Some Thoughts About Health Care
Some Thoughts About Health Care
A blog reader sent me this letter:
Amy:I am not asking for advice, but after reading your blog, I thought I would share my experience concerning doctors and insurance for you to ponder. If the thought of reading a lengthy email is turning your stomach, just skip down to the last four paragraphs where I sum up my thoughts. ; - D
It seems to me that although we like to think that doctors are healers that only have our best interest in mind, the way that we pay doctors has an unusually strong effect on how doctors choose to treat us. It was only after I got on a top-of-the-line insurance program that health problems that I had lived with for most of my 45 years were finally diagnosed. Below are some events that seem to highlight how my insurance affected my treatment thorough the years.
First of all, when I had my first child, I asked my doctor how long I needed to stay in the hospital. He asked how many days my insurance would pay for the stay. I repeated, "How long do I need to stay in the hospital. He also repeated his words. Angrily I said that if I didn't need to be in the hospital, I should go home and not needlessly cost my insurance company money. On the other hand, If there was a problem and I needed to stay, I would stay even if it meant paying out of my own pocket. His advice did not waiver.
After my son was born, I encountered health issue after health issue and I suspected a deeper problem. I had infection after infection and grew increasingly ill. Doctors treated me with antibiotics and told me not to worry. I was involved in an HMO where my primary physician acted as a gatekeeper and the fewest tests resulted in the biggest paychecks. After 7 doctor visits, my health had continued deteriorating and I sought second and third opinions. I even went to a lab and asked them to run tests for me. Unfortunately, that is against the law. (WTF?) Finally, my weight had dropped below 100 lbs. (I am 5'6") and my fatigue was overwhelming. It was becoming a struggle to stand or even breath. I went back to my original doctor and stomped my foot and said that they were going to have to do something or I was going to die. I was finally sent to a specialist where I was diagnosed with a parasitic infection.
Due to continuing health problems, I left employment to be a stay-at-home mom. Because my illness ended up costing more than $5,000, I was a high risk patient (1 year at $5,000 does not make a high risk patient, but 2 years does. Since my son was born the year before, I fell into this category) . Ironically if doctors or the lab had run the tests I requested, the parasitic infection could have been treated with a $6.00 antibiotic rather than a hospital stay because my condition had become so poor. Of course, I am not counting the physical toll it took on my body and the cost to my career and my family because I was not treated promptly. It was 5 1/2 months after initial symptoms of my parasitic infection that treatment began.
As a high risk person, our insurance premiums went up to $1,750 per month. This was 17 years ago. I expect that rates would be close to 3 or 4 times that now.) Our family decided this was not a wise use of our money. At those rates, we could pay for an operation every year and still have money left over. We found insurance with a $5,000 deductible per illness that only cost $750 per month. At 37 years old and weighing 127 lbs, I felt something strange in my brain, like a rubber band popping. Suddenly my world began to spin like a pinwheel. I yelled at my husband to stop the car. I opened the door and fell onto the pavement, so dizzy that I was unable to even lift my head. My husband took me to a small town hospital that was nearby where they simply treated me with a drug to quell the nausea that accompanied the vertigo. The diagnosis - car sickness. I went back to school and had another strange episode in class. Again I went to the hospital. I few tests were run, but I was quickly discharged into the care of my regular physician. This time I was diagnosed with a migraine.
I have since been told that hospitals consider insurance with a high deductible on par with no insurance because they are often not paid by the patient. Hospitals, with their eyes on the bottom line try to get the patient out of the hospital as cheaply as possible.
Finally, I graduated and went to work with full benefits. I had another "spell". Perhaps it was because I arrived by ambulance. Perhaps my symptoms were more dramatic. Perhaps it was simply because I had aged. Perhaps it was because I now had full coverage where the bigger the hospital bill, the bigger the payout - guaranteed, but this time they ran a plethora of tests, $50,000 worth, in fact. Rather than complaining about the tests, I have been thankful. I feel that no stone has been left unturned. Doctor found 2 blood clots in my brain. Unfortunately, doctors had missed the opportunity to treat the clots. The window for treatment had already closed. They also found 2 arteries that had been damaged and atrophied - this was likely evidence of previous strokes. Since my carotid artery was 100% clear and my heart was healthy, they kept searching for a cause. Finally, a likely contributing factor was found. I have a genetic marker that is linked with immune system disorders. - about 95% of the people with the gene are diagnosed with some sort of immune system problem. I wonder how many are like me, who show some signs of an autoimmune disorder but are never diagnosed.
