Ever have one of those days?

[GunnyMack]

Got up this morning, figured it's going to be a good day to get some stuff done and bow hunt the afternoon.
Started by pulling out the pellet stove for yearly deep cleaning. Done in about 1 hour.
Next up the new 20w solar charger for my equipment shed. Took a couple hours as of course I had to reengineer the mounting setup.
In the midst of that the farm camera sends me an alert, darn it the hired farmer is there to mow trails for bird season.
There goes my afternoon plans.
Now to work on my 80s vintage Cub Cadet. New ignition switch, new starter. Both are shot.Easy enough except to change the switch I have to pull the gas tank.
Put the tank back in and pour in some gas.
Turn the key and it cranks and cranks and cranks. Hmm, pull the plug and it is wet with gas. Let it air out for 20 minutes. Go back out and crank it to blow any gas out of the cylinder. Hey let's check spark... no spark while engine is cranking- turn key off and it sparks! WTH, am I seeing things? Try again and spark at shut off! I call a retired mechanic buddy and he said it's a bad switch, from the auto parts store.
Somewhere I have a push button starter switch but you think I can find it? NOPE!
AND to top off my day about 3:30 my trail cam at the farm sent me a pic of a big 8 point walking by my ground blind where I was going to hunt today!

[GunnyMack]

OH AND WHEN I WOKE UP THIS MORNING I FOUND A TICK DUG IN on my jaw just inside my goatee!!

[AJMD429]

.
My ADD would have kicked in halfway through that day for sure…!
I’d take two weeks of doxycycline (for the tick bite)…

[GunnyMack]

I have to try and get an Rx... I'm sure the doc won't write one without an office visit.

[GunnyMack]

The day continues!
Return the first switch to auto parts store. Go to small engine place. Sells me a cross referenced switch.
No joy, engine doesn't even turn over.
Take it back and leave with the same switch as he insisted it's the starter solenoid. I take the bait. Install the solenoid and the switch. Nuthin! If I jump the two terminals the engine spins and makes spark! Gotta be a bad switch.
I give up for today, gonna go sit in a tree and hopefully fill a tag!

[AJMD429]

I have to try and get an Rx... I'm sure the doc won't write one without an office visit.

It's like that around here, too. I can't prescribe unless there is a bona fide and documented 'patient-physician relationship' (i.e. having seen and examined the patient in-office at least once, and an ongoing updating of history and so on), which makes sense, but docs around here lose a lot of patients because they won't accomodate reasonable requests. I guess that's good for me, because they often transfer to me, since I don't accept any health insurance plans.

Most of the inconvenience, lack of creative service delivery, and excess cost, is due to insurance intruding as a third-party in the patient-physician relationship; the insurance companies set the reimbursement at about $81 for a visit (called the 'level 4) that uses about 25 minutes of time (8 minutes in room with patient and 16 minutes doing 'charting' - most of which is mindless garbage we have to insert into the record to 'justify' our billing them - EMR vs paper charting resulted in 2 of every 3 minutes being outside the exam room instead of in it), and since office overhead is usually $3.00 to $4.00 per minute, it means that physicians try to do those visits in four minutes or less (a '4 minute level 4' is the goal) room-time, keeping the total time related to the visit at 12 minutes. If we can do that, we 'get' $81 4 or 5 times per hour - $324 to $405, and after the overhead of $360 to $480 per hour, we hope to make some take-home. (Primary Care docs employed by a hospital are typically salaried around $120/hr around here, so obviously they are put up as 'loss leaders' to suck patients into the 'system' for labs, imaging, and referral to 'specialty clinics' where even more will be vacuumed out of their insurance).

WIth that kind of setup, the docs really feel they cannot do anything without a 'face to face visit', because that's usually the only way they can bill insurance (billing for phone calls is nearly impossible).

