Some 120 miles away, a friend is lying in her bed. In pain. It’s been six days. She works around the clock – an independent – and has no medical insurance. Just one more thing that disappears for many women when they divorce. And she is over 50.
Without an employer, the cost of medical insurance is prohibitive. Equally prohibitive is the expense of seeing a doctor. And a trade-off she must assess: physician vs mortgage, or physician vs food.
Two days ago she was in so much pain she relented, found a doctor, and went. $320 later, she was told to take Motrin and sent home. In fact, there are things which can be done for the spasms that are running through her body on a regular basis – but only if she has insurance, or money. She’s $320 poorer, $320 angrier, still in pain – scared, and immobilized.
She has some family, but not much. When I checked with her last evening, she had found someone to stay with her – for the night. But what about today and the hours ahead – alone and in pain? What about tonight?
My friend is an independent worker, as am I, but with a more regular source of income. Still, each day she cannot sit at her computer and produce, her earnings dwindle. So she will be worse off still – with no pain killers, no answers, and additional worries about covering her monthly bills.
She is despondent and furious. But right now, more than anything, she’s worn out. And scared.
The “Family” Doctor: A Vague Memory
“What did they say?” I asked her on the phone.
She was between spasms, but sounded exhausted. “They said inflammation, but didn’t explain it. And they wouldn’t give me any kind of pain killer. I think they thought I was there looking for dope. So they sent me home, and said take Motrin.”
Her breathing grew labored. Another wave of spasms rippling up her back and through her neck.
“I’m sorry,” she whispered. “I have to go.”
She has no regular doctor. She cannot afford one. She has only whomever is on duty when she goes to the hospital or clinic, in the most extreme situations. And then the bills will roll in – hundreds of dollars – and generally that’s without tests or treatments. If she had a physician, or even a physician’s assistant – they would know her well enough to realize what conditions (and pain) she lives with daily, and that she isn’t seeking to get high.
Patient-doctor relationship. Ever hear of that? It used to exist. Like the family doctor. Forget house calls (and yes, they existed, too) – I’m simply speaking of someone with whom your family had a relationship. He or she knew you – well enough for you to trust, and for your word to be trusted.
The Health Care Bill – Will it help?
I plucked this from The New York Times, a July 2010 reference to the Health Care Reform bill, and its overall content:
The landmark bill signed by Mr. Obama will provide coverage to an estimated 30 million people who currently lack it. . . and would subsidize private coverage for low- and middle-income people. It will regulate private insurers more closely, banning practices such as denial of care for pre-existing conditions.
Well, that sounds like a step in the right direction – in principle. My friend has pre-existing conditions. No insurance. But will this do her any good? What will the details look like? How much will have to come out of her pocket? Will the doctors be as callous as the one that dismissed her with no tests, no prescription, and no particular concern?
And if I understand correctly, the plan is to have these provisions in place by 2014. And the next three years, as she continues to make a constant choice between a roof and a doctor, or food and a doctor?
My experiences with health care
When I can see a PA – a Physician’s Assistant – I do. Generally, they’re easier to schedule, and in my experience (as with nurses), they’re more personable, more empathetic, very pragmatic, and understand the budget-challenged patient. Pharmaceutical companies provide samples; Physician’s Assistants can dispense them, and save you some cost.
But a PA cannot diagnose. And physicians seem to spend less and less time concerned with diagnosis, settling for a quick pulse and blood pressure, then tossing a few pills – or none at all – at whatever may be the problem. Worse – if you’re a woman – they interpret pain to be the result of stress, depression, or hormones. And a female physician is as likely to respond in that manner as a man.
In the 1990s, I went through a string of physicians over the course of about 7 years. I suffered from a variety of symptoms as well as insomnia which was constantly chalked up to two babies, a traveling husband, and a hectic job.
The complaints were varied, granted. The problems came and went. I was told, repeatedly, it was all in my head. “You’re depressed, so you’re in pain,” they would say.
“No,” I insisted. “I’m in chronic pain, so I’m depressed.”
In 2000, I got lucky. Finally. One doctor took the time to ask questions. To diagnose. He wanted to solve the puzzle, not pretend it didn’t exist. He found an underlying cause – Restless Leg Syndrome – a sleep disorder, from which all the other problems stemmed. That doctor changed my life. But his life moved on, and with it, his practice.
