A Tale of Two Health Care Systems

I have now experienced the best and worst of health care and I think it's worth discussing, as this is a fairly timely topic.  Lately we've been inundated with all kinds of stories about the website for the new Affordable Care Act healthcare, which I hope to find a good deal on, given that I presently pay nearly $500 per month for my health insurance, and which frankly, I cannot really afford. 

This summer, Leah and I traveled to Ecuador.  Leah got sick.  We are not Ecuadorians, so we are not insured there. 

Three weeks ago, my mother fell and broke her ankle.She is American, but she is not insured. 

Who do you think made out better?  Who do you think was treated more respectfully?  (Hint:  It wasn't my mother)

So, Leah and I are in Ecuador, having a lovely time, and I notice she's starting to cough.  And she gets a fever.  And this kid NEVER gets a fever.  So I was immediately concerned.  My brother took us to the local emergency room that morning and we were taken in and seen by a doctor, and the first question we were asked was, "What's wrong today?".  Leah was diagnosed with a virus typical of Ecuadorian children, we were given some medicine and sent to a cashier.  Total visit for an uninsured person to go to the ER?  $200.  By way of comparison, when I broke my leg in 2006, the hospital here charged my insurance $200 just for the ace bandages.  The next day, things hadn't improved and I was really getting worried, so I asked to go back, we were seen again, this time with blood work done, medications given, doctors seen, and again, $200.  Done.  No questions asked. A few days later nothing had changed, and my friend Emily suggested we go see her uncle, who was a pediatrician in Quito.  One office visit, $50, done.  No questions asked.

In Ecuador, which I suspect many Americans would turn up their noses at as an example of the third world, all medical care is covered.  What's more, the government promotes wellness programs.  We were at the pharmacy at one point and there were a bunch of senior citizens there doing yoga together.  I asked Franc what it was about and he said the government provides for such things because a) exercise is good for you and b) it lets the seniors socialize, which is good for them.  I can't even imagine telling anyone in this country that we need to sponsor yoga for old people. 

In Ecuador, they pay nothing for health care.  Nothing to see a doctor, nothing for medicines, they are citizens, they pay their taxes, and they have an expectation that they will be taken care of.  And what's more, just because citizen A pays more in taxes  than citizen B, Citizen A doesn't whine about how his money is going to pay for the health care of someone with fewer resources to contribute to the system.  There are people in Ecuador who are dirt poor, but they do have access to health care if they need it.  And if you aren't a citizen, you can still access great care for less than a fraction of the cost of what it would cost you here in the US.

Fast forward to 3 weeks ago.  My mother fell and I heard a snap.  A day later, she could barely walk, and I demanded that we were going to the hospital.  She really didn't want to go because she is uninsured.  Because of the Healthcare.gov mess, we haven't been able to get her signed up for health care, although we would like to.  Unfortunately the mess has meant that we haven't been able to and so she was left in the lurch.  So anyway, I absolutely insisted we were going to the ER, if I had to sling her over my shoulder and carry her myself. 

When we got to the ER, the first question we were asked was, "What kind of insurance do you carry?"  We did get to go to triage so we could have her blood pressure checked and temperature taken, but before they even looked at her ankle, we had to go to billing and get forms to fill out for medical hardship.  And I don't think that's so unusual.  I recently went to the urgent care clinic because I was pretty sure I had a UTI, and although I couldn't go more than 5 minutes without having to use the bathroom, I still had to go and sit in a billing office and provide my insurance information before I could see a doctor.

And I don't think we were alone in this regard.  I saw many people go into triage, and come back out and go into billing, and then go back into the ER.  I have a serious issue with this. People go to the ER in pain, suffering from not feeling well, but we make them whip out their checkbooks and insurance cards?  Ridiculous!  No, the ER can't refuse to treat anyone, but they don't treat them like human beings, that's for sure.

So we got the X-rays taken, diagnosed with a broken ankle, cast on, and out the door.

