Surviving the Medical Meltdown (19 page)

PAYING FOR YOUR MEDICAL CARE

If you are not on government-funded health care, the most cost-effective solution is to sign on with a cash physician for your everyday needs, and pay cash. Then buy high-deductible catastrophic insurance for those times that you have a major medical issue, such as surgery, heart attack, or cancer. If you need to, ask your employer to give you the money in your paycheck that is being paid for insurance; then buy your own care. Note that I said “care,” not “insurance.” Yes, I hope you will purchase some form of insurance, but you have to start thinking of buying care. If you have learned nothing else so far in this book, you should have learned that insurance is not synonymous with care and insurance doesn’t guarantee medical care. You will find you are financially ahead because group insurance is vastly more expensive than private insurance for generally healthy individuals. Unfortunately, as the result of Obamacare, even high-deductible insurance has become significantly more expensive. And the plans for this government-administered nightmare change daily, so I cannot be more specific.

If you are of Medicare age, you should still seek out a cash doctor because, in the future, your Medicare doctors may discharge you from their practice, or they simply may not have the resources to care for you. But, how do you afford essentially paying twice for your health care? Establish yourself with a cash doctor, and see that physician often enough so that he or she knows you and considers you one of the practice’s regular patients. This may be twice yearly or yearly – depending on the physician’s requirements. If you need
treatment above and beyond that, you may be able save money by using your Medicare benefits – as long as they are available- – with another physician if testing or hospitalization is required. This may not be acceptable to your cash doctor, so you need to be careful how you handle the situation. Many Medicare patients always use the cash doctor because cash doctors generally spend more time with the patient. Although it costs more, the value per dollar is much higher.

Don’t forget barter. My father opened his office the day the banks closed for the depression of 1929. Not infrequently he got paid in the currency of the local farmers: ducks, chickens, and hams. I have taken floor laying and Kansas City barbecue in exchange for medical care. In the old Soviet Union, medical care was bought with shoes, food, and any comestible the people could scrape together to bribe the doctors and nurses for medical care.

START NOW

Do not wait until care is unavailable. Start now by weaning yourself off the system. If you stay with what you have until it is unavailable, you will not be able to easily jump ship. And typically we always get sick at the most inopportune time. You want to develop a relationship with a freethinking, non-government-dependent physician
before
the system collapses.

15
BE YOUR OWN CORPSMAN:
STORING AND STOCKPILING MEDICINES

E
very independent adult has a medicine cabinet, and it seems to get bigger as we get older. This may be adequate for today’s needs, but in the event of a medical meltdown, you will need an expanded, well-thought-out medicine cabinet – not just the little one behind the mirror in your bathroom. Included in the 90 percent of things you may be able to care for yourself are: common febrile illnesses, diarrheal diseases, minor scrapes and cuts, sinus infection, minor eye infections and scratches, sprains, arthritis pain, rashes, insect bites, contact allergies, simple broken bones and dislocations, neck and back pain, and external ear infections. To this end you will need a systematically stocked medicine cabinet. (
Appendix B
has a list of drugs and a table of disease-specific medicines.) There are various cost-effective ways to build this. You should check out farm animal supply stores for medical supplies.

The farm or vet store drugs are cheap, and the quality is good. The same drugs we use on humans are also used on animals. But because they do not have to undergo FDA testing for the animals, because they do not have to meet the same packaging requirements, and because they don’t have to be dispensed by pharmacists, they are sometimes much cheaper – especially if bought in bulk. A cow
does not have to sign a disclaimer at the checkout window that it is declining counseling about the side effects of the drug it is being given. Everything has a cost. And just like food, the requirements for purity
may
be less. But honestly, I have no qualms about using farm store drugs. (Although I cannot in my medical practice officially recommend the same, remember: we are stocking for the time when standard medicine may not be available.) I am reminded of a famous ’60s drive-through fast-food joint in Nebraska. They were known for miles around for having excellent chili. Teenagers hung out there, and many people flocked there for this excellent chili. But the garbage man always wondered why there were so many Alpo cans in the trash every week. As it turned out, they were making their famous chili with Alpo – to save money and increase profit, of course. But the point is, until it came to light and violated a health ordinance, no one cared. Canned dog and cat foods have more contaminant parts per million and may not have the top-quality cuts ground into them. But they are nutritious, and I’d sure eat them before starving. So, too, with these medications. They are produced by the same companies, are packaged well, and are extremely unlikely to be significantly different from those given to humans. If you are in doubt, you can choose not to use them.

FARM STORE ANTIBIOTICS

Cipro and clindamycin
used together are a great broad-spectrum (kills many types of germs) antibiotic combination that we use commonly for infections of skin and bone – especially puncture wounds.

Amoxicillin
is a good start for ear infections that are internal, and it will work against strep throat. (Keep in mind that
most
sore throats are not strep but viral, and antibiotics do not work against viruses.)

Doxycycline
is used for treatment of Lyme disease, for post-exposure prophylaxis, for urethritis (infection of the tube from the bladder), and for some sexually transmitted diseases. Regarding potential bioterrorism, all the drugs listed will treat anthrax. Doxycycline can also be used against plague and tularemia, also known as rabbit fever.

