Health Care Reform Part 1

In spite of my diet, I’m a remarkably healthy guy. I’m happy, my HMO is happy, and I had no reason to listen in on the recent health care reform debate. As we used to chant in Sunday School, “Borrrr-ing”. About two months ago I was forced to care by a rupture in my right groin region, an inguinal hernia to be precise. Since then, I’ve become an expert.

I still can’t read past the opening paragraph (OK, sentence) of a health care reform op-ed, and they certainly don’t discuss the issue in football telecasts. No, I get my information from overhearing conversations by people who have time to read and who can sit through cable news. You can find these people easily at coffee places (especially the ones embedded in book stores), but I don’t drink coffee. I make due with donut-eaters and the PTA Moms I hang out with.

As far as I can tell, and this may be too simplistic, there are some people who want a package of health care reforms generally supported by the President [I’ll call this group HCRPP] and other people who would rather not have drastic changes [I’ll call them OTHER]. I’ve decided that my ongoing health care experience will settle the issue once and for all. I’ll keep score as I recount my story, and you can let your representatives in Washington D.C. know the outcome. Or you could tell me who mine are, and I’ll send them an e-mail.

Diagnosis

I’ll spare you the details of my heroic, albeit imaginary, wounding, and skip to the fix. About a month ago it occurred to me, my wife, and all the people watching me hobble around DisneyWorld that my remedy for an inguinal hernia—ignoring it—was not working. Sorry, Blue Shield. I visited my primary doctor, who at first tried to ease my mind by telling me that most hernias can be tolerated indefinitely. He said I could still do upper-body lifting. I told him that I tried, and woke up the next morning thinking that a knife was poking in my groin. He took a quick look, said, “Oh, that’s a bad one,” and left the room, promising an immediate authorization. His 2-second diagnosis was spot-on: score 1 for the OTHER group, [HCRPP-0 / OTHER –1], and the authorization did come quickly [0 – 2].

At this point, I’m thinking, “what’s the big deal?” Can’t Congress work on something everyone I know agrees on, like the legalization of marijuana and prostitution? Or declaring war on Canada? My visit to the surgeon’s office confirmed to me that all the health care horror stories that people are probably sharing on Cable TV are true. First off, the wait was 2 hours (actually 45 minutes, but it felt like 2 hours because all the chairs were taken, and I had to sit on the floor). [HCRPP – 1 / OTHER – 2]. The magazines were old [2 – 2], but at least the waiting room didn’t have Highlights for Kids [2 – 3]. Do dentists and pediatricians get Highlights for free? Who would pay for it? Has any kid ever spent more than 5 seconds looking through one of them? I mean, without a parent ordering them to. Highlights has been a health care crime for at least 40 years, so score 2 points for HCRPP [4 – 3].

Whenever I have a long wait at the doctor’s office, which is always, I’m told something like, “I’m sorry, the doctor had an emergency to attend to this morning,” or “The doctor had 8 surgeries to perform today.” If that’s always the case, why not account for that in scheduling? If there’s an emergency every day, maybe come up with a different word for it. Were the surgeries a surprise? Why not just be honest with people, and schedule them for 4:00 if there’s no chance of 2:00 happening? Why not get a bigger wait room, with enough chairs so that I don’t have to sit next to a creepy sick guy? If I were a doctor, if I had any job at all, I wouldn’t make people wait two hours. I don’t tell the termite inspector to “take a seat on the porch, I’ll be with you when I’m done playing my Jumping Penguins computer game.”

From there, the situation deteriorated. A jaded nurse took my pulse and blood pressure. Good numbers for a donut-eater. Fifteen minutes later (again, why?) she asks me to move to a different room that appears to be no different from the first room [5 – 3]. Here’s where things get weird, i.e., after another 10-minute wait. A young female doctor, clearly new to her craft, walks in the room. “Woo-hoo,” I’m thinking, “a young lady doctor is gonna examine my groin region!” She asks me a few questions about my general health, and I give her great answers (those of you who’ve met me know how smooth I am). Then she leaves. Did I say something wrong? Five minutes later (the waits are getting shorter), the doorknob turns, and frankly I’m having a hard time trying to hide my excitement. Then, despair. It’s not the female doctor coming to look at me, it’s a middle-aged guy. WTH (H stands for Heck)? I paid a $15 co-pay. I know I’m not in a brothel, but come on. I’ve been married 14 or 15 years. Sorry, OTHER group, this ain’t cool. [10 – 3]

By the way, this isn’t the first time my hopes have been crushed by a cruel medical profession. One time about ten years ago, I kid you not, another young woman doctor was examining my privates [10 – 14] when she suggested a prostate exam. “Every man over 30 should have one.” I tried to play it cool, using all my mental energy to keep from embarrassing myself, if you know what I mean. She misinterpreted my reaction as resistance, unfortunately, and the deal was off. “I won’t insist on it this time, but you should really have it done soon.” [15 – 14] I was speechless for once in my life. I’m old enough to know how damaging regrets can be, so Michael J. Fox, I need your car. I’ll speak up this time: “I don’t mind if you stick your finger in my ass. You can even wear a latex glove.” (I'm saying this to the nurse, not Michael J. Fox.)

