Those who know me well know that I am fascinated by my family history and our cultural heritage. I am proudly very German and, it's my hope, to someday learn as much as possible about the area from where my family emigrated. But, as important as it is for me to know where we came from, it is equally important for me to understand where we ended up and how history shaped us and our cultural traditions. It's also interesting to me how my family fit into the cultural landscape of their neighborhoods, no matter how 'insignificant' our roles were.
A large part of my paternal family's story is based in Cincinnati, Ohio. My great-great grandfather was born in Germany around 1820. From what I have found thus far, he settled his family in the Mt. Adams neighborhood of Cincinnati, working as a laborer. I haven't found much more than that...simply one listing on an 1880 Census record. I would like to imagine that he was an early part of the great German immigration to Cincinnati in the 1850s, an immigration that sparked debate similar to that of the current Mexican immigration debate. That period in history really effected the cultural landscape of Cincinnati, as German-language churches, newspapers, and neighborhoods took hold throughout the city.
My great-grandfather was born in Cincinnati and lived there his entire life, though in various neighborhoods. He was a driver for a brewery (he was the beer delivery guy!), listed in Census records as both a Stable Driver and simply a driver, meaning that he likely delivered said beer via cart and horse to the city's bier gardens.
My grandfather, born at the end of the 19th century, grew up in Over the Rhine. OtR, as it's now known, was a cultural mecca of sorts for Cincinnatians of German decent. As an adult, he moved for a short time to Price Hill and later, with his new family, to Mt. Auburn. My father was born in a house that still stands on Dorsey Street in Mt. Auburn. They lived in that house until the mid-1950s when they moved to Northern Kentucky. My grandfather owned and operated his own business in Cincinnati. Frank's Coal and Ice was a delivery business in the days before electric heat and industrial refrigerators. Grandpa had a dump truck and would literally dump coal and/or ice orders into the cellars of businesses throughout the city. I am lucky to have a placard of his business that businesses would use to place their orders -- from their windows.
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The house where my dad was born/raised in Mt. Auburn.
The point of all this background is that my history, my family, has direct ties to the cultural make-up of Cincinnati. So, Cincinnati history and culture still means a lot to me. Sure, I live in the Cincinnati metro area so it should matter anyway. But, honestly, I live in Northern Kentucky and consider myself a Kentuckian before a "Tri-Stater". We're kind of like a little world of our own here in NKY. And, from the perspective of a suburbanite, it seems that many of the recent arrivals to our fair area have little desire to learn nor appreciation for the culture/history of the region. And yet, it is important - for understanding the early make-up of Cincinnati neighborhoods and the cultural traditions of families that have long ties to the Queen City.
Yet, part of my personal story took me away from Cincinnati. For 7 years, I lived in the heart of Appalachia in Knox County, Kentucky. I worked at a college there and was, despite my role in connecting the campus to community, considered an "outsider." Yet, I learned a great deal about Appalachian history and culture while living there. And I definitely came to appreciate the wonderful things about Appalachia, though I did long for "home." I was also blessed in my first year there to be able to connect my 'two worlds' of my "home" and my new home. As the community service director, I worked with a faculty member to arrange a service-learning trip to Cincinnati. The class was meant to be an introduction to Appalachian culture and the professor wanted to teach about both rural Appalachia and urban Appalachians, specifically those who were descendants of the the Appalachian migration to urban areas like Detroit and, you guessed it, Cincinnati. So, we travelled the three hours north and worked with the Urban Appalachian Council. They gave us a wonderful tour of neighborhoods, discussed the needs of those they serve, and introduced us to cultural and social issues for the 1 in 4 Greater Cincinnatians with ancestral ties to Appalachia. Our service was to paint the inside of a community center that they operated for local Appalachian youth.
Earlier today, I was dismayed by the local Twitter response to an article posted in the New York Times. In the article, the author says, "The old neighborhood of Over-the-Rhine still serves as a northern outpost of Appalachia." Somehow, this line offended people. The Cincinnati Enquirer posted this opinion piece in response. I mean, I get some of the backlash. After all, Cincinnati is on the defensive a little after a terrible article in Vanity Fair. No one likes the idea of an outsider coming in and writing a national piece that "picks on" Cincinnati. But, this anti-Appalachian stuff really got under my skin because of my aforementioned personal experiences. I even had one tweeter respond to me that she's never seen an Appalachian in OtR. Really? You can tell who is Appalachian by looking at them? I do have to give kudos to one prominent Cincinnati Twitter user who removed his posts about this topic when the stereotyping issue was pointed out, though it was too late to avoid the dreaded re-tweet of his main posts by one of his colleagues.
