Note: This is a re-post of something I wrote in July 2009 – at the height of the debate over the passage of Obamacare. Still relevant.
This one might go a little long. I’m going to talk about myself a lot but there’s no other way to do this.
By the time you’re my age (44) you tend to have had a few medical issues come up. Colds and Flu are one thing, but so far in my life I’ve been in an auto accident that separated my right shoulder blade, busted up my knee skiing, had chicken pox, been mugged and got a broken nose, had dental surgery, an allergic reaction to a medication that nearly killed me, tubes poked in both ends, had mono, a sunburn that landed me in the hospital, a 3rd degree burn on my left hand, and two other incidents that truly stand out that I’m going to tell you about in detail.
You see, I’ve had health insurance my entire adult life. And while I’ve had everything treated and everything covered as you would expect there are some medical issues I’ve had that are a prime example of what’s wrong with the system. Health insurance companies don’t have to exist. I’m going to have to get long-winded to explain why, but trust me, I can.
I get sick to death every time I hear some simpleton politician talk about how bad it is in Canada or England. Sure, they have issues, but please stop pretending the things you’re complaining about don’t happen here every day on a grand scale. Allow me to tell you the story of someone fairly ordinary. Me. I’m going to use three separate examples.
When my shoulder got hurt I needed physical therapy. My insurance covered 4 appointments. I needed more – after 4 appointments I could barely lift my arm to 90 degrees. I paid for the rest of my therapy out of my own pocket.
Okay, that one’s simple. The insurance company would only cover the bare minimum for a person to regain their mobility. Alas, 20 years later my shoulder had issues again, requiring a shot of Cortisone and more physical therapy. I ran into the exact same issue – my insurance (a different carrier than the one before) only covered 4 appointments and they weren’t enough. I paid for the rest out of pocket.
I am a cancer survivor. Survivor is really the only way to describe it. From start to finish, the whole thing from when the lump was discovered in my throat to the time it was removed was 4 months, and it was grueling. But I need to back up a step to explain why it was only 4 months instead of the 10 the insurance company wanted.
I had a good doctor near my office in downtown San Francisco. She was in a good location for me and was good at what she did. But 5 years ago she decided she had had enough of the insurance industry and opted out entirely – she formed a co-op with her own insurance plan, an idea I really liked. Thing is, she was only my doctor, not my wife’s and not my kids’. It wouldn’t have worked for them so I went on the search for a new doctor.
I found one out near my home. Actually, two – and they run their clinic in a way I had never seen before. They treat the patient, make the referrals, and then figure out the paperwork afterwards. They seem to take some glee in tweaking the system as much as they can while still following the rules. I feel lucky to have found them and plan to keep them as my primary physicians for as long as I can.
It was at an appointment at their offices two years ago that one of them discovered the lump in my throat the size of a walnut. She knew what it was – I had a growth in my thyroid. There is only one treatment for it; remove the thyroid. Sure, there are doctors and insurance plans that tell you that you should do radiation therapy, chemotherapy, only remove the tumor, try to control it with medication but you can see the results of that in Roger Ebert – we had the same thing and it gives me the shivers to think about it. My doctor knew what had to be done, so she started the process to make certain that my insurance could be convinced of this.
First came the specialist, and that came quickly – within a week. She ran blood tests to confirm that my thyroid levels were out of whack, and that took another week. Confirmation came quick and it explained why I had suddenly gained weight, was losing my temper easily, and my heart was going a bit too fast (there is no history of heart disease in my family at all – got lucky there). She put me on meds for slow down my pulse and then ordered the next step, a biopsy.
Again, here is a circumstance of a step the insurance required as necessary to show that I needed the surgery. The specialist already knew what the outcome would be, but this had to be done. Two weeks later, they stuck a needle in my neck and snipped out a few cells of the lump in my thyroid – an incredibly painful procedure. There is no anesthesia for this, and they did it three times.