Back to the future, meaning now, the office manager schedules my surgery and gives me assorted pre-op information. I say, “I don’t need an authorization?” She explains that since I have a PPO, I don’t need one. Ethical dilemma—do I admit that I’m in an HMO? Since they’ll probably find out anyway, I let her know, and she gives me the polite but telling look that apostles would have given to lepers, and Jesus would have given to Frankenstein. “We shouldn’t have even seen you. You didn’t bring us authorization for this visit.” Huh? The authorization, complete with contact details for this surgeon, is sitting at my house. If I have a copy, why wouldn’t the HMO send one to the surgeon's office as well? They're the ones who need it. [16 – 14]. I get home quickly, and fax it in as promised, right before the office closes (at 4:00!). I’m in business.

Pre-Op

Covering your ass is a big portion of health care costs. The surgeon wants 3 tests done—a blood test, a chest X-ray, and an EKG. And they all have to be done in the week leading to surgery. This means I have to postpone the surgery until after the school year. I can’t do 3 medical tests and a surgery and also drop off and pick up my children every day. Not to mention various PTA obligations. It also means more authorizations, waits in under-chaired waiting rooms, and 2-year-old Sports Illustrateds. Which brings up another gripe: do doctors really need to hold on to their personal copies of magazines for a year or more before they can bring them to the office? If you don’t read Time within the week, what’s the point of keeping it around? Do they have another waiting room at home for visiting friends that gets first dibs?

I had the EKG done at my primary doctor’s office. According to him, and I hope I’m not violating doctor-patient privilege, having all these tests done, especially in the limited time frame, is “stupid.” He actually used a worse word, but I’ll keep that confidential. He told me he’d call the surgeon in protest. The EKG was done quickly, and my heart is fine. What I don’t get is how one doctor’s office says that I’m authorized (for insurance coverage) with one particular form (a horribly illegible copy of a copy of a copy, and so on), and another says that I need a different form. My surgeon’s office gave me a form, the primary doctor gave me another set of forms, and now I’m covered either way as I head to the other pre-op tests. [HCRPP 18 – OTHER 14]

The blood test was simple and quick, and my only gripe is that I signed in ahead of another guy who then had his blood drawn first. In this case, it was probably just a simple mistake. But sometimes not, sometimes rude people complain about the long wait, and receptionists think they can solve the problem by putting jerks ahead of patient patients. This has happened to me at least three times. I like to point out that no one likes to wait, that rude people are not more important than patient people, and that by accommodating the bad apple you make one person less angry, but two or more people more angry. The reform group wins this round easily. [20-14]

Anytime anything in health care seems to be too easy to be true, it probably is. I called the imaging clinic, which only does MRIs and x-rays, on a Saturday, and they assured me they were open. That would have been very convenient for me, since on weekdays I’m a virtual prisoner in my home with only one family car. When I arrived, however, the receptionist explained that they are open, but not for x-rays. She was watching TV and sipping boba, with no other staff, nor any patients, present. I guess they’re open if you want to watch TV and sip bobas. [21-14] With surgery on Thursday, a time frame of 3-5 days prior to surgery to get the tests done, and 2 days needed to get the x-ray results to the hospital, I had to go in on Monday. The wait was only 10 minutes and the x-ray technician was a quiet, but polite, Russian immigrant in her mid-20s. [21-17] To get a usable x-ray I have to be in the proper position—my chest pressed against the machine, with my shoulders awkwardly pulled back. [22-17] Fortunately, I’m not in the proper position and she has to guide my body to the right place [22-20], not just twice, but an extra time as well, because my “torso is too long.” [22-22] Later I asked my surgeon if he saw my x-ray. He says he didn’t get a copy, and I’m wondering if anybody actually looks at the results of the tests, or if they were actually even received by the hospital in time, or ever. I wish I could see my medical test results, but whenever I’ve asked to do so, I get the run-around, even though the tests concern my body, and not the doctors. I believe that everybody should automatically get copies of their medical test results. I have no idea if health care reform would make this happen, but I’ll give them a point just in case. [HCRPP 23- OTHER 22]

To be continued when I get around to it...