Ask a doctor, nurse or home health care practitioner to recommend the best health insurance plan and they'll probably look around to see if anyone's listening. Then they'll whisper: "Be your own advocate."

With our oldest generation spending much more time in hospitals and nursing homes, as well as with home health care, I've discovered a big secret about our medical system.

You must keep track of how your money is spent, who it is spent on and what you get for it. No amount of money or "Cadillac" health plan will help if you lose control of your own health care. If and when you are incapable of making your own medical decisions, be sure that someone who is trustworthy -- and aggressively looking out for you -- is put in that position.

'How are you?'

Most doctors I've dealt with are dedicated professionals, but some won't hesitate to run up expenses when they know your insurance will pay.

  • The doctor who billed my insurer for "surgery" after wrapping my foot with an ace bandage.
  • The parade of specialists who walked into my father's hospital room when he was in the last stages of cancer, said "How are you?" and then submitted $500 bills.
  • And the doctor who wanted to perform an expensive and painful procedure that would have kept my mother alive, but in a vegetative state, when she was already in a fatal coma.

An advocate is good

There's no substitute for someone -- relative or friend -- who actually spends time at your bedside. He or she doesn't have to be a qualified health professional, but should be available to listen to your complaints and do something. Patients who push the call button often tend to be ignored. But if your advocate shows his or her face at the nurses' station enough times to ask for help, they will get a response.

A friend of mine had to cause a scene in a hospital emergency room and shout at the doctor just to get her terminally ill mother readmitted. So having an advocate is good.

Wake up!

The most remarkable story I ever heard was about a nurse's aide who took a personal interest in a young man in a coma. She sat by his bedside every chance she got and kept telling him to wake up.

One day when the doctors tested his functions and pronounced him "brain dead," his family finally agreed to pull the plug. But in those last few hours, that nurse's aide stood by him, actually shouting "Wake up! Wake up!" The staff and his family thought she was crazy. Until he woke up.

Different goals

Sometimes it's the ordinary people who save us, or at least keep us alive longer. That's particularly true with home health care. My mother never had a live-in nurse, but instead a woman who took care of her during her final years. She earned a good wage, got a paid vacation and received presents from me throughout the year. Because I was loyal to her, she was loyal to me, and I never had to worry about my mother's care.

After my mother died, an acquaintance called and inquired about hiring her former home health care worker to care for him. But when he asked about her salary, it became obvious that he didn't want to pay what she was worth. She went to work for him anyway, but was ultimately dismissed because he felt she was costing him too much.

His goal: Save the money for his daughter. His daughter's goal: Have him sign over everything when he got sick, warehouse him in a nursing home, and visit infrequently. Not much of an advocate.