To sum it up, would Universal coverage be a life-saver for people like me, or would it make it harder than ever to get a diagnosis? Left unchecked, I think doctors would abuse hospitalization and diagnostics increase their bills to be the highest they could get out of the payer - whoever that might be. Thus, laws would be put into place restricting diagnostic tests. Now that screening mammograms are recommended starting at age 50, would a young woman who felt a lump be turned away? Would my strokes have been diagnosed sooner or even later?
Personally, although I see a lot of possible problems with Universal health-care, I think it is something we will have to try. I just hope that there is some kind of provision allowing supplemental care. If I feel that I need lab tests or a mammogram, I should be able to get it by paying for it without going through a gatekeeper.
The best thing to get us over our fear of Universal health-care is to look at Universal education. When I do, I see a system that is not perfect, but honorable and great in its own way. It is the great equalizer. It allows children even if they come from impoverished backgrounds to get an education and follow the American dream. Bill Clinton and Supreme Court Justice Sotomayor are prime examples of this.
Can people really have access to the American dream if they are handicapped by illness? While people contend that there are avenues for health-care even for the poor, a current study showed a 90% increase in the death rate for uninsured accident victims from ages 18 to 35. My experience indicated that doctors are not colorblind when they treat patients. They see green.
Thanks for reading,
Jen, Lubbock, TX
My reply:
Dear Jen,
I'm so sorry for what you went through, but I'm also sorry to say I think you're naive to think you'd get a better standard of care through government-provided health insurance.I, too, had a doctor I didn't get satisfactory care though. I changed doctors and would have kept changing doctors until I found one that was satisfactory. I did my homework and managed to find an excellent doctor in my HMO. She actually had her nurse call me because I hadn't been in recently enough, and she wants to give me a physical.
I also was very careful in choosing my HMO, Kaiser Permanente. They don't raise prices on you beyond the standard for your age if you develop some illness. I looked at that as a primary reason to choose them, in addition to their standard of care, when I picked a company when I was in my 20s.
There have been times when I've been denied certain things, and I've always prevailed on them, but it took a little work in some cases.
It's important to remember that there isn't a bottomless pit of money for your health care or anyone's -- somebody has to pay for it. The idea that the government will not ration care...well, I think that's pie in the sky thinking. Look to Britain and Canada. Best, -Amy
Jen writes back:
Amy, I do agree that health care will be rationed, but I contend that it already is. I don't think that my care would have been any better, but I imagine it would not have been any worse than what I was getting before I went on a full coverage plan. And if I become to ill to work, I will be on my own for insurance. For those that lose insurance coverage and have a pre-existing condition, it is unaffordable. That is why I think we also need to be able to pay for things ourselves. I don't think any Universal coverage would have paid to screen me for a stroke at age 37, especially since I had no risk factors.My first HMO was chosen by my employer. When I left employment, I was no longer eligible for the same insurance and had a pre-existing condition. Portability would be nice.
Perhaps the only cure is to get in with a good government plan like I finally do have. Just pray that I can keep working.-Jen
A few bits from my reply:
George Bush, who I wasn't a big fan of for a number of reasons, tried to untie health care from employment. I would have kept my Kaiser insurance even if I'd gotten a corporate job. I never got one, but I thought that out.Rationing is sure to be worse under government care.
Also, there's this from below: "If I feel that I need lab tests or a mammogram, I should be able to get it by paying for it without going through a gatekeeper."
You can get lab tests or a mammogram by paying for them. Why do you think you cannot?
When health care is "free," that's when you'll have a problem.
Also, I work very hard for what I earn -- why should my earnings go to subsidize others' health care? Why should my earnings belong to you? Why should parents not pay for their children's education (except for the very, very poor), and have only as many children as they can afford to educate?-Amy
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