My current doctor dilemma
With one exception – a specialist I see once a year whom I’ve known for 7 years (soon to retire), I’ve been through the round robin of physicians over the past 5 years. It has, unfortunately, coincided with my years post divorce, sans employer, and a medical insurance burden that has become increasingly untenable.
Yes – I have individual medical insurance. I pay for it with borrowed dollars. What cost me $350/month about 6 years ago spiked to $900/month 3 years ago. In order to bring it down, I had to increase the deductibles, the co-pays, and reduce the benefits. It’s been a yo-yo ever since, as each year the premium spikes anywhere from an additional $60 to $140/month, and I have to bite off a higher deductible and fewer benefits.
And yes – I worked with a firm that specializes in helping people find the lowest cost but workable solution. Because of pre-existing conditions, I was locked into a particular company, and my only real options – the game of yearly yo-yo.
Two days ago I visited the doctor, one I’ve seen once before, but with whom I have no relationship. This is the fourth doctor I will have seen in less than a year, for a variety of symptoms – painful – some of which are an old condition, some of which may be tied to injuries from an accident, and some of which remain unexplained – and worsening.
To net things out from the doctor’s appointment, had I not insisted – literally no tests whatsoever would be in process. Instead, I believe two things are being looked for. Other than that, what I was told is “Depression makes you hurt. Aspirin and Prozac.”
She handed me the Prozac prescription, which I’ve yet to fill. I may. I may not. I want those test results. I want to do some research on my own. I wish I knew a doctor. A real doctor. Who believed in diagnosis.
What ever happened to medicine?
I know the sort of pain that depression causes. I also know that the very specific pain in my legs has nothing to do with depression, stress, or whether or not the sun is shining. Something is wrong.
Were there a doctor-patient relationship, this physician might have actually listened to me with an open mind. And rather than focusing on the stressful elements of my life, would have focused on the streaks of pain in my calves, the back of my legs, and my lower back. She would’ve respected the fact that I am an adult, with a highly functioning brain (thank you very much) and “body intelligence.” Something I believe we all have. A sense of knowing that something is amiss.
Were there a doctor-patient relationship, the physician who saw my friend a few days ago would have sought to alleviate her pain rather than dismissing it. He would have respected her need for answers as well. He would not have sent her home to an empty house, with instructions to take Motrin, her body racked with days and nights of spasms.
I come back to trust and institutions. Broken trust and institutions.
I fully understand that many fine physicians are caught between a rock and a hard place. Patients unable to pay. Insurance companies that burden them with mountains of paperwork. Reimbursements that don’t compensate them as they should. There are good doctors and bad doctors, as there are quality professionals in every field, and those of lesser quality.
But with or without medical insurance, if your funds are limited – it’s a crap shoot. And even then, you may find yourself hundreds, if not thousands of dollars poorer, with no answers, and growing worse.
The future?
I have no idea if Health Care Reform will help my friend. I have no idea if it will help me. But I know that the limited doctors’ visits I’m allowed will run out very quickly, and I still have no answers. I know that I spend some $12,000 / year or more, out of pocket, for insurance premiums, co-pays, and very basic, generic prescriptions that are nothing unusual for a woman my age.
And my premiums will go up – again – in 6 weeks. Will it be $60/month more? $140/month more?
I cannot raise the deductible any higher – it’s already so high that it’s a toss up between the premium savings each month and the additional out-of-pocket expenses. Especially as I continue to be passed from physician to physician.
Still, with no answers.
Oh, I SO know this issue, from the inside out. It TOTALLY sucks, and I also have no idea if health care reform will help the situation, or even if it will survive until 2014 so that we can find out, since the Republicans are determined to either repeal it or gut it if they get the opportunity.
Whew doggies! And you are so not alone. You know this. So many are in this boat with you. Our country, so rich in so many ways, is so poor when it comes to health care.
Nothing will ruin a family as quickly these days as a health care crisis. And, as you’ve said, you’re not even experiencing a crisis, just an on-going chronic problem. How else might you have spent that $12,000?
It is only when enough of us get fed up with this system that we will support true and lasting change. Your voice adds to the frustration so many of us feel. Thank you for telling your story and your friend’s.
Keep in mind that is $12,000 each year, only for me – not my children. Not vision care, not dental care. Minimal, routine medical.