THAT is why most quality Primary Care physicians have long since dropped 'participation' in insurance networks of any kind. Our overhead is less since we have a bit less bureaucracy to deal with (we still need to argue on the patient's behalf with insurers about prescriptions and labs and imaging), so it is closer to $3.00/minute to run things, but if we charge $80/month as a 'retainer' then $20/visit or something like that, after we sign on about 400 patients we can usually break even, and 500 patients will give us an income about the same as our front office staff, but 600 patients will start feeling good. Capping at 700 patients means we'll be working 70 hour weeks most likely, but we'll at least make about half what the soul-selling docs make who became hospital-employees.

Folks who really want good health care, without a bunch of 'fluff' and without some big-pharma medication being the 'solution' to every single thing, should find a DirectPay physician. Sometimes you can get reimbursed by your insurance for the fees you pay them, but even if not, it's about the only way to get any semblance of decent and affordable care. What people don't realize is that it may be an extra $1,000 per year they seem to be spending on their primary care, but you have to physically go to the office less (miss less work), and you can get multiple things dealt with at one visit, versus the "well, you'll have to come back later for that..." or getting sent to specialists for simple stuff just because that's the way the system makes the most money.

Of course the OTHER thing most people don't see is that although their employer tells them they get their health coverage for $200 a month or some nonsense, there is NO plan that is going to be less than $1,200 per month - the insurance companies couldn't survive on such low premiums. The employer usually sends $1,400 or so per month, but only charges the employee $200 or so to 'participate'. The game is set up that way so the patient doesn't realize how expensive their insurance really is - most people would rather have the extra $1,200 per month (...or $14,400 per year...!) as pay versus 'benefits'. The other end is just as bad - insurers pressure labs to charge $85.00 for a simple CBC, even though the insurer will only pay $4.00 or so for it - the reason is so the patient gets an EOB statement later saying there was an $85 test and it was 'covered'. So they think the insurance paid $85 for a test they paid $4.00 for, and they think the insurance costs them $200 a month instead of $1,400 a month. Quite the smoke-and-mirrors, eh...????

The problem is that currently there aren't many physicians willing to borrow a quarter million bucks for college and finally start their income-earning at age 31 or so, and then on top of all that take the financial risk of independent practice - nearly all of them take a lucrative hospital employee deal. Sometimes a Nurse Practitioner can be found who is willing to do good Primary Care, but a lot of them push botox and lasering off pubic hair and other cosmetic stuff (although if they just do a limited amount of that to offset the losses of their 'real' practice, I can't blame them).

Anyhow - good luck... (...there's alway the feed store, for some things, although it is sad patients have to do that...)

[rossim92]

The day continues!
Return the first switch to auto parts store. Go to small engine place. Sells me a cross referenced switch.
No joy, engine doesn't even turn over.
Take it back and leave with the same switch as he insisted it's the starter solenoid. I take the bait. Install the solenoid and the switch. Nuthin! If I jump the two terminals the engine spins and makes spark! Gotta be a bad switch.
I give up for today, gonna go sit in a tree and hopefully fill a tag!

might BE a SEAT SAFETY. UNHOOK PLUG AND LOOP PLUG WITH WIRE TO BYPASS SWITCH. SEE IF THAT HELPS

[GunnyMack]

Good info Doc! I good buddy of mine is a chiropractor and he is always fighting with insurance companies.

Only recently I learned my local Dr's do not take the forced upon insurance I have. This policy only covers urgent care/ ER. I gotta call a few places and start shopping something that actually covers me.

[GunnyMack]

Already been done. And I hooked it back up and used a bag of shot to hold the seat down. Tried the orignal switch but it is shot.

I ordered 2 other different switches from Amazon, one looks like it is correct. That's tomorrow's cuss festival!

[piller]

When on Doxycycline, no milk, vitamins, or real creamer in your coffee for about 2 hours before or after the pill. Yes, Doc is totally correct on using Doxy. Do not give it a chance to let a bullseye rash develop.