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.
One:
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.
Progress, yes?
Two:
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.
Three:
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.