I would negotiate the bill if paying cash. Also, I would check with Adult and Family Services on possible resources she may qualify for. NP’s and PA practice varies from state to state, but I have not heard that PA’s cannot “diagnose.” What state are you in? I am a NP and where I live am completely independent (by statute). My kids and I did not have insurance for a year around the time of my divorce. I had my fingers crossed the whole year! It makes no difference that I was a health professional. It’s a scary place to be for sure.
This is so scary – and so common. I read and wrote much about this when my goal was to be a health/science reporter. Among the many offensive and unjust practices: the disparity in charges billed for the same service, uninsured patient vs. insurance company.
My parents have never had insurance. We were born at home, taken to the health department or the local clinic for shots, and to the dentist for twice-yearly cleanings and exams. When I broke my hand for the sixth time and saw a specialist, my mother signed my cast “$278.62.” Among the five of us kids, we’ve had three oral surgeries and seven years of orthodontics; one bone surgery, one biopsy, some mysteries. And even so, the out-of-pocket expenses were lower than the cost of insurance over all those years would have been (My father is self-employed; my mother worked for a small business that couldn’t afford health benefits.)
When I got pregnant (surprise!), I had been insured – for the first time – for only six weeks. (Whew.) I’m very, very fortunate, and very aware of how much that could change with job loss – or even job change.
It is scary. And all it takes is losing your employment to set this in motion. But one of the other things which I find distressing (to say the least) is the assumption that any complaint from a woman is less real than a complaint from a man.
While some might happily take a prescription for an anti-depressant, I want to know what is wrong with me – not “feel happier” though something’s off in my body. And the irony is that I’m really quite upbeat these days. Yes – stressed – worries are very present and pressing. But I feel as though I’m advancing in ways I need to. I’m sleeping decently, eating decently, and my son and I are working on some things together, communicating well. I went to the doctor over several very specific issues which were literally ignored.
Would this happen to a man?
And where DID the doctor-patient relationship go? I feel very luck to have a pediatrician that remembers us, that always seem to have interest and time. But when I got sick last winter and wanted an appointment for myself, I couldn’t get in because I hadn’t been there before. On the phone with my so-called PCP’s office, I asked: “So I should make an appointment now for a physical next month, so that the next time I’m sick, I’ll be able to get in?” And she said yes, brightly. Talk about wasted resources…
I lost my health insurance about a year ago and have pushed the fear of what that means to the back of my brain, where it rears its ugly head from time to time. I have friends in the same boat. I don’t know whether health care reform will solve our problems or not. Paying for some sort of health insurance now or paying for the uninsured’s health care later, something’s going to have to give.
As an aside, life-long, strong doctor/patient relationships, doctors who care about and know their patients, doctors who will make exceptions and come to your house, doctors who take what you say seriously even if you are a woman, pharmacists who will drop off your prescription, etc., are alive and well in small towns all around the country. They’re struggling, but they’re still out there!
It’s good to know they’re still out there. I think there are many caring, good physicians, PAs, nurses and others in the medical field. Unfortunately, it may be a matter of luck – as to whether or not you get one.
I’m sorry, BLW, for the ways in which the health care system – or lack thereof, I suppose – has violated the Hippocratic oath where you, your friend, and so many others are concerned.
I am a big fan of Dr. Paul Farmer, the founder of the non-profit organization, Partners in Health. From him I became convinced in my teens that medical care is a human right. And I am reminded by your post of the ways in which a lack of good care wreaks havoc on all the other areas of one’s life. What, really, can we do if we can’t get help for our medical problems?
Wishing you and your friend all the best: for miracle cures in the absence of ready and real ones.
To your point, Kristen – when I’ve spoken with French friends, they’re appalled at our system. They also believe that basic medical care is a basic right. They just don’t get it. But then – neither do I.
BLW, I don’t think hanging the washing is going to help me think this one through. I had no idea. What DO the US tax dollars get spent on, then? Are there just so many people, that the budget doesn’t stretch far enough for health? I just went to one of our health funds’ web pages, and checked every box, to see what having cover would cost. $155.10 per month.
When Pres. Obama was first elected, I heard a lot and listened a lot, to discussion of the health care reform bill. Then other issues replaced it in the press here. What is the history of the funding of health care in the US? Has there never been accessible public health?