I guess the reason that I got upset about it was this: the culture of Appalachians is just as important to Cincinnati as that of my own German heritage. Everyone was focusing, it seemed, on the stereotypes associated with Appalachia rather than on the historical context from which the author was writing (funny, as the entire article was about history of the city and its baseball tradition). Throughout Cincinnati, there are residents who can outline their ancestry as I did above, but trace it back to the Appalachian Mountains rather than Germany. I was offended for them....to the point where I felt the need to write after a year hiatus. I was also offended for the many friends I still have in Appalachia, those that have moved from the mountains to other places throughout the country, and my cousins who moved from Cincinnati to Appalachia. When you talk about Appalachians, you aren't talking about the fictional Clampets...we're talking about real people here despite your desire to stereotype.
I am, yet again, thankful to my high school classmate Jason over at The Cincinnati Man who, as always, can write a point-blank shot about the issue way better than I ever could (and more succinctly, obviously). He's done this on a couple of issues and I absolutely love seeing him weigh in on these items. (HINT: if you don't follow TCM, you should)
My point is, if you are going to espouse the virtues of a city and say, as the Enquirer piece does, that we have so many "cultural offerings," I think you might do well to include cultures of historical importance. I love seeing a strong influx of new cultures to our area and look forward to seeing the significance they will have in shaping the future of the region. But, we shouldn't trample on those cultures that have made the city what it is. To do so shows a lack of historical knowledge and, quite honestly, an insensitivity to a culture that you clearly don't understand and/or didn't know existed.
Showing posts with label social issues. Show all posts
Showing posts with label social issues. Show all posts
Monday, August 23, 2010
Thursday, August 13, 2009
Weighing in on the End-of-Life Debate
It was 1993. I was 16 years old. And, we were sitting in the nursing home waiting for my paternal grandmother to arrive via ambulance from the hospital where we had determined that she could no long live independently due to being diagnosed with dementia. Prior to this decision, she had taken a laxative, then had a minor stroke. She hadn't answered my father's phone calls and, concerned, he drove the 15 miles to her house to find her alive, but unresponsive. Over the next week or so, she literally fought with the nurses at the hospital, giving one a black eye. In a semi-coherent moment, as she lie in bed with arm restraints in place, she tearfully looked at us and asked, "why are you doing this to me? You're my family; you're supposed to help me."
None of us had had experience with nursing homes to this point. My paternal grandfather, the only grandparent who was deceased at that point, had had a major stroke at home on my sister's 6th birthday. He died a few days later in the hospital at the age of 74. So, this was all new to us. I had personally only been in nursing homes through my volunteer work, having visited residents and performed Christmas carols as part of organizations in school. It was an uncomfortable place to be.
My grandmother was alert that day, and seemingly herself, as she was wheeled into the home on a gurney. She smiled at us and waved hello. We - me, my father, aunt, and uncle - were then called into the office of the facility director. During the course of the conversation, while she listed a litany of both services and family responsibilities, she asked us what our DNR decision was. We didn't know what that meant. She explained the "do not resuscitate" order and repeated her question. My father and aunt looked at each other and said, 'well, we'd like every effort to be made to save her.' I had been quiet up to this point...I mean, I was just a teenager sitting in on a very adult conversation. But, I had to jump in. I had seen news stories on television about people who had to go to court to get loved ones removed from life support. So, I asked, "if we did not have this DNR, then she would be put on life support, right? And, if that were to happen, would we be able to take her off when we felt appropriate or would we have to take legal action?" The director smiled and responded that we would, indeed, have to go to court to get her taken off should she be put on life support. That question and subsequent answer changed the entire course of dialogue. After all, my grandmother would not want to be kept alive as a shell of herself. And, she certainly wouldn't want us to go to court over it all. So, my aunt - grandma's power of attorney - signed a DNR and instructed that CPR could be administered, but she was not to be put on life support. After that meeting, my father and aunt both thanked me for asking that question, and for helping them to make an important decision at one of the most difficult times a child can face in the deterioration of a parent.
