This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf.  Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist.  This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.  I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf.  The middle ground is often where the best public policy decisions lie.  And it is where you want to be on a golf course.

It would be appropriate to call an experience I had this week stunning, disappointing, stupid, shocking.

Find another negative word.  It would fit.

Here’s what happened.

In late May, I was scheduled for an annual, “routine” visit with my cardiologist, something I have done for about 20 years since my “episode,” which was a heart attack in 2004.

So, for me, this visit was another important step on the way to preventing a future, emergency event.

In advance of the appointment, I had my blood drawn to provide information for the doctor to review.

All fine, so far.

Then, guess what?

Medicare, in its infinite wisdom, turned down reimbursement for the blood draw, using these words to decline:  “Medicare has denied payment stating that these are non-covered services because this is routine exam or screening procedure done in conjunction with a routine exam.”

Those words, quoting Medicare, came from a company called Labcorp, which wanted payment for the blood draw. 

In response to the bill – as well as other “stupid bills” — my wife and I spent about an hour on the phone with our supplemental insurer, MODA, where we learned that, when Medicare makes a decision such as the one in our case, MODA simply goes along with the federal decision.  So denial.

Say what?

If that “go-along” simply exists, then why do we have a supplemental insurer here in Oregon?

All of this defies rational explanation.

The service from my cardiologist was not “routine.”  To be sure, it was an annual procedure, but it was designed to avoid a future emergency.

So, why was it not covered?

I have no idea.

I suppose my wife and I could argue with Medicare, but we would have to do so in Washington, D.C. and no doubt would make little progress.

The fact is that this may come down to another health insurance word – “coding.”

If the blood draw I got was coded as “routine or preventive,” then I guess it would not be covered.  [Though, I add quickly, that, under our previous Medicare Advantage insurer, Providence, we never got a bill for a blood draw.  So, at the earliest opportunity, we’ll likely go back to Providence, which fits in the sense that, as a lobbyist, I represented Providence for about 25 years.]

The key:  Code the procedure differently in an effort to gain insurance coverage.

In this episode, the bottom line is this:  Our current health system in America – is it really a “system” in the normal sense of that word – is screwed up.

It does not reward solid behavior for persons who are committed to “prevention.” 

The incentive ought to lie with preventing future emergencies which, if left unchecked, would cost much more than “routine” procedures.