Certainly topical antibiotics are equivalent and effective. Also, most drugs do not become magically worthless at the “use by” date shown on the bottle. Ask most physicians. Since we cannot ethically write prescriptions for narcotic pain relievers for ourselves or our families, we hang onto any such medicine prescribed by the dentist or other physician so we may use these for injuries sustained years later. I learned the hard way to take a bottle of narcotic pain medicine with me along with basic slings and splints on all snow-boarding trips. It cost me $750 just to have a retired cardiologist in a ski-slope clinic tell me – an orthopaedic surgeon – that I had a clavicle fracture. I needed the sling and the pain medicine, so I had to pay the price for information I really didn’t need – having diagnosed my own fracture the minute I hit the icy ground!

Long-term expiration dates are extrapolated from short-term studies that subject medicines to temperature and light and other extremes that seldom replicate conditions in anyone’s medicine cabinet. There is no literature – except in the case of a form of tetracycline no longer in use – that confirms that expired drugs cause harm. I don’t worry about harm. I do worry a little about efficacy.
The one drug I know about that does degrade and should be replaced when expired is the epinephrine in EpiPens for allergic reactions, such as bee stings.

THREE THINGS TO KNOW ABOUT EXPIRATION DATES

1.
Outdated drugs have not been shown to be harmful.

2.
Most drugs retain their efficacy for years past the expiration date.

3.
Never rely on outdated EpiPens; always keep these updated.

The Department of Defense, in conjunction with the FDA, has been testing for the loss of chemical stability of 122 medications for more than twenty years.
¹
Two thousand six hundred fifty lots of drugs were kept unopened and left on a shelf. They looked at potency (chemical assay), physical appearance, water content, and dissolution. No chemical failures were recorded one year past expiration date. Four hundred seventy-nine lots failed after an average of sixty-five months. There were no failures of amoxicillin, cipro, or doxycycline, or of potassium iodide tablets (kept by some people for use in nuclear accident/radiation exposure).

Now, of course, these were unopened bottles on a shelf in moderate temperature and no light. It doesn’t translate to a bottle of aspirin left in the back window of your car in Phoenix over the summer. But in general, I keep drugs for years. If they smell too much like vinegar (aspirin degrades to that smell) or are crumbling or don’t look right in any way, I get rid of them. I don’t automatically dispose of them when the expiration date comes. Keep in mind that expiration dates make money for pharmaceutical and other medical supply companies.

One time I was about to scrub up for a spinal surgery and found that all the Hibiclens surgical hand scrub had been removed from the sink dispensers. When I asked what had happened, I was
told that cases of Hibiclens had “expired” – i.e., were older than the stated “use by” date on the bottle. This meant that the hospital disposed of cases of perfectly good soap to be replaced by more costly new soap. Why should Hibiclens hand soap expire? Does your home dish detergent expire? Some of this is clearly nonsense for profit. (I demanded that some outdated soap be used in the interim, pointing out that a surgeon not scrubbing before surgery was probably a bigger deal for sterility than Hibiclens that was a few weeks too old.)

STOCKPILING PRESCRIPTION DRUGS

Because shortages are sure to occur with the vast overregulation that Obamacare piled onto Medicare and OSHA and the FDA, you should stockpile at least three months and preferably six months of any medicine you need. This includes hormone replacement. When you fill your prescriptions, your insurance may pay for only a month or ninety days at a time, but
you can pay cash
and get more. Do it. You can often pay less for ninety days of a generic medicine than you would pay for just the co-pay of a name brand. For example, for ninety days of Singulair – a name-brand asthma medicine – I might pay a fifteen-dollar co-pay but at the cost of a much higher monthly premium. But for seventeen dollars with a much lower monthly premium, I can buy one month of montelukast, the generic equivalent, thus saving myself a couple hundred a month in premium costs. Also, insurance companies give you a little fudge factor on the amount you can get. They may authorize ninety days, but at the eighty-day or seventy-day mark, they will let you get another ninety days. So by being careful, you should be able to slowly add to your stocks.

Another option is to utilize an overseas pharmacy. Many winter visitors to cities along the Mexican border go across the line and purchase their prescription drugs for cash. The savings can be so significant that it pays for their winter vacation. On overseas trips
I have purchased antibiotics over the counter in India and in Italy. I am often asked about quality of these overseas pharmaceuticals. Again, I cannot officially recommend them in my role as a licensed US physician, but I can tell you that for me, I am willing to accept the uncertainty about quality (and there is always a degree of risk even for US medications) in return for ease of purchase and astonishingly lower prices. I want good packaging and usually try to get a brand with which I am familiar. In the 1980s, while I was on active duty in the Navy, I flew on Alitalia; and in those days, having observed the Italian telephone system, I was more worried about flying Italian airplanes than ingesting Italian medications. Every aspect of life has risk. In spite of our government doing its best to regulate each fragment of medical care in the name of safety, it is ultimately up to the individual to judge risk versus benefit.

To keep medications fresh, rotate the medicines so nothing outdates and always keep a stash to survive three to six months. Refrigerate when necessary. Again, as noted before, in modern history, when countries experience monetary collapse, it usually takes at least three months for the monetary system to be restored to a degree that allows goods and services to flow. You need to stock for this probability. And I am stocking for longer – under the assumption that when America goes down, it will shake the world more than the fall of Zimbabwe or Argentina.

Next, I would get some antibiotics – either via a friendly physician, buying them over the border, or via a farm animal supply. I keep antibiotics that cover most minor things and also most treatable bioweapons agents (see
appendix B
).