Finally, everyone was on board – time for surgery. We can get you scheduled in 8 months as that’s the earliest opening we have with the surgeons we’ve approved for you. My specialist shook her head on hearing the news and started placing phone calls. I don’t know if she was owed a favor or now owes one, but she got my surgery moved up more than 5 months. It was still quite the wait, with my endocrine system throwing my body out of control the whole while and possibly causing problems I still don’t yet know about. I had the surgery and am now left with a small scar (which all other patients I’ve ever seen who have had this done have scars much larger than mine – again, I was lucky) a gland short and little pills that I’m going to be taking for the rest of my life.
You see the issue, of course. From the very first moment my doctor knew what had to be done, and it all could have been resolved quickly, within a month or so, but my insurance had to be convinced and it took all of these hoops jumped through to make it happen. You cannot tell me that a government program would possibly be any worse than this. I got treated, but that was due to the perseverance of my doctors, colleagues calling colleagues and doing everything they could to speed up the process, not because I actually had insurance.
This story is fairly ordinary in our country, and I eventually came out on top. I am cancer free and thyroid free, and I get my medication without any real trouble. It’s an example of everything that is right and wrong with healthcare all in a nutshell – that getting it good requires some luck and the right doctors, and convincing the insurance company that the doctor is doing everything right.
But I told you that story so that I could tell you this one.
People tend to goggle when I tell them the history of my cough. Many people don’t believe it and I do understand that. In this day and age, in this country, how can something so simple go misdiagnosed for so long?
Ask anyone who has known me more than a couple of years and they can tell you about my cough. It’s loud and obnoxious. I got kicked out of a library over it once. And a movie theater. A conductor at a symphony performance tried to stare me down over it once. A comedian I went to see once worked it into his act. It comes when the weather changes, and whenever the hell else it feels like. I’ve never really been able to predict it – all I know is that I cough without actually having a cold or the flu.
Let that sink in a moment. I’ve been coughing most of my life. When people ask me how I stand it I reply that it’s just a part of my life. I’ve had it for so long that I often don’t even notice it. It drives my wife crazy though, and two years ago she asked me to try again to have it diagnosed.
So I went to see the doctor and told her about the cough, coughed a bit, and then she asked the magic question; how long have you had this cough?
34 years, I replied. She just stared at me for a moment, as if I were speaking Flemish. She asked me to repeat it, and I did. She sat down and asked me what I had already tried. I told her that it first appeared when I was 8 and was diagnosed as fluid in the lungs – I can remember seeing an X-ray. I spent 4 years coughing before the doctor said that my lungs had cleared up. The cough continued but by that point we had all grown accustomed to it.
I’ve been told I have asthma. I was once diagnosed as having pneumonia. I was diagnosed twice as faking it. Both of those times I eventually came down with bronchitis and the doctors recanted their original theories. I’ve been told it was allergies. I’ve been told it’s environmental (I did live in a heavy smog area for quite a while). I’ve tried steam treatments. I’ve tried inhalers. I’ve had enough chest X-rays that I refuse them now over fear of overexposure. I’ve tried steroids. I’ve tried pills. In every case it works for a few weeks and then wears off – and I cough again.
My doctor then said, "Maybe we’ve all been looking in the wrong place. Maybe it’s not your lungs." She then proceeded to find the lump in my thyroid, which was unrelated to the cough, and then she theorizes that maybe it’s my stomach that’s doing the damage. Maybe I have a strange form of Acid-reflux.
I had never thought of that. I used to get heartburn a lot and I took antacids to control that. No one, not even me, had made the connection that when I took antacids I didn’t cough. Not in 34 years. Not until a doctor with some imagination and a knack for doing her diagnostics without thinking about the paperwork implications first saw me.
I take OTC acid-reflux medication once a day now – it was a prescription until the OTC got cheaper – and my cough is under control. It turns out it was something simple. Unusual, but simple.
So what’s my point? The insurance industry stifles the imagination of otherwise good doctors. The doctor I first saw for my cough as a kid got me through chicken pox and mono. The doctor I saw who gave me steroids also helped me get my shoulder working again. The doctor who told me I had asthma also gave me Codine whenever I caught a cold, which is the only medicine that ever works for me. All good doctors, but they are all hamstrung by the fact that the insurance providers they work with all say the same thing, "if the patient has a cough check these things first – else we won’t pay for the tings you want to try next."
