Wednesday, November 11, 2009

Define health care reform

I wrote a few weeks ago about my friends who are poster children for good people getting the shaft over health insurance. Since then, I've been thinking a lot about the topic, both because it's in the news (I don't have words about the Stupak Amendment that aren't Anglo-Saxon) and in my life.

Michael left his job last month. This is the last month to make sure that I got in my annual physical and my semi-annual dental exam, which really hasn't occurred since before I was pregnant with the twins about seven years ago. Also, because Michael is starting to get paid, I was finally able to schedule Sam for a long-overdue acupuncture treatment. She was very happy about this- hands were clapped- particularly because we were both dissatisfied with the recent visit to the pediatrician about a specific issue. Let's take those one at a time- I will try to be brief.

Sam saw the acupuncturist last Monday. I rented a Zipcar. I drove to Lexington. It isn't covered by our insurance. It was, however, so satisfying. Sam had a specific problem, and the acupuncturist had a specific answer. Sam was soothed, not only by the nice music, heat and soft lighting, but by the confidence this person has. When we saw the pediatrician the week before, the nurse we had the appointment with and the doctor she corralled guessed. Good enough, except that part of their recommended treatment was taking steroids. Great.

My previous doctor left the practice last year. She recommended that I (and a slew of other patients) see Doctor A. When I first began developing scary food allergy symptoms, I made an appointment. Before the appointment was over, I vowed to myself to switch doctors. She'll be fine in a couple of years, I'm sure, but her bedside manner left much to be desired. I've never felt so rushed at a doctor's appointment before, and trust me, we hadn't gotten anywhere close to my twenty minutes.

So be it. Michael had started seeing Doctor B a few months ago and spoke highly of her. Plus she had room in her practice. Good enough. I finally secured an appointment with her for last Friday. I waited about twenty minutes before she could see me, but she was wonderful.

The problem was that though we chatted a bit about my allergies (and the answer was go see the allergist again), we really didn't do that much. She got my medical history, she palpitated my abdomen and listened to my lungs. Her nurse took my blood pressure and weight. We didn't do a breast exam because doctors aren't really doing that anymore (but if I really wanted one I could have one). We didn't do an internal exam because I'd had one last year and since I had a clean history I didn't need one for another two years. It was... sort of a whole bunch of nothing. When she was done with the questions, she was at a loss for words. There was nothing that we needed to worry about.

This is a good thing, of course. I'm healthy, and I evidently have yet another doctor's seal of approval. But determining that cost a lot of money. Fortunately, my insurance covered most of that (there is a copay), but boy would I have felt stupid if I had gone in for the annual every responsible adult is supposed to have and paid money out of pocket to find out how okay I was.

Contrast that with my visit to the dentist this afternoon. I had a higher copay because this dentist is out of network. Fine, because I really wanted a cleaning at long last, and I know he's good. His hygenist performed the cleaning. A lovely woman named Maria from Russia. Oh, how she worked! She was concerned about my wisdom teeth and saw something that looked like a cavity on each of them. She was leaning towards removal. Otherwise, my teeth were in good shape. The dentist came in at the end and took a look, and he said the wisdom teeth were fine as well. Yay! All of that flossing when I would rather sleep has been paying off, but I do need to back off a little on the brushing technique. I liked getting a good bill of health on my teeth- I didn't care of my primary teeth when I was younger, and I always got yelled at for it- but I also didn't mind this visit that much because we actually did something.

I am not sure how much all of the doctors cost, but from what I know of the dentist's price and previous experience, I think that Sam and I spent over $500 in a two week period to get medical attention. (And this doesn't include copayments I paid on Halloween weekend.) In Sam's case, not so bad, because she had a problem, but only an 1/8th of that or thereabouts addressed the problem.

In my case, not so much. The problem is that nothing was wrong with me, and I paid money to have someone tell me that. The bigger issue is that nothing was wrong with me because I do all of those things healthy people are supposed to do on their own. Really, at this point, the doctors have nothing to do with it. So why, as a healthy person, do I have to pay so much for insurance?

To be fair, years ago, my doctor told me that I needed to lose some weight, and I took her seriously. I was about 15 to 20 lbs heavier than I am now. By today's standards, though, I'm not sure anyone would blink. That isn't obese, and it certainly isn't morbidly obese. I think doctors have started to see so many serious health problems that something like being somewhat overweight doesn't faze them anymore. They've got bigger problems to deal with.

I understand that the flip side of me and other healthy people paying a high price for insurance is that if we don't share in the cost, the truly sick, the ones who need not just that annual visit but possibly visits every week, will ultimately pay a higher and probably prohibitive price when they need care. If we lived in a perfect world where we all had level circumstances, then maybe they should. But we don't. There are millions of people of people in this country who don't have access to fresh produce, which I believe is our first line of defense against illness. Many of those people also don't live in areas where they can safely walk and get regular exercise. On top of that, people have different genetic predispositions, and Social Darwinism is unconscionable in a hospital.

But... why do I have to see the doctor every year if two out of three of those years are going to be a big nothing? The acupuncturist is all out of pocket, but her charge is much less than the MD's. Why can't insurance cover her? I mean, she palpitates abdomens as well, and she also knows how to take blood pressure too.

I'm happy to go to the dentist though, because there is a specific service s/he provides, and few chronic ailments are more annoying than a toothache.

We keep talking about health care reform in a way that's making everyone look at their insurance premiums and copayments. Good, because it's an expensive system that isn't efficiently working. But we should be talking more about prevention. We should be living in a country that encourages people to eat healthfully and get regular exercise. And no, we don't, and I can prove it by the ads that are being put up advocating the consumption of chocolate milk as part of a healthy, balanced lunch and the purchase of a fuel-efficient, hybrid or solar powered vehicle as the ultimate in "green" living. Sure, healthy food is out there, but it's taken on a very weird gourmet cast to it. As has exercise in its own way, because now most of us believe that if we don't belong to a gym we can't do it. Health is just one more thing we have to pay for. But it's not.

Even if we all ate well and exercised daily, people would still get sick. See: Swine Flu, the common cold, or a gene mutation that turns into a cancer. Those things require care, and someone will have to pay. I'll pay happily- through my taxes, thank you- because evidently I'm paying now. In return, let me go to my acupuncturist, if I so choose, for a cold or digestive problem, but keep the emergency room open for those times when one of those rare vehicles does damage to a pedestrian. And one more thing: make organic foods affordable (remember when most food didn't use pesticides?), and build public walkways.

Sadly, I can't imagine a utopia, and maybe that's okay because utopian stories aren't fun to tell unless they turn into a dystopia. But I can imagine a world where my health care- and everyone else's- could cost significantly less.

Including for my dentist...

Deb in the City

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