptured in palace style; That our barns may be full, Supplying all kinds of produce; That our sheep may bring forth thousands and ten thousands in our fields; That our oxen may be well laden; That there be no breaking in or going out; That there be no outcry in our streets. Happy are the people who are in such a state; Happy are the people whose God is the LORD!” (verses 11-15). That sounds great! We all want to serve a God like that. Think of Exodus 14:13-14, “And Moses said unto the people, Fear ye not, stand still, and see the salvation of the LORD, which he will shew to you today: for the Egyptians whom ye have seen today, ye shall see them again no more for ever. The LORD shall fight for you, and ye shall hold your peace.” That is another great one that we love to remember and quote. If that is all there were to it, it would be easy to decide to follow Christ.
However, we may tend to suppress other scriptures which are equally relevant and point us toward walking down a road that none of us who are sane want to travel—the path of suffering. Paul certainly learned this; “For I will shew him how great things he must suffer for my name’s sake” (Acts 9:16). In Second Timothy 2:12, we find that “If we suffer, we shall also reign with him.” Obviously, there is more to God than just wanting to rescue us from everything so that it all goes our way all the time. “For what glory is it, if, when ye be buffeted for your faults, ye shall take it patiently? but if, when ye do well, and suffer for it, ye take it patiently, this is acceptable with God” (1 Peter 2:20). God wants us to learn from suffering and He wants to strengthen us through it. “But and if ye suffer for righteousness’ sake, happy are ye: and be not afraid of their terror, neither be troubled;” (1 Peter 3:14). Our attitude is supposed to change from one of fear and avoidance to that of embracing the suffering before us.
As Christians, God does not promise to preserve our physical bodies during our earthly lives unless it serves His purposes and allows us to accomplish His will for us. The suffering in our paths can only hurt us so much. We may die physically, but only God has charge over our soul and He has promised to preserve our souls. Therefore, when suffering is in front of us, we naturally are going to look for a way out of it, but if we learn that there is no way out, we are actually to run toward it and accept it as part of His plan for us. That is where it is hard to understand again –to accept that God allows us to be killed, beheaded even. However, Christ went down that road, “For Christ also hath once suffered for sins, the just for the unjust, that he might bring us to God, being put to death in the flesh, but quickened by the Spirit:” (1 Peter 3:18). We are good at proclaiming that we want to be Christ-like, but most of the time that means only in ways we agree with or want.
Christ made it clear although that if we want to be like Him, we will have suffering, not possibly, but will. That just goes against the grain of what many Christian churches in America teach nowadays. Jesus Christ explained to those who said they were following Him that He was their food and they did not understand because they did not want to understand. “When Jesus knew in himself that his disciples murmured at it, he said unto them, Doth this offend you? What and if ye shall see the Son of man ascend up where he was before? It is the spirit that quickeneth; the flesh profiteth nothing: the words that I speak unto you, they are spirit, and they are life. But there are some of you that believe not. For Jesus knew from the beginning who they were that believed not, and who should betray him. And he said, Therefore said I unto you, that no man can come unto me, except it were given unto him of my Father. From that time many of his disciples went back, and walked no more with him. Then said Jesus unto the twelve, Will ye also go away?” (John 6:61-67). It is easy to follow Him when the miracles are performed which sustain us physically in some way or make life comfortable for us, but it becomes hard when it is learned that this is not really what Christ is ultimately after in dying for us. We also are called to the same in our lives here. “For verily, when we were with you, we told you before that we should suffer tribulation; even as it came to pass, and ye know” (1 Thessalonians 3:4). “Yea, and all that will live godly in Christ Jesus shall suffer persecution” (2 Timothy 3:12). It is not easy, but it is part of the Christian walk. Christ was in anguish so much that He sweat drops of blood in the Garden of Gethsemane and sought another way if it would be God’s will for Him, but in the end accepted what He had to do for us.
Sometimes God chooses to use us in ways we will not like either and we will be in anguish, too, during those times, but we can know that it is to work a greater purpose than what we can understand. God rewards those who suffer for Him and those parents who lost their children, or whomever is missing someone due to such cruelty, can know that those who died are now comforted and will never die again after they physically die in Christ. In America, it usually does not come to that. We should seek God’s face to know if that came to us, would we seek to continue with Him, or would we turn and go another way. May God help us to know Him and His way fully in these perilous days in which we are now living.
I sought to hear the voice of God,
And climbed the topmost steeple.
But God declared: “Go down again,
I dwell among the people.”
We all have an innate nature to desire someone we can look to as being a good example to follow. Even those who are leaders in our society also have that craving for connection to something higher than themselves. Many times, that quest for finding significance leads to seeking out other humans to fill that role. Even back during the days of Moses, many of the newly freed Hebrews could not be satisfied with worship of the unseen God, but coaxed Aaron into agreeing with them, while Moses was upon the mountain, to fashion a golden calf to worship. We humans want to have proof before our eyes and something we can touch. “And they made a calf in those days, and offered sacrifice unto the idol, and rejoiced in the works of their own hands” (Acts 7:41).
I remember few times in my life when I have entered into someone’s home or business and have seen an idol placed in a position of prominence. Nowadays, most folks do not have such visible and tangible idols made of the inanimate, but often have living, human ones instead. An example from popular media would be the search that goes forth on the television series American Idol. More commonly although, people search for someone in their everyday surroundings who they put up on a pedestal and expect to be able to follow only to have the inevitable disappointment that will always occur when any other human is ever idolized. The disappointed person, instead of learning from the experience, usually proceeds to find another person then to put up on their pedestal and the cycle repeats itself in our culture indefinitely.
