Thursday, September 17, 2009

Financial Aid Woes, Insurance Reform And A Musical Observation

Many things should be done to change the student loan situation and foremost should be making sure that the jobs you are able to get after graduating are worth the cost of the loan.

Before I went to acupuncture school the dean said that it would cost approximately $28K to receive my degree.  He lied.  Tuition increased every year, from $128 per unit when I started to $185 a unit when I graduated and they kept increasing the amount of units required to graduate.  Sometimes books were more than a $1K per semester.  We had to pay to work in the clinic.  The patients paid for their treatment and herbs, we paid for the privilege of treating them.  Quite a nice little racket for the school.  Every 18 weeks our schedule changed.  One semester would be day classes, the next might be nights and weekends (I was in class on Easter three out of the four years I was in school), and the following would be a mixture of the two. Employers don't like that which made holding down a job to cover living expenses very difficult.

I graduated with $68K in debt and no way to pay it off.  Despite having done shifts at the San Diego Hospice and some classmates had worked in UCSD clinics, there were no jobs in our profession which meant you had to start a business.  And that is a completely different mindset from being a doctor and was only covered in one three unit class.  Treating patients was no longer the point, paying for office space, advertising, phones and equipment was.  Coming up with $845 a month for my student loan, wasn't.  So, I deferred and consolidated and am now income contingent.  Instead of having the loan paid off it is over $100K and still growing.  I will never earn enough to pay it off.

Was I stupid?  You betcha!  Halfway through school I realized it was a con (not acupuncture but the school itself), but I had already borrowed so much that I couldn't pay it off unless I graduated.  And then I had to hope that I was going to be wildly successful, which I sort of was until Silicon Valley crashed.

I had been in business about a year and was finally making enough to keep a roof over my head and able to budget a loan payment.  In less than a month that thought went the way of the dodo.  Patients disappeared as fast as their jobs did.  Cash patients could no longer afford to come in on a regular basis because they had become the sole breadwinner in their family.  Jobs with insurance benefits became nonexistent and then the great Arnold decided to revamp the worker's compensation system, mainly to the workers detriment.  This was followed by some idiot changing insurance codes to make acupuncture the equivalent of physical therapy and reduced our payments to a little over $20 a treatment, unless you lied to pad your bill or performed unnecessary prcedures.  Which many were forced to do if they wanted to stay in business.

A treatment typically takes about 45 minutes.  We do an intake which is at least ten minutes longer than the 18 seconds you normally get at a doctor's office, and we leave the room so the patient can remove one or two items of clothing and lay down on the table.  We insert the needles and if we've been in practice for twenty years or don't care about needle location or the comfort of the patient this can be done in two to three minutes but it usually takes five or six.  Then the patient rests for 10 to 20 minutes before you remove the needles.

Most acupuncturists have a single room office when they start out which means that if they are completely booked in an eight hour day (don't they wish) and if the patients have insurance they aren't going to make more than $200 a day unless they aren't honest.  This might sound like a good wage to some people but they forget about the expenses since that isn't a salary.  You still have two rents to pay, two electric bills, telephone, required schooling to keep your license, food, transportation, advertising, needles and other equipment and other assorted living expenses.  Like health insurance that you really can't afford.  You do your own reports and billing since you obviously can't afford a secretary or billing service.  Very few acupuncturists see forty patients a week and certainly not ones who are starting their own business.   I lasted almost two years before I quit practicing.  And I still have the loan but it's much larger now.

I never wanted to run a business, I wanted to be a doctor.  Technical schools count on this.  People want to be fashion designers, medical or computer technicians, auto mechanics, acupuncturists, chiropractors, etc. and these schools promise you that it's possible.  They take the money that you have to borrow to attend their school (if you had money or skills you wouldn't consider them a viable option but you're desperate to change your situation) and in return you get a degree that isn't worth the paper it's printed on.  And a huge loan that you can't pay back.

I understand why traditional doctors are frustrated with the insurance system as it currently stands.  They may graduate with more debt than I did but most of them have jobs waiting when they're eligible.
As long as they stay in a hospital environment they don't have to deal with the majority of the insurance issues but heaven forbid if they go into private practice.  In order to survive they have to see so many patients that they can't give any of them quality time, then they spend hours charting and justifying their decisions to people who may never have attended medical school or whose personality precludes them from seeing actual patients.  Why would anyone ever want to be a primary practitioner when they spend less time treating their patients than they do filling out the paperwork to justify their treatment decisions?

Both our education and medical systems are broken.  One is expensive and rarely prepares you for the real world, the other is even more expensive and prevents you from receiving quality healthcare.  Both of them cost money that those who aren't rich don't have.  And requiring people to purchase health insurance that they can't afford and won't cover them when they need it won't solve the health care problem just like bogus technical schools won't produce an educated populace capable of repaying those loans on a consistent basis.

I love music.  While classic rock is my favorite I enjoy all kinds with the exception of opera, country and rap. Some guy named Jay-Z, who I have only seen in commercials or in the tabloids, has more number one albums than Elvis.  Mariah Carey has almost as many singles as the Beatles, but I couldn't sing or tell you one song that they have done whereas with Elvis and the Fab Four I can think of quite a few.  Word for word.  And Madonna?  She may be a brilliant businesswoman but I honestly don't think I've listened to a complete song of hers more than once. Elvis and the Beatles have had their music covered by many bands in many cultures, Weird Al becoming famous as he makes fun of you isn't quite the same.


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