My family learned from that initial experience. Since that time, we've made conscious efforts to have those important conversations before the decisions are needed. I've known the wishes of my maternal grandparents and my aunt and uncle. I also know the wishes of my parents. There will be no question in my mind of 'what they would have wanted.' But, prior to that experience with my grandmother, we would have never have thought to talk about it.
Ours is a family that could have benefited from having an end-of-life conversation with a doctor, to learn of all implications of our decision, to understand how it would impact our entire family, and to learn what the common national standards were for such decisions. And, if that were available to us back then, I would certainly hope that it would be a meeting covered by our insurance.
To all of the politicians who are amping up this fallacy of "death panels" and who are threatening to take end-of-life counseling services out of potentially covered expenses for proposed health care reform: how dare you. How dare you spread lies, feed on fear, and hinder important conversations that we should be encouraging. How dare you use such an important issue that will, inevitably, impact every single American to further your personal political agenda. How dare you. And to the Senator who said, "you should be having these conversations 20 years before you die" and 'you should be thinking of your soul's salvation through Jesus'....a double how dare you. First and foremost, most families are too busy living their lives and, quite frankly, trying to simply survive nowadays, to have that conversation. It's a difficult one to have, Senator. And it's morbid, obviously, making it quite uncomfortable. Most Americans lack the personal funding to have a lawyer on-call, as I'm sure you have. And, we struggle to even get in to see a doctor sometimes, as I suggested in a previous post. Second, who are YOU to tell me who my salvation should be through? I am a Christian, as are all in my family. The paternal side of my family are devout Catholics. Yet, that didn't make this decision any less difficult in the case of my grandmother. In fact, that can complicate matters sometimes. However, Americans come in all forms, Senator. Please remember that your constituency - which in your position now includes ALL AMERICANS - includes not only Christians.
In addition to my disgust over the lies perpetrated over this end-of-life issue, I am more and more angered by the use of the term "Nazi." I have family who fought in WWII. They didn't overthrow the Nazi regime to have it, decades later, used as a political tool to discredit the President of the United States. If you want to pull the socialist card, fine...whatever. But, the use of the term Nazi, the painting on office signs of the swastika, and the portrayal of President Obama with a Hitler mustache all need to stop immediately. To continue to use these symbols not only shows your ignorance of what the Nazi movement was about in its entirety, but also your insensitivity to those who lost family members in European concentration camps, those who served heroically to free nations from that power, and every single American who today would be targeted by Nazi-following groups: the non-white, non-Protestant, and non-heterosexual. The only thing that does make me chuckle, just a tiny bit, is that those sub-groups who truly follow the Nazi philosophy are probably cringing at the idea of a black man being portrayed as one of them, in the symbolism of the dead leader they so admire.
This debate - the true debate - over how to reform our health care system is too important for this ridiculous behavior by both elected officials and their supporters. Yes, people are scared. Change is always scary and difficult. So, let's let those who are scared ask legitimate questions and let's answer those questions honestly. Instead, we're now seeing politicians and the industries who pay them play on those fears, using them as propaganda simply so they can continue to personally make money and/or get reelected. I have yet to find a politician against health care reform who has a true, legitimate argument against some sort of reform. I beg of our elected officials to take a serious look at this issue, to stop feeding the fear, and to compromise in the true interest of the American people -- an interest based on the health and well-being of us all, not just a select few or those who believe exactly what you do. And I encourage you to set the standard for your followers to protest, if they so wish, in a constructive, non-offensive manner so that their concerns and opinions can truly be heard instead of dismissed as fanaticism.
None of us had had experience with nursing homes to this point. My paternal grandfather, the only grandparent who was deceased at that point, had had a major stroke at home on my sister's 6th birthday. He died a few days later in the hospital at the age of 74. So, this was all new to us. I had personally only been in nursing homes through my volunteer work, having visited residents and performed Christmas carols as part of organizations in school. It was an uncomfortable place to be.
