An Opinion Editorial About
Guillotine-Related Medicare Claims

          Did you know that Medicare has a category for reimbursement of claims caused by “Legal Execution, Beheading, Decapitation (By Guillotine)”?
          Well, it does.
          When I became aware of this fact, I felt compelled to ponder what sort of a person could perceive a need to put guillotine-related incidents into the Medicare coding manual.           Not just think about it, or joke about it, but actually do it. And skate it past all the editorial and medical reviewers.
          Help me out here. Under what circumstances would a senior citizen (or their bereaved family) seek reimbursement from Medicare in connection with being guillotined?
          Even if you could cook up a possible scenario, how often could this kind of thing be expected to happen? Couldn’t it be covered under a catch-all provision at the end of the coding manual called “Other”? Shouldn’t it be? Should I have to pass it coming and going several times a day while desperately trying to locate the code number for “sore throat”?
I think not.
          This absurdity first came to my attention several years ago when a family emergency forced me to swap my cushy, inside-the beltway Washington lifestyle for answering the telephone, manning the reception desk, and filling out the insurance paperwork at my father’s medical office near the Smoky Mountains of East Tennessee.
          I’m willing to admit that I didn’t make the most graceful of transitions. But the most painful aspect of my new down-sized life was not struggling with the precipitous loss of status and income, or trading Hermes for Wal-mart. The worst shock was learning that the insurance system which I had easily mastered during summer vacation at the age of fifteen, had been “streamlined” by the government to the point that it was now incomprehensible to me, a forty year old former U.S. Senate lawyer with an engineering degree.
          I, who had aced my way through three years of calculus and who had been competent to draft our nation’s nuclear legislation, was utterly buffaloed by the challenge of filling out a Medicare form for a patient with a stomach ache.
          Because I couldn’t cut and run, I had to try to slog my way through.
          All day long I paged back and forth through the Medicare code book, searching, but rarely finding, the secret formula that would cajole the government into reimbursing the treatment for a ninety year old lady’s joint pain or a retired miner’s lung problems.
          What I found instead was a section for “Accident Involving Spacecraft, Includes Launching Pad Accident, Excludes Effects of Weightlessness in Spacecraft”. So if an elderly citizen is crushed on the launching pad under a toppled rocket, they’re covered. But if they hit their head on the ceiling of the Space Shuttle once it has reached cruising altitude, they’d better not come crying to Medicare.
          Although my former boss, the brave and beloved Astronaut and Senator John Glenn, went into space again at age seventy-seven, I’m willing to stick my neck out here and suggest that this is not really a sufficiently common occurrence to merit inclusion in the coding book that each physician’s office must consult for every single patient visit.
          The nation debates how to bring health care costs under control and yet allows Medicare reimbursement for “Problem, Spoiled Child” and “Quarrelsomeness”.
          And the entry for “Double Whammy”? I’ve certainly experienced the situation, but never dreamed anyone could get medical insurance coverage for it.
          Recently I faced another painful revelation about the lack of common sense underlying our nation’s health care system as I watched my parents, both of whom have doctorates in Pharmacy (my father went on to get an M.D. as well) struggle with the new changes in the Medicare prescription drug benefit program.
          It was frighteningly similar to a lottery or gambling. They had to sign up at a cost that was subject to change, for benefits that weren’t certain.
          If a team of pharmacists, one of whom is a doctor, can’t figure out how to proceed, how is a more typical senior citizen supposed to navigate the labyrinth?
          Are we a nation serious about addressing the health care needs of our citizens? Are we willing to get real about creating a humane, sensible, and efficient system to care for each other?
          Apparently not.
          Are prescription drug benefits available for seniors who have been guillotined?
Probably so.