It’s so frightening to read all this. Even WITH insurance, the medical system is so challenging to navigate when symptoms don’t add up to something “real” in your doctor’s eyes. I’m in the midst of re-evaluating the care team I have after the most recent medical mess. I’m afraid to change things up (don’t know whether it’ll be worse) and afraid to stick with what I have (where nobody seems to communicate, no one is looking at the big picture). In the meantime, the body continues to run amok.
I’m not an economist, so my knowledge of such is very basic. I went to the WHO statistics on health expenditure,
http://apps.who.int/ghodata/
and somehow the figures I read don’t seem to reflect what is happening on the ‘ground’.
I compared the statistics for Australia and the USA:
per capita Govt $ expend on health (in USD) – AUS 2691, USA 3317
per capita total $ expend on health (USD) – AUS 3986, USA 7285
Physicians per 10 000 popn – AUS 9.6, USA 26.7 (in 2004)
Popn (1000s) – AUS 21074, USA 311666
% expend on health as % of GDP – AUS 8.9, USA 15.7
Out-of-pocket expend on health as % of private expend on health –
AUS 55.5, USA 22.6
So, your government is spending a lot on health, per capita; and so are you, out of your own pockets. Who is making the money out of the health care costs in the USA? That’s the question in my mind.
This is fascinating data, Di. My government is spending an average of $7,285 on me? Hmmm. Who’s getting my money indeed???
Broken trust, broken institutions. I appreciate your writing about this as I hope (perhaps even trust) that there will be real change, eventually, especially when enough people recognize that the current brokenness is not only unconscionable from a compassion and humanistic standpoint, but it doesn’t even make economic sense (given that most of the pillaging has already been done), especially for most people.
There is not much money for big business in wellness, but there is a lot of gain for the people in it. So much is spent at the end of life, often on people who don’t even want it, while a little real help and good doctoring would not only help people heal and stay healthy, but save great amounts of money along the way.
An informed and conscious populace will find some way to take care of its people, and so you are part of the informing and consciousness-raising; but for now all I can send are healing wishes and respect for your pain.
“An informed and conscious populace…” Let’s hope so.
Reading this is such a wake-up call. I have insurance, but even with it, it’s a struggle. I’ve been through 12 doctors in the last year trying to find answers to this undiagnosed skin issue I’ve had. Since none of them have “ever seen anything like this before in their careers” they hand me a prescription for prednisone (which clears things up) and push me out the door. Which is great. Thanks. But as horrible as this has been, I can’t even imagine how much worse it would be if the bills we’ve received for it weren’t paid in part by insurance. Sometimes I feel like it would make sense to try and live in another country for a few years just to see their doctors.
And house calls? When I see that in movies or on TV shows, it doesn’t even register that doctors used to do that.
I know I am very fortunate. Because my ex (and that is what he is) and I are only legally separated, I am still on his family policy. I can remain there until divorce papers are signed. I have no idea when that will be.
I do sit, though, and worry about my 23 year old daughter. She is out of college so not eligible to be on her father’s policy. She is not employed full-time so does not have insurance through an employer. We have spent over a year hoping she doesn’t get sick. She doesn’t catch something while substitute teaching. In NYS, she is eligible for a subsidized insurance program run through the state for low income people and families. It is $300 a month less than the COBRA from when she became ineligible for her father’s policy. It is still too much for her or for me to afford.
And COBRA, last I checked, has very specific situations that allow for continuation of medical coverage at 103% of your premium cost for up to 18 months or 36 months – according to the reason for the severing of the insurance (divorce vs job loss, etc.). That goes by in a heartbeat. And of course, for those of us who are independents or with whom firms only use us as contract workers – we never have benefits, so COBRA (or unemployment or anything else) can never “kick in” when we are let go.
No, sadly BLW, the balance of $3968 between the $3317 the Govt is contributing per person, and the total health expenditure of $7285 per person, is coming out of yours or your insurer’s pocket.
And why do I think it’s coming out of my pocket – and then some?
None of this makes sense to me. None of it. It may have snowed here today but I know that if I get sick or one of my family members gets sick we won’t starve or lose our home over it. Unbelievable. Seems to me if you take the “for profit” insurance companies out of the picture and allow your government to manage your money via taxes that more of it will land where it belongs (in health care) instead of making some insurance paper pushing monster rich. I can only imagine your pain.