My grandmother was alert that day, and seemingly herself, as she was wheeled into the home on a gurney. She smiled at us and waved hello. We - me, my father, aunt, and uncle - were then called into the office of the facility director. During the course of the conversation, while she listed a litany of both services and family responsibilities, she asked us what our DNR decision was. We didn't know what that meant. She explained the "do not resuscitate" order and repeated her question. My father and aunt looked at each other and said, 'well, we'd like every effort to be made to save her.' I had been quiet up to this point...I mean, I was just a teenager sitting in on a very adult conversation. But, I had to jump in. I had seen news stories on television about people who had to go to court to get loved ones removed from life support. So, I asked, "if we did not have this DNR, then she would be put on life support, right? And, if that were to happen, would we be able to take her off when we felt appropriate or would we have to take legal action?" The director smiled and responded that we would, indeed, have to go to court to get her taken off should she be put on life support. That question and subsequent answer changed the entire course of dialogue. After all, my grandmother would not want to be kept alive as a shell of herself. And, she certainly wouldn't want us to go to court over it all. So, my aunt - grandma's power of attorney - signed a DNR and instructed that CPR could be administered, but she was not to be put on life support. After that meeting, my father and aunt both thanked me for asking that question, and for helping them to make an important decision at one of the most difficult times a child can face in the deterioration of a parent.
My family learned from that initial experience. Since that time, we've made conscious efforts to have those important conversations before the decisions are needed. I've known the wishes of my maternal grandparents and my aunt and uncle. I also know the wishes of my parents. There will be no question in my mind of 'what they would have wanted.' But, prior to that experience with my grandmother, we would have never have thought to talk about it.
Ours is a family that could have benefited from having an end-of-life conversation with a doctor, to learn of all implications of our decision, to understand how it would impact our entire family, and to learn what the common national standards were for such decisions. And, if that were available to us back then, I would certainly hope that it would be a meeting covered by our insurance.
To all of the politicians who are amping up this fallacy of "death panels" and who are threatening to take end-of-life counseling services out of potentially covered expenses for proposed health care reform: how dare you. How dare you spread lies, feed on fear, and hinder important conversations that we should be encouraging. How dare you use such an important issue that will, inevitably, impact every single American to further your personal political agenda. How dare you. And to the Senator who said, "you should be having these conversations 20 years before you die" and 'you should be thinking of your soul's salvation through Jesus'....a double how dare you. First and foremost, most families are too busy living their lives and, quite frankly, trying to simply survive nowadays, to have that conversation. It's a difficult one to have, Senator. And it's morbid, obviously, making it quite uncomfortable. Most Americans lack the personal funding to have a lawyer on-call, as I'm sure you have. And, we struggle to even get in to see a doctor sometimes, as I suggested in a previous post. Second, who are YOU to tell me who my salvation should be through? I am a Christian, as are all in my family. The paternal side of my family are devout Catholics. Yet, that didn't make this decision any less difficult in the case of my grandmother. In fact, that can complicate matters sometimes. However, Americans come in all forms, Senator. Please remember that your constituency - which in your position now includes ALL AMERICANS - includes not only Christians.
In addition to my disgust over the lies perpetrated over this end-of-life issue, I am more and more angered by the use of the term "Nazi." I have family who fought in WWII. They didn't overthrow the Nazi regime to have it, decades later, used as a political tool to discredit the President of the United States. If you want to pull the socialist card, fine...whatever. But, the use of the term Nazi, the painting on office signs of the swastika, and the portrayal of President Obama with a Hitler mustache all need to stop immediately. To continue to use these symbols not only shows your ignorance of what the Nazi movement was about in its entirety, but also your insensitivity to those who lost family members in European concentration camps, those who served heroically to free nations from that power, and every single American who today would be targeted by Nazi-following groups: the non-white, non-Protestant, and non-heterosexual. The only thing that does make me chuckle, just a tiny bit, is that those sub-groups who truly follow the Nazi philosophy are probably cringing at the idea of a black man being portrayed as one of them, in the symbolism of the dead leader they so admire.
This debate - the true debate - over how to reform our health care system is too important for this ridiculous behavior by both elected officials and their supporters. Yes, people are scared. Change is always scary and difficult. So, let's let those who are scared ask legitimate questions and let's answer those questions honestly. Instead, we're now seeing politicians and the industries who pay them play on those fears, using them as propaganda simply so they can continue to personally make money and/or get reelected. I have yet to find a politician against health care reform who has a true, legitimate argument against some sort of reform. I beg of our elected officials to take a serious look at this issue, to stop feeding the fear, and to compromise in the true interest of the American people -- an interest based on the health and well-being of us all, not just a select few or those who believe exactly what you do. And I encourage you to set the standard for your followers to protest, if they so wish, in a constructive, non-offensive manner so that their concerns and opinions can truly be heard instead of dismissed as fanaticism.
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.
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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