Thursday, August 6, 2009

Thinking About Health Care

First, I want to categorically state that this post will in no way be an intellectual debate about the various health care options being worked out in Congress right now. That debate, while incredibly important, is not something that I wish to enter into without knowing a great deal about it, which I don't. Quite honestly, the details of health care and insurance make my head hurt.

What this post is about is my personal experience with health care over the past decade or so of adulthood. It is this experience that leads me to believe that there is something wrong with our system, something that requires some sort of reform.

I want to begin with an experience I had outside of the United States. In 1998, I was blessed to have been able to travel to Mactan Island, Philippines (not far from Cebu). It was a 3 week service trip during my college's interim term and was a trip organized and sponsored by the university. We had three sub-teams to our team of 27: one to build a pre-school, one to present public health education (brush your teeth, wear condoms, etc.), and one to run a daily traveling health clinic. I was part of the latter. We had a doctor from Indianapolis with us who handled examination and diagnosis. We students filled prescriptions of basic over-the-counter medications such as cough medicine and topical lice lotion for scabies, as well as taking blood pressure and temperature. In fact, most of the people we saw during those long clinic days were children - large families, actually - with basic earaches, coughs, and lots and lots of scabies-infected legs. We also saw children who were classically mal-nourished. There is one story, however, that I want to share tonight.

One day, in a village whose name I don't recall, an older woman (maybe in her 50s) came in to see us. She complained of a pain in her breast. I was working side-by-side with the doctor that day, rather than at the medicine dispensory. We had her lay on a table on her back and the doctor performed a breast exam. He glanced at me sideways, and I knew from the look on his face that it was bad. He asked for my hand and placed it on a particular spot. "Do you feel that?" he asked. Yes, it was clearly a mass; there was no mistaking it. He then told the woman that there was a lump there, but without essential technology, there was no way for us to know what it was. He advised her that she needed to go to a doctor immediately. She looked up at us, with a surprising mixture of sadness and amusement. "I have no money for a doctor," she said. She went on to explain that there wasn't a public health care option for her...not even going into the emergency room as we do in America when we have no insurance. She left us that day with a feeling sadness and a sense of dread for her. I have no idea if that lump was benign or malignant. All I know is that that woman had no other options because she was poor. And, that fact has stayed with me all these years...that it is possible that that woman died prematurely because she, an impoverished individual, had no access to appropriate health care that could have saved her life.

It is so easy to argue against public healthcare if you've never lived without insurance, never seen a culture without access to basic services. The lines for our daily clinic were so long that we often stayed after our posted time to see everyone. We never had real breaks during the day, save lunch. We regularly, in single villages, saw over 100 patients. These were people without access simply because they were poor. That same fact is something I see, in part, in America. The poor are penalized, are deprived of the basic right to live, simply because they are poor. It is not nearly as bad as what I saw on my one international service experience. But, it's still an issue.

And what I don't understand about the current health care debate is that people don't seem to get that the poor are deprived of quality health care. One video I saw today showed a woman saying, "why do the 80% of us with health care coverage have to change for the 20% who don't?" I truly believe that this same woman would identify herself as "pro-life," arguing that there is an inherent "right to life." Do the poor not have the same right as the fetus that you so diligently seek to protect? Or does that person forfeit your passion for life after s/he is born? To me, it just seems to be a contradiction.

I digress. Shortly after I returned from the Philippines, I injured my knee at school. I was in a free weights class, doing step ups with weights that might have been a little too heavy, and the whole room heard my knee pop. It swelled that night and I had it looked at by an EMT who was dating a sorority sister. He helped me wrap it and I elevated and iced. I went to the school's health clinic that week and had it examined and x-rayed. I was in pain and the doctor suggested that I had a micro-tear in my ACL. He didn't think it would have required surgery, but said that I should have a specialist look at it. I was still on my dad's insurance at the time. That insurance was through his retirement from the Commonwealth of Kentucky. Each year, they bid out their employee insurance and that year, funny enough, we had the same insurance carrier that I have now through my employer (also a state institution). They required that any visit to a specialist be referenced by the primary physician. So, one week, I bummed a ride with a friend to make the three hour trip home to see my family doctor. I showed him the x-rays and told him what the doctor at the university had said. Without even looking at or touching my knee, he said, "call the insurance company. I'll write any reference that you need. This is a case for a specialist." So, I called the insurance company and told them that. I went to school outside of Kentucky, so I needed a specialist near Indianapolis. The response? "That's not how it works. I can't give you an in-network specialist in Indiana." When I asked how it did work and what I needed to do, I got the run-around. To this day, that knee still has not been properly examined or treated. I imagine that the pain I feel with cooler weather and rain is from scar tissue now. But, it begs the question: why did we pay for insurance that wouldn't help me when I needed it? Other than that, the only other claims I had were basic annual visits and medication for sporadic bronchitis. That company made a LOT of money off of me, my family, and the state. Yet, I got no help when it was needed. And, I was too young to know how to navigate the system aggessively.