I didn’t read all the comments, but as someone in healthcare, a few consumer things are greatly misunderstood. First, your friend can and should see a primary care physician, it will save her money over waiting and going to the ER. In addition, she will get a diagnosis there, for less money, and proper medications. Most internal medicine physicians charge a mere $75-125 for an office visit with them with no testing, just the exam. Well worth it over waiting until it’s so bad you have to see an urgent care or ER clinic and pay more, and get hurried treatment which is set up for a different kind of patient, thus costs more.
Secondly, PA’s and NP’s can diagnose and dispense medications. They can in fact do almost everything a MD can do. Certain medications and procedures are off limits to them, given their specialties, however, they may absolutely diagnose, as it’s illegal to prescribe without a diagnosis.
If your friend would like, CVS stores around the country have “minute clinics” run by Nurse Practitioners who will diagnose and prescribe for a lower fee than an MD. However, she may want to call first to find out what the restrictions are and if they are able to help with her particular issue. It may be worth it to spend the money on an internal medicine doctor instead.
I hope your friend feels better soon, I take it her back hurts? if you would like you can describe to me her symptoms, I have a pretty bad back, and have done physical therapy for it and know some stretches that help more than any medication I can take. I can find a link online and send it along.
Thank you for this thorough and thoughtful response. I’m sure my friend will see it.
I may be way off base, but have either of you been checked for a herniated or blown disc? I had one in my lower back and the pain was debilitating. Vendetta has some excellent ideas on some alternative ideas. I hope you both can find someone better than who you’ve seen so far.
Vendetta spoke my feelings clearly.
I will also add that it isn’t only patients that are frustrated with our system, it is our doctors as well. At least those who do care about the patients. With Ben on the threshold of attending medical school, we often discuss this. One of the biggest problems doctors encounter is the cost of education. I believe that in many places with socialized medicine, pursuing an MD/DO degree is either free or very very cheap. Not so in our country, doctors are getting $300,000 into debt. Because of this, not many are interested in PCP. Most go for the higher income specialties.
We must also consider the amount of hours doctors are working, and the amount of patients they see. My OB’s office, for example, has 5 doctors and has a total of 50,000 active patients (that they will see at least once a year). They are working many, many hours which often become very long. Based on how much they work, their compensation is not nearly as much as a CEO or other business person would expect.
But. The amount of patients isn’t even the hardest part. It’s the time. Because they see so many patients, they must often decide which patient is in the most amount of trouble (healthwise). This is a very hard decision. 5 minute appointments are often scoffed at among patients, but remember, they are seeing at least 100 people a day. Plus hospital visits. It is a very demanding job.
Having said all of this, I am saddened by how the quality of doctor’s care has gone down. I believe that we, and the insurance companies, are responsible for this. We demand that we have everything right now and how we want it. It’s called capitalism. For profit healthcare is ridiculous. In my sate, the majority of the hospitals are non-profit. They offer financial assistance and very excellent care for even the poorest of the poor. I will be sad to move away because I have been so impressed by all the doctors we have seen while here.
Now that I have hogged your comment space, I will go. : )
Happy to see you, Amber. Definitely not hogging!
I do understand that health care professionals are frustrated with our system (such as it is) as well as patients. In fact I mentioned that. But it doesn’t change the fact that people fall through the cracks every day – and with far worse issues than anything I might complain about. And they have no voice whatsoever – not even a place to write online where a few people may read, and may reconsider their position.
I don’t have an answer as to how we fix things. But I grow increasingly concerned when I start tallying up the number of doctors who either do not care, do not have the time to care, or cannot operate in a system that allows them to perform even the basics. Like an actual exam. Like proper tests.
As for insurance programs – when you sink deeper and deeper into debt with insurance as well as without – and get no answers (except “aspirin”) – what next? How can that be any good for any of us – individually or collectively? And how shameful is it – as politicians argue over health care – when you multiply my situation by I don’t know how many millions of people who will not, or can not speak plainly and stand up – even if only to say this is bullshit?
BLW, the number of comments (and the quality of the comments) on this post speaks for the pervasiveness and seriousness of the problem. I hope you will continue exploring this area and reporting to your readers. Since I got in so late on this post, I may communicate some things to you “offline” that may be of interest for future posts.
I congratulate you on tackling this topic and for doing such a good job with it. You have also brought out some excellent information from your readers. Good work.