My view on health care reform will outrage many: I support a single-payer system. There, I said it.
BUT, for those of you who’ve just written me off as a “socialist,” please bear with me for a few paragraphs before you...pull the plug. Or call me a LIAR!
At this point in the debate, I don’t care WHAT kind of single-payer system we devise. It could be public...or PRIVATE. We could copy the British national health care system, or we could all pay premiums to a single, private, mega-insurance monopoly.
We need ONE health insurer. No more. No less.
During his speech on health care reform to a joint session of Congress, President Obama cited several tragic cases where our broken insurance system abruptly shortened patients’ lives. But I don’t need to cite similar tragedies to make my point. I need only talk about my own, garden variety experiences in dealing with the “world’s greatest health care system.”
Two years ago, I fell off a ladder while painting my dining room ceiling. More accurately, the ladder toppled over, tossing my scrawny body across the room. No cause to sue the ladder manufacturer -- I alone was to blame. It was late at night, and I was rushing to finish applying a coat of primer so I could get to bed. The ladder got to rocking and...kaboom!
It was my first serious injury. My femur broke in three places, including a nasty compound fracture which produced blood and gore. There was also a spiral fracture running nearly half the length of the femur. And I’d broken my left elbow, too. Amazingly, the tub of primer landed face up on the floor, right next to my head Thank God for small favors -- primer, once it dries, is permanent!
I’d always wondered what broken bones felt like? Now I knew. It was midnight, and I was hollering loud enough to wake up the neighbor’s dogs. My wife called 911. The EMTs showed up within fifteen minutes. Wedged as I was between the dining room table and the window seat, the EMTs had to figure out how to gather me up without harming my back before they could load me into the ambulance.
The half-mile trip to the hospital took all of four minutes. Treatment at the ER bordered on torture. Dick Cheney would have approved. But violations of the Geneva Conventions were necessary to determine the extent of my injuries. At one point, I lifted my head up from the gurney and asked the doctor peering down at me, “This isn’t going to become an episode of ‘House,’ is it?” He grinned and then proceeded to catheterize me. “TRAUMATIC INSERTION!” he barked to the nurse who was jotting things onto a clipboard pad. That meant the insertion had drawn blood.
I was scheduled for emergency surgery at 6:30 that morning. It took three hours to clean up the wound, repair my femur with a 10-inch titanium rod, and sew me up. The orthopedist had hoped to untangle the gnarl of damaged ligaments around my left knee, but he was unable to do so -- thereby limiting the ultimate range of motion of my left leg.
My hospital stay lasted a week, to insure that the open wound caused by the compound fracture would not become infected. The hospital environment was godawful. The parade of nurses and technicians was, for the most part, a tour de force of arrogance and indifference. The food was vomitous. The room was dirty, with an unemptied potty chair in the corner by the bath. One of my three roommates that week was psychotic. At one point, I dropped my plastic urinal, which was filled nearly to the rim. A nurse’s assistant, brand new to the job, rushed to clean up the mess -- only to be called away and scolded by an R.N., telling her not to perform an orderly’s job. The puddle of piss sat there, unattended, for more than an hour. Mere existence in that hospital seemed to put me at risk of serious infection!
Despite these indignities, I was reasonably pleased with my orthopedic surgeon, and the physical therapists who worked with me afterwards were great. Today, my fourteen-inch scar is almost invisible, and I walk with my normal gait and speed -- though not without pain or diminished flexibility. My knee looks weird, but it could have been much worse. Compared to some of your own hospital experiences, I got off easy!
Yet, during my week in the hospital, and the three full months of recuperation at home, I learned just how poorly our health insurance system functions. There is little or no choice, but there IS rationing of health care. And there is waste and inefficiency galore -- much of it to the benefit of insurers, doctors and hospitals alike.
The half-mile ambulance ride to the hospital cost over $700, most of which I had to pay myself. I asked the insurance claims adjuster why the ride was so expensive? She blithely replied that the uninsured, using ambulances as cab service to the ER for minor ailments, are jacking up the costs.