Having to be responsible for paperwork above all else, having to check with the rules of an insurance company first, these things lead to rushed diagnoses, mistakes, and in my case, an acceptance of a medical condition that I didn’t need to live with after all.
And quite frankly, I’m fairly ordinary. I can’t possibly imagine that my case is all that unique. Sure, 34 years is quite a stretch, but imagine a much shorter period with a person whose condition is life-threatening. My 34 years is nothing in comparison. My 34 years weren’t a misery – I got married and had two kids during those years. I traveled the world during those years. I have a pretty good life. I know lots of people who have had it far worse than me.
The problem with the insurance industry is that it exists at all. It’s an industry. It exists in order to make money, and that drives every decision. When GOP Chairman Michael Steele said the other day that the Obama plan would get in the way of the relationship between the patient and their insurance company (and I assume he mis-spoke, he has a history of it) he summed up everything that is wrong with the picture in a single sentence – that the insurance industry drives health care.
It’s wrong. It should be doctors and their patients driving health care. Everyone should have access to a doctor like mine – one who makes the diagnoses and figures out the paperwork afterwards. But that kind of doctor is very rare, because we have spent decades entrenching an industry into the relationship between our doctors and ourselves. The insurance industry is the weak link, not the strength, and that’s the fight that needs to be fought.
Yes, the Obama plan would probably have a serious impact on the insurance industry. Maybe that’s why they call it "reform" instead of "repair". But for my two cents the industry should be eliminated altogether. Virtually every story about someone waiting months for proper care, a proper diagnosis, a proper payment of a covered procedure, has to do with the insurance industry making things difficult. It’s what they are and they can’t help it.
It’s why they have to go.
Real reform should have nothing at all to do with insurance. It should eliminate insurance from the equation entirely. Health care should be affordable to everyone, and the reason it isn’t is because of the insurance industry. But we don’t have the guts or the political wherewithal to actually eliminate an industry, so this is where government has to step in.
I’m not saying it’s going to be easy. I’m not saying that there won’t be bumps in the road. I’m not saying that will solve everything. But this is what government is for. And speaking for me personally, I’d rather pay the higher taxes than get a $500 tax cut and watch my insurance bill climb $3500 – which is what I’ve seen during the past 8 years. Of course my premiums went up – I’ve been sick and now have conditions that will require drugs to control for the next 50 years and some.
I’d rather the government keep the $500 and fix the system already. I’d actually have more money in my pocket if they did.
Yes, if given the chance I’d probably dump my insurance company for the public option. I’d dump anything that gets in the way of the relationship I have with my doctor. Yes, the insurance industry will take a hit, and that’s how it should be. They had their chance, and they failed. We can no longer afford to reward their failure. It’s time for them to go.
And for those millions and millions who can’t even get the level of care I got because they have no insurance at all, it seems to be that the bare minimum we can do is at least get their experiences up to the level of mine. It’s not great, it can be better, but come on now, can you honestly say that what happened to me is worse that what could happen to you? The millions and millions of you? One bad flu epidemic like the one we’re expecting this fall and a lot of people will be wishing for my 34-year cough.
Roughly 1 person in 5 has it worse than I do just from the simple fact that they have no insurance at all. Why is it that we can’t have a system where these people have it at least as good as I’ve had it, and I’ve complained for over 2,600 words now? Why is it that so many people in Washington D.C. don’t understand that the level of difficulty they say will come is a step up for so many people?
It’s because they’re tied to the idea that the health insurance industry has to exist. It doesn’t. My own life experiences have shown me that everything that these politicians say will go wrong has already gone wrong – just within an industry instead of government. And I can’t vote out my insurance company.
If the government screws up we’ll vote them out and try again – yet another advantage to it being government that runs things. I assure you that nothing will get a different political party in power than dissatisfaction with how things are being done. We don’t have that option with our insurance companies.
To put it simply, there is no reason for the health insurance industry to exist. It can be done as well if not better without them at all, and this scares the crap out of them. It is obsolescence clinging onto power, and if there wasn’t so much power already grabbed it would be sad to watch.
I handle money for a living, and I know this.