In January 2017, I passed a kidney stone. I self-diagnosed, and got through the long night of pain with only profanity, lots of water, and a little bit of beer -- taken medicinally for its diuretic qualities -- to get me ready for work the next day.
After several months, I thought it might be a good idea to inform what passes for my primary care physician that I had suffered this misfortune. I used to go to an actual doctor, but he took advantage of his superior financial decisions to leave the practice and go adventuring. He was a bright guy who laughed at my jokes, but he was also really good at keeping the clinical wall between us. The practice has not provided a consistent replacement practitioner since his departure. The nominal MD at the head of it has never seen me as a patient. The people I have seen have been delightful, but the place seems to be the last stop before imminent retirement for all of them. Or, if it's a young PA or someone like that, it's just a stepping stone on the way to greater things. There's no continuity and little sense of any more than formulaic care for the person rather than the customer.
As an uninsured American -- or even as one with the typical overpriced, under-insuring policy -- I was reluctant to get into the investigation at all, because of the bureaucratic rat maze and unclear pricing of health care services. Because there is no uniform standard for charges and service quality, people travel a long distance to find either providers "in their network" or self-pay prices that they can afford for diagnostic services that their insurance company's accountants have deemed unnecessary to cover.
Does every community disparage its local hospital? Certainly the one around here has garnered its share of scathing reviews from former patients and the surviving family members of patients who didn't make it. Whatever the truth of the matter may be, local gossip describes it as a place to pay too much for too little when you have no other choice.
Because health care is a marketed commodity in this country, health care providers use advertising to communicate, rather than presenting information fully, completely, and readily accessibly. Hospitals are selling themselves. They want you to be happy with the result so that you will patronize them again and tell your friends that it was good, but if you're not happy they'd prefer that you shut up and stay out of sight, same as any other business would. A good business tries to learn from its dissatisfied customers, but dissatisfied customers do not feature as the lead element in any of their advertising.
By a stroke of pure chance, a customer at the bike shop where I work is a nephrologist in the Harvard Medical School system. He had offered many times to help any of us with medical issues. Indeed, as one of the leading researchers studying polycystic kidney disease, he had been very helpful and comforting to my wife and members of her family after they discovered that several of them had that genetic disease. So, when I had a kidney issue, I eventually turned to him. Because he had no commercial motive, and his credentials as a scientist are impeccable, I trusted his judgment.
Unfortunately, his ability to conduct examinations and treatment is limited by his contractual obligations to the hospital in Boston where he works. He can provide his time and knowledge, but no lab work or medical imaging. I have had to scrounge those up for myself, with as much guidance from him as he can provide.
The process of navigating the health care labyrinth is awkward enough without adding any confusion. I already felt unwelcome because of my inconvenient income level and the fact that I don't sport the brand logo of an insurance company. The health care industry in this country is geared toward extracting as much money as possible from reluctant third-party payers. They seem very accommodating to self-payers. But because the majority of participants in the system operate within the framework of the adversarial game between insurance companies and medical facilities, things are very compartmentalized. The seeker of services has to open every door and look in every room with few allies who don't have their own financial stake in the game.
When I go to the local hospital for a service requested by a Boston doctor, what will the local providers think...if anything? Will it occur to them that this is an outgrowth of the intimidating facade of commercialized medicine? Or will they just be resentful that I seem to consider myself "too good" for them? Conversely, will they automatically pigeonhole me as a charity case, uninsured because I am destitute, or a cheapass who simply refuses to fork over the coin for a real insurance policy?
When I was a kid, it was simple. If I got sick, my parents took me to the doctor. If I needed more than what the office could provide, it was arranged. Granted, my parents had the backing of the United States government through CHAMPUS. And I was a kid. Complexities were hidden from me. But health care on the whole seemed a lot more systematic, geared toward healing rather than cash flow.
As I read the history of CHAMPUS, and its transition to the current Tricare system, between the lines I infer that a growing population of people who don't die of their injuries and ailments puts increasing financial strain on any system of medical care. That would be true no matter who is paying, so it does not in the least justify our current American system based on profiting from fear and ill health. But it does explain how accounting departments looking to shift costs would entertain increasingly complex mechanisms to divert expenses onto someone -- anyone -- else. This burst forth in the 1980s and has mostly gotten worse as our country does anything it can to avoid settling down to create one coordinated system based entirely on patient outcomes rather than its own income.
Discouraged by the prospect that any pursuit of health services could metaphorically lead me down an alley where my pockets would be emptied, I have been very slow to follow up on my situation. Having an illness is bad enough. Feeling like an illness turns you into some corporation's cash crop makes it all the worse. I feel like a beggar, and a blind beggar at that. I dropped the ball last autumn after the first round of lab work ordered by my nephrologist friend because I still felt awkward taking him up on his offer, no matter how often he had repeated it. When he confirmed it this summer in person, I felt like I'd let him down by taking so long to go further. But I still have to make the contract for services and pay whatever the bill turns out to be when the dice finish rolling and stare up at me.
In the end, looking for cost-contained, competent medical advice and treatment, I'm not sure if I merely made it much more complicated as I try to manage the interface between my doctor friend and the other service providers in the process. And my situation isn't the stereotypical nightmare of phone tag with higher and higher levels of corporate supervisors that a lot of really sick people have to go through. Imagine having a really serious illness and having to go through a process clearly designed to weed you out.
A genuine system of universal care is decades overdue in this country.
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