Upon my arrival in the ER that fateful night, the doctors asked me what medicines I was taking? In divulging that information, I was tuning my pharmaceutical routine over to the hospital. The hospital would determine if, when and how much medicine I could take -- and THEY would administer it. So, the Albutirol I took only occasionally to treat mild asthma would, I soon learned, be administered to me every day by a respiratory therapist. At grandly inflated hospital prices!
One evening, while receiving my Albutirol treatment, the psychotic roommate went berserk, convinced that flies and mosquitoes were buzzing about the room and eating him alive! Panicked, he began rattling this bed. Then he began rattling mine! The jostling knocked my nebulizer out of whack. The face mask filled up with drug-laced water vapor and my eyes began to burn. The bitter taste in my mouth was sickening. I rang the bell for assistance, repeatedly, but the nurses ignored it. I waited a few moments, then pressed the buzzer four times fast. There was an eruption of laughter from the nurse's station. Finally, I yanked the mask off my face and let the Albutirol steam pour into the air. The respiratory therapist arrived about ten minutes later, on her regular schedule. She wondered what the hell was going on? By then, the psycho, babbling and drooling, had drifted off to la-la land.
For the privilege of staying at the “Hospital St. Ritz,” my insurer was charged $1,600 a day for room service alone. Thank God there wasn’t a mini-bar! The entire bill for the ER, surgery, hospital room and in-house therapy came to $60,000. My insurer paid for nearly all of it, and for that I’m eternally grateful. But I had to deal with insurance agents, and claims adjusters as though it were a full-time job. I was forever on hold, calling the wrong department, or typing detailed letters. And I had to do a selling job, over and over, to convince these industry bureaucrats that I had, in fact, suffered serious injury.
* * * * *
...On ordinary visits to a doctor, I typically sit in the waiting room for at least an hour, sometimes two, before I’m allowed into the “inner sanctum” of the doctor’s office. Then, I’m ushered into a little room, where I’m left to wait for another twenty minutes before the doctor deigns to see me. The consultation lasts about six minutes.
(Don't get me wrong. I don't wish to portray doctors as ogres. One physician of mine, in particular, takes his time with me and takes copious notes. But he's an exception to the routine).
Virtually every one of you knows this dreadful routine. It remains one of the great mysteries of modern medicine: How can a patient wait two hours for a six-minute appointment? If you’re visiting a group practice, there may be ten medical secretaries crowded behind the front desk, juggling a hundred different insurance companies trying to limit or deny referrals and tests for patients. Hostility lurks just under the surface. Their job seems like a living hell to me.
When your G.P. recommends a specialist, you go to THAT specialist. Few of us have the time or information to make educated choices about doctors. But once you start going to specialists, as so many middle-aged folks do, there’s no escape. You’ve got to keep going back for more tests and consultations -- if only to insure that your insurance company will continue partial coverage of the medicines your doctor has prescribed.
There’s got to be a better way to do this. I'm under no illusion that a government-run system, or a private, mega-insurance company, would make health care easy or cheap. The rich may have choices; they always do -- whether it’s medical care, college education or asset management. But the rest of us, the toiling masses, have only false choices. We have the insurance plan our employer (or, in my case, my WIFE’S employer) provides. We go to the specialists our G.P. selects for us. We go to the nearest hospital if we’re injured. And when our insurer raises a premium or denies a procedure, we get by with less or do without.
Now, efforts to reform health care are in the hands not only of Barack Obama and Kathleen Sebelius, but of members of Congress with names like Max Baucus and Chuck Grassley, Olympia Snowe, Nancy Pelosi -- and, yes, Joe Wilson. And just like when we go to the doctor’s office, we sit and wait. And wait some more. We’ve been waiting for decades.
On that grim note, thanks for stopping by. If you’d like to see additional samples of my work, please click here.