A few years ago, I visited the city of Philadelphia, Pennsylvania, and was told by a historian there that the city in its beginning had no person’s name on any city street sign or building because the Quakers recognized that no human should elevated above another. If all of society would recognize that truth again, think of all of the problems that it would solve. This does not mean that we should not have mentors in our lives or have parents and those in authority over us that we should respect, however. There is a difference between learning proper respect for others and idolizing others. We have to recognize that we cannot expect perfection out of any person any more than what we can do ourselves. We all want someone to give us a break, so that should result in us giving others a break, too. That is what grace is all about; if you want grace, you have to give grace.
Many churches lose pastors, communities lose doctors, and many organizations lose leaders because of this same cycle repeating itself as people look to other people for something that no person can do — be God to them. What is able to stop the merry-go-round pedestal is the recognition that we should put no one on a pedestal and throw the pedestal away. It is just a present day way of having idols in our lives that might be a little different than in Old Testament days, but it is just as wrong now as it was then. That innate desire to have someone to idolize and place on a pedestal should be replaced with looking up to the only person who was ever perfect –Jesus Christ. Compare your life only to His and you cannot help then but to give grace, mercy, compassion, understanding, and lose the critical spirit, self-righteousness, and false expectations of others.
Not my home
Walking in light
Surrounded by dark
Against the flow
Put together again
Frustrated into brokeness
Loved before born
Away from completeness
One heart with you
Heart bursting into you
Angels fly, stars collide
Take me away from here
Falling into you
Clinging but letting go
In safe arms
Feeling them more
Life everlasting awaits
Fear of death gone
Dirty rags removed
Feed me yourself
All of you
Nothing of me
It used to be that when one would go to a physician’s office, the greatest cost was paying for the visit itself. Nowadays, that cost is just a drop in the bucket compared to what medications cost. Medication costs were already starting to rise, but have risen to unprecedented levels since Medicare Part D became law about a decade ago and with the latest government attempt to help us through the un-Affordable Care Act. In the last few years, add the cost of laboratory testing to that list.
Most people can remember the days when lab testing was done in the physician’s office and the billing for it was reasonable in most instances. If a physician had prices that got too high, patients could choose to go elsewhere. Competition would take care of any price gouging problem with no government intervention was needed. How all of this morphed into the current problem started with the introduction of CLIA laws which were intended to improve laboratory standards and were generally well intentioned, but have increased costs. After CLIA laws went into place, many physicians stopped offering in-house lab work, but there were still many continuing to operate labs in their practices. It was then decided later by Medicare that if a patient had lab testing done which was not approved as “medically necessary” (that means they don’t want to pay for it, not that it isn’t necessary), the patient was not responsible for it and they could not be billed for it. After several years of that, the last nail was driven into the coffin of most physician office labs. While the physician labs were declining in numbers, the large reference lab companies were growing in leaps and bounds. Eventually, most lab work was being done by these lab companies and still is. Then, Medicare decided to change the rules again in allowing that patients could now be billed for any lab work that Medicare didn’t approve. Whereas before in the physician office, a much lower price, or even a negotiated amount, could have been charged for a non-approved lab test, now there is hardly an option as larger and larger lab companies have made it difficult for patients and physicians to avoid these companies and their policies.
For one example, patients are restricted in how many lipid profiles that they can have performed within a year, but if there are complications with adjustments to medications being required, then the rechecking may not be approved. It is certainly necessary to know how a medication is working or not. A lipid profile is reimbursed by Medicare at just under nineteen dollars, but if Medicare denies it, these companies are sending bills to patients for over one hundred dollars. If one could make over 500% more money instead of the usual payment, it is not a stretch to think that these companies would not have as much interest in trying to help patients get their lab work covered through Medicare. Medicare has went from one extreme to another and patients are being put into financial jeopardy. A common sense solution is for anyone performing lab tests to be able to charge the patient what they would have gotten from Medicare had it been approved, but allowing over five times as much to be charged is allowing inflated pricing to occur.
Upon learning about what these reference lab companies are being allowed to do, I contacted via telephone one of Congressman Gregg Harper’s (R-MS) offices and discussed my concerns with one of his staff members. I had thought that there would be interest in protecting people from being charged such outrageous prices for inexpensive lab work. However, I was accused of not being a “capitalist” and questioned about how could I possibly “desire for (them) to tell these lab companies what (they) can charge”. I was stunned at such indifference and at being made to feel as though I was out of the mainstream, maybe even not American in my thought, according to their viewpoint. I replied to them Medicare, which is regulated by Congress, certainly did not mind telling physicians what we can charge and restrict us all so severely that hospitals and clinics are having trouble making ends meet now. If it is good enough for the doctors, hospitals, and other health care suppliers and workers, why should these large reference lab companies be exempted from price regulation? I could not get an answer to that question and was left frustrated that this is apparently okay with Congress while patients are being fleeced. Just as Congress is allowing this to occur, they can also decide to not allow it to occur. Concerned citizens should contact their U.S. Representative and U.S. Senator and let them know that they should reign in this unnecessary extra expense being placed on the backs of those who are already overloaded.