Thursday, November 25, 2010

Healthcare In The Real World: Or How We've Politicized The Personal

Lately, it seems like there has been a lot of talk about healthcare in the US. No one on either side of the political debate seems particularly pleased with the new healthcare bill, and many seem unhappy with the state of healthcare as it is. I often hear people complaining that private healthcare is available to anyone who is hard working, a tax payer, and who wants it and publicly assisted healthcare is there for the poor. Since it’s already so widely available, they seem to reason, then why should we change the system?

They’re right, to a point. Yes, private healthcare is available to nearly anyone who wants it, at least on the surface, and yes there are already public assistance programs for the poor, but this is a pretty incomplete view of the American healthcare system, which avoids addressing the fact that many Americans fall somewhere between having ability to pay for their own healthcare and being poor enough to qualify for public assistance.

I am one of those Americans.

I have worked, mostly full time, for the past 16 years. During those 16 years, I had exactly one year of working for a company which provided reasonable health insurance to its employees. Most of my jobs have involved waiting tables, and most of them have been for corporations, as opposed to mom and pop restaurants. I think this is important to note, because the corporate jobs which did provide any healthcare at all, provided bare bones, emergency only coverage to employees who worked a minimum of 40 hours a week. However, the one independently owned company I worked for offered the best insurance they could afford to their employees. Many of my friends have had exactly the same experience, with major corporations offering piss poor or no benefits to employees while smaller companies seem to offer livable policies. This experience flies in the face of those naysayers who bemoan the fact that it would be unfair to “force” small businesses to provide health insurance. You see, most small businesses seem to operate under the belief that their employees are human beings and, as such, deserve to be treated fairly. If a business is already providing good coverage for their employees, the healthcare bill as I understand it will not affect them at all.

However, this is not about the healthcare bill and what it will or won’t do. This is about what it is like to be one of the many people who cannot afford to insure themselves, but are not eligible to receive publicly assisted healthcare.

For me, it is pretty horrendous.

As a 31 year old student with little to no income during the school year, I certainly cannot afford to purchase private insurance for myself and, even if I could, half of the things which concern a thirty year old woman would not even be covered. These include, but are not limited to: birth control, maternity, some forms of cancer screening (including breast and cervical), yearly gynecological exams, and STI screenings. However, as an uninsured woman, I can access these things though my local Planned Parenthood where I can pay on a scale that relates to my current income level.

This may sound like a pretty good deal, but a trip to Planned Parenthood is not a very pleasant experience. For me, an annual checkup must be arranged months in advance, I must answer hours worth of questions about my sexual history, medical history and current income every single time I walk through the door, and I often spend hours in their waiting room only to be led to an exam room, told to undress and left sitting, in nothing but a paper robe and knee socks, for up to an hour while I wait for the clinician on duty to come into the room. I never see the same clinician twice and, as a result of that, a routine pelvic exam can take over hour as each new caregiver must ask the same questions each time. Furthermore, using Planned Parenthood as a resource for birth control means that I have very little personal choice in terms of which type I receive. One clinician may determine that I need a combination pill one year, while another (as was my most recent experience) may aggressive push me toward having an IUD inserted to the point of refusing to continue my previous pill. If I take issue with the method they are prescribing, I am often told that as a non insured patient I should be grateful for what I can get and take it or leave it. Don’t get me wrong here, I am grateful for the resource, but it is still very frustrating to feel as though my opinion regarding my body does not matter as much as it would if I were insured. Although trips to their clinics are not often pleasant or comfortable as an overtaxed system must provide care for thousands of men and women each day, I am at least able to access some healthcare through them.

Even with access to sexual healthcare through Planned Parenthood, not having insurance still leaves me in a precarious position in terms of general sickness and health issues. In my position, being sick rarely means a trip to the doctor, unless there is something seriously wrong. This means that I will often hold off on seeking care until I am nearly disabled by whatever sickness I have and, even then, will not seek help unless I am pretty certain that the illness requires antibiotics. Instead, most illnesses involve a lot of googling, a lot of self medication and a lot of hoping that I am not further damaging myself. The only time I will immediately seek medical care is when I am certain that I’ve got a urinary tract infection, as those absolutely cannot be effectively treated by any home remedy and can progress into sepsis or kidney infections.

In those rare situations where I must seek medical attention, I am often at a loss for what to do. You see, most primary care doctors won’t keep a self paying patient because there is too much risk of unpaid services. Without a primary care doctor, I am often given two options. I can spend an entire day and a month’s salary at the emergency room, or I can utilize an urgent care center.

Whenever the option exists, I use the urgent care center to avoid taking up the time of emergency room staff and incurring the ridiculous cost of being seen in a hospital. Again, I am grateful that such places exist, but using one is not a comfortable experience at all. As with Planned Parenthood, I must redo a full patient history every time I am seen. This means, again, spending hours in a waiting room and constantly having to repeat that I am self paying. Often just those very words are enough to cause the staff’s attitudes to change ever so slightly. Depending on the staff member, I have received everything from lectures on the importance of health insurance to pitying glances in the waiting room and downright degradation in the exam room. Because these centers are often staffed by students who perform all initial consultations, I have been lectured on eating disorders, been told that the student examining me is “certain” that I am sexually promiscuous based on my tattoos, been warmed that my seasonal congestion is a sign of AIDS and been prescribed medication that I am deathly allergic to, despite having clearly marked the allergy on my intake forms. All of these snafus could have easily been avoided if being a self paying patient wasn’t seen as akin to being uneducated or unemployed.

Furthermore, they could all be avoided if I had the ability to have one primary care doctor who I see repeatedly. Having a consistent doctor would mean the world to me as it would mean that I did not have to jump through hoops, be embarrassed, degraded or talked down to, whenever I am in the already frightening position of being sick. It would also mean that I would have access to preventative care and advice beyond the realm of WebMD.

Unfortunately, given our current system, this will not be possible until I am employed by a company which provides decent care, or the system is massively reformed to address the stranglehold which drug manufacturers and insurance companies have on the system. As one doctor recently explained to me, the current system has doctors answering to insurers and drug companies exploiting this fact by offering samples under the table in order to convince doctors to prescribe their drugs. This means that a doctor with a private practice must justify every service he or she performs to the patient’s insurance company before he or she justifies it to the patient. It also means that it is not in a doctor’s best interest to make services affordable to self paying patients as it takes money out of the pockets of the very insurance companies which pay most of their salaries. Often, giving away those free samples from drug reps is the only way for a doctor to circumvent this. In other words, most doctors have their hands tied in terms of being able to provide service as they see fit and this leaves many patients with less autonomy than they should have.

I know the healthcare debate is shrill and fully loaded for every American, but I also think that we have become so lost in the sound and the fury or it all that we may have forgotten who really is affected by the way our current system operates. This is not to say that I am looking for a handout, or, as one Planned Parenthood receptionist recently inferred, crying “poor” in order to exploit the system. On the contrary, I am looking for a reform which will remove the power over our well being from the hands of the insurance and drug companies and return to its rightful place in the hands of each American citizen and their respective caregivers. I only hope that whatever happens in 2014 makes that more possible than it is at this point.


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