The real fun began when we went to the orthopedist.  Mom was referred to Fredericksburg Orthopaedic Associates.  We were told to make an appointment to see Dr. Sokolow.  I called and spoke to the appointment specialist and was told that we would instead see the physician's assistant, a Mr. Bee.  I was asked about insurance, and stated that Mom was uninsured.  The scheduler said they require a $100 down payment before we could be seen and then she said, "Go early and ask to speak to billing.  If $100 is an issue, they will still let you be seen as long as you pay something."  This was the first and last bit of compassion anyone in that office displayed towards us.

So I relayed this to Mom and we decided to see if we could pay a little bit less up front. The morning of her appointment, we went over and asked to speak to billing.  A woman came out and brought us in the back and demanded $100.  She treated us like we were wasting her time and like we were scum of the earth.  Like it was some moral failing on our part that Mom didn't have insurance.

Why doesn't Mom have insurance?  A year and a half ago, the governor of the state of Florida decided to privatize the prisons to save money.  My mother and many other prison employees were laid off as a result of this decision.  My mother was offered her health insurance benefits at a COBRA cost of over $800 per month.  Her unemployment would come to $500.  It was impossible to carry health insurance.  It was a gamble to be sure, but for nearly 18 months, it hasn't mattered.  Until now.

So I explained to the woman that the person on the phone told us that as long as we paid something, we could be seen.  She launched into quite a tirade about finding that person and educating them because that is not the policy of the clinic and they should not tell someone that because we have to pay $100.  The woman was so obnoxious that it just flipped my switch within about 2 minutes.  I usually am extremely patient, and particularly face-to-face I hate to get confrontational, but honestly, I just didn't give a crap.  This woman was treating my mother like garbage.  And so I decided to give her some crap back.  So she made sure to let us know that a typical office visit was $400 and she was doing us a favor by letting us come in for only $200, but there would be X-rays taken and that would cost more, and had we ever looked into getting on Medicaid?  I told her that unless we could get on Medicaid at that exact moment, she was going to have to let us see the doctor without insurance and it was really none of her business why Mom was uninsured.  She let me know that we were only there because their doctor had been on call that day at the ER and if he hadn't, we wouldn't be seen at all.  I let her know I also really didn't give a damn about that. 

Finally after slinging mud at one another, she left to go make sure we could be seen for a lousy $50, which we could.  We were taken in the back and left.  Our appointment time was 11:00 and we were finally seen at 11:45.  Mr. Bee came in and looked at the X-rays, told Mom she could wear an air cast and come back in a month, and left the room.  A nurse came in and said the air cast would be $65 and we could either buy it from them or take a prescription.  We decided to buy it from them, so they put the cast on her and sent us on our way.  IF they spent more than 5 minutes with us, I'd be shocked.  Honestly.

So we went back out and our friend the billing woman came racing out to the release desk and said, "If you don't give us $65 for that cast right now, you can't leave with it!"

yes, that's right, we were accused of plotting theft.

I slapped $65 cash from my wallet on the counter and $50 on the counter from Mom's.  My mouth was literally hanging open in shock, and I could feel my blood pressure rising.  Billing Woman continued, "You should try to pay off your bill before your next appointment."  I was thinking to myself, "Fuck you and fuck this office, we'll be going to MY orthopedist before we come back here."

Because honestly, guess what?  We have no idea what Mom can and can't do.  We left not knowing if the cast should stay on for a set amount of time.  We have no idea if she's allowed to drive.  We have no idea if she's allowed to walk, dance, skip, jump, or anything else.  We were given no instructions, no one taught us how to put the cast on her, all we know is she broke her ankle and the cast is $65, come back in a month.

So we are NOT going back there.  I will call my orthopedist and get her an appointment there, because I have a good feeling that given the amount of money BCBS and I have given them over the course of my broken leg, bad knee, and dislocated elbow, they will treat us kindly and respectfully.  Even without my history there, I feel confident that they will do so. 

It is shocking and devastating to watch a person you love be treated so poorly by a medical establishment that is meant to help people, all over money.

I hope the Affordable Care Act does what it is supposed to, and I hope that we are able to get Mom insured soon.  Because it is a sad day when I can get better care in the so-called Third World than I can in my own country.