America's broken healthcare system

A personal tale from a science supporter

Since launching “Conspirituality” in 2020, we’ve gone to great lengths to separate the efficacy of pharmaceuticals and other modern medical practices from the challenges of navigating America’s for-profit health care system.

This is increasingly challenging in a binary social media communications network.

Still, we recognize many frustrations arise from living inside of a corporatized healthcare system that puts profits over people, which turns people off from the system entirely. Anti-vax indoctrination often begins from just these frustrations.

I want to share my recent challenges with this exact problem.

Preventive bias

This season, it took me over three weeks to get a flu shot that was covered by insurance. And, after a month, I’ve yet to receive an updated Covid booster. I could’ve gotten both had I paid $200, but I was not willing to do so, for reasons that will become clear.

First, I want to frame this story with another recent healthcare system struggle. 

In early August, my wife went for her first breast cancer screening. She wasn’t in the clear. Cutting to the chase, she doesn’t appear to have cancer, but some conditions means we have to track it in the coming years. In the process, a biopsy was required.

Those few weeks of uncertainty were challenging. Yet as the possible pathways forward were presented, we had to discuss what procedures we could afford—never a conversation you want to have regarding your health. Yet quite common in America, as too many people forgo screenings and surgeries to avoid debt.

Reminder: we’re the so-called wealthiest nation in the world. 

Our insurance is through United Healthcare (UHC). Every month, we pay roughly $500 alongside the percentage her company kicks in. Even still, we ended up being a few thousand dollars out of pocket for what is marketed as preventive screenings.

UHC lists breast cancer screenings in such a manner. Yet something troubling became clear: my wife has dense breast tissue, which is true for 40% of women. Because of that, the procedures were no longer considered “preventive.” And so after paying what we thought was the total bill in advance, we continued to receive bills—which shouldn’t be surprising because, as it turns out, Providence is being sued for shady billing practices.

2D mammography shows dense breast tissue as white, effectively useless in the screening process. Insurance companies leverage this fact to avoid the “screening” part of their coverage.

Right now many women with dense breast tissue must pay for follow-up screening — usually ultrasounds and sometimes MRIs — because it is not covered by insurance. Even though these tests are done for screening purposes, they are classified by insurance companies as diagnostic tests.

We’re not along in this struggle. As it turns out,

Just like supplemental screenings for dense breasts, extra screenings in these situations are not often covered by insurance. Without insurance, such screenings can be very expensive and create access issues for those who cannot afford to pay out-of-pocket.

While legislation is being pushed for more breast density coverage in cancer screenings, there’s no national law requiring insurers to cover them.

Meanwhile, the top five executives at United Healthgroup, the parent company of UHC, each received between $10 million and $21 million in compensation in 2022. 

On Thursday’s “Conspirituality,” Silicon Valley Veda, we discussed the unrestrained free market ethos that dominates billionaire thinking. No one’s preventive healthcare shouldn’t be funding someone’s second yacht.

But that’s where we are, which brings us to our recent vaccine challenges.

Where’s the jab?

The US government wants 70% of Americans to get a flu shot. As of today, peak flu season, the number is 28.4%. Covid booster numbers are even more dismal: 7% of adults and 2% of children have gotten the jab.

Some of this is due to increased anti-vax efforts. Some goes to decreased trust in institutions, which dovetails with anti-vax propaganda. But we also have to confront poor messaging from public health agencies. And we have to look at our broken system.

In early September, we tried confirming which pharmacies were covered by our insurance. We kept receiving conflicting and false information.

• We initially made appointments at CVS, which we were told was in our network. This was wrong. 

• Then we made multiple appointments at Walgreens, each of which was rejected by their booking system.

• Finally, we confirmed that Fred Meyer, part of Kroger pharmacies, was in our network. A UHC rep told us this directly. I scheduled both shots. 

Oddly, the online system only allowed me to register for the flu shot at certain locations, and the Covid booster at others. I scheduled the flu shot at one location on Thursday, another on Friday.

When I showed up on Thursday, the pharmacist asked why I didn’t schedule a Covid booster. After my reply, her supervisor said that the government forced all pharmacies to use its booking system during the first wave of Covid vaccines. Then, when Covid was “over,” the government dropped everyone. Due to this, their system still isn’t functioning properly—and might be why I had such an issue with Walgreens.

The pharmacist entered my insurance information, even though I had already done that online (see previous graph). Turns out that neither the Covid vaccine or flu shot was covered.

I’m not adverse to paying for my health. But given the events leading up to this, both in regards to breast cancer screenings and the vaccine fiasco, I wasn’t handing over a dollar, especially as I knew someone would cover it, somewhere.

Fast forward to the parking lot. The UHC rep had no log of my wife’s call confirming Krogers was in our network. But he wasn’t sure who was in our network since UHC farms all pharmaceuticals out to a third-party company, Express Scripts.

Here’s what followed:

• Another UHC rep found the log, confirming they said Krogers was covered

• Which turns out to be irrelevant, because Express Scripts doesn’t cover Krogers, meaning the UHC rep was sharing data they didn’t have access to

• What they did have access to was a 92-page document they emailed my wife of all the primary care doctors who offer vaccines

• We called five doctors marked “accepting patients”; none were because UHC hadn’t updated that doc all year

• Who were we covered by? According to Express Scripts, no one. They ended all pharmacy relationships in September 2022, which UHC didn’t know about. I could only go to a primary care doctor to be covered for the Covid vaccine

While we like our primary care doctor, I’ve never had any problem walking into a pharmacy to get a flu shot, of even a Covid vaccine. So we finally called Providence.

The situation didn’t get any better.

Turns out that doctors don’t administer vaccines in our system. But Providence offers a dedicated room for both flu shots and Covid boosters, no appointment required. Then my wife asked the rep if the cost was billed to our doctor, since UHC only covers those shots.

Nope. Providence farms out all vaccines to a third-party pharmacy that operates in their hospital.

Meaning we’d get billed by a pharmacy, which wouldn’t be covered.

At every step, another middleman, with no one really taking responsibility because no one has access to the thousand other moving pieces in this completely fucked up network called our healthcare system.

We finally received flu shots at a local, independent pharmacy. And we might be able to get our Covid boosters there through the CDC’s Bridge program, an extremely under-marketed program that covers uninsured and underinsured citizens, but we’re not certain. Even though that pharmacy is listed on the CDC’s site, no one at the pharmacy ever heard of the program.

Advocating for good science is extremely challenging in a broken system. Centuries of medical experimentation led to one of the greatest public health interventions ever invented, and here we are, the so-called rich country, and our government can’t supply citizens with the most common-sense preventive medicine imaginable.

When people scream about our outsized healthcare costs each year, factor in the incompetence of legislators to get anything done to favor citizens.

Right now, a lot of conservative institutions are trying to deregulate our government out of existence, meaning access to healthcare is going to be even harder for those of us without millions of dollars in the bank—which is most of us.

I’ll continue to push back on the anti-vax, fear-mongering wellness grifting rampant in our country because that’s where science leads.

Yet I’ll agree with anyone raising their voice about our broken for-profit healthcare system. And I hope we can all find common cause in making it better.