Since my experience in college, I've been lucky to have my own insurance through employer-provided group plans for which I pay a premium. So far, I've had no problems with my plans through the past 9 years, thankfully.

But, I do want to say something about the structure of the doctor's office and mention some experiences my family has had. One of the big arguments I keep hearing is "we don't want the government coming between you and your doctor." You know who comes between me and my doctor? MY DOCTOR! I found out the other day, from my father who got it directly from the doctor's office, that the doctor in our physician's group is to spend no more than 15 minutes with each patient. The last two times I've been in to see the doctor, I've been in and out in less than 1/2 hour. The last time, I actually had to stop my doctor from walking out the door while I was asking a serious question. But, what I want to say has more to do with my family than with me personally. I think the best way to do this is to list actual experiences...

Scenario 1: My mom had a surgery in the late 1990s. Since that surgery, she's struggled with stomach issues. She has trouble keeping down food and can only eat very small amounts. While, undoubtedly, some of this is due to her surgery, some of it is just unusual. She also struggles to lose weight despite the small intake of calories daily. So, she went to our family doctor. He told her it was possible that there was a mass and ordered an ultrasound. My mom, a 'glass half-empty' type, convinced herself following that consultation that she not only had a mass but that she had cancer. She was terrified. She was told that she would have results approximately 1-2 weeks after her procedure. Those weeks went by and she heard nothing from the doctor. She called and was told that the results had been in for a week but that she had to speak to the doctor directly. She called again in week 3 and finally was given the results -- that they found nothing. But, why on earth did she have to worry for 3 weeks to be given her results? Why didn't someone call her? Is this the type of "service" that we pay for??

Scenario 2: My dad had pneumonia. He ended up in the hospital for 16 days. They had predominately gotten rid of his pneumonia, but he still felt something was wrong. He felt a pain in his left lung. The man is 71, so if he feels something is wrong, he's not lying...he knows his body at this point. The family physician wanted to send him home. He had to argue with her to stay in the hospital and get the lung tested. She hesitated because of the insurance. But, he won out. And thank goodness he did. He had a fungal infection in his lung - something quite common in this area, but because his immune system was wrecked from the pnuemonia, he couldn't fight it off on his own. I guess my issue with this one is that my dad is one who doesn't go to the doctor for every cold. His pnuemonia was actually so bad because he waited too long to see a doctor about it. So, why on earth would you argue with someone like that when he is telling you that he clearly knows something is wrong with his body? Why are you putting insurance before the patient?

Scenario 3: My mom needs to have a knee replacement surgery. Desperately. She's been in pain for quite awhile, but hesitated to have the surgery because she's afraid that something will happen to my dad while she's in rehabilitation and she won't be able to care for him. With my brother and I so close, she's now okay with the idea. And, she's found out that it is now 90% deteriorated and is causing back problems, including issues with her spine and sciatica. So, she's ready. The specialist has green-lighted it and is ready to schedule the surgery. Before he can, however, she needs to be cleared by our family physician so that general anestheic can be used. So, the specialist contacted the physician to request this. A couple of weeks later, my mom goes into the specialist for what she thought would be the final visit prior to her surgery. He tells her that he still can't schedule the surgery because the physician won't clear her without a direct examination. That's fine. But, the doctor's office didn't call her to tell her this. So, she calls to set an appointment and they tell her it will be at least 2 weeks before she can get in! My mom argues until she's literally nauseous. My dad gets on the line and argues until he's furious. My brother hears about it an hour later and drives my mom up to the office and argues until he gets an appointment within a week or so. In the midst of this, he is literally MOCKED by one of the workers in the office. I hear about it that night and am working on a complaint letter to send to the office, its physician's group, and any groups/associations it is affiliated with.

My point of this is, quite frankly, that we aren't getting what we pay for. We pay thousands of dollars each year for insurance. When we have appointments, hundreds of dollars are charged to our insurance company. In scenario 3, my mom's insurance was charged $180 to be told by the specialist that the other doctor needed to make an appointment. And when this is pointed out, both offices state that it was the other's responsibility to notify her. What are we getting for our money? This system is broken. It is not efficient, with time nor money. It is contrary to the oath of doctors to serve the sick. It is about money, not about service. If it was about helping people, then my mom wouldn't have to be in severe pain for weeks on end simply because 1) someone can't pick up a phone and 2) they want to shuffle people in and out in 1/2 hour or less.

Okay, my rambling rant on this is done. I have no answers, only examples of how this system isn't working for middle-class individuals who do fall into the "80% of Americans who have coverage." I challenge our lawmakers to do the right thing and create reform. Reform that works for people. I, personally, look forward to an America where health is considered a human right - not something that only the rich can afford. And I'd love to see an America where doctors can work in the best interest of the patient, not in the interest of the insurance company or physician group stockholders.

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