The Doctor Will See You…Eventually

So I had today off, thanks to our megacorp’s groovy policy of giving us one Friday off per month in the summer. Last month the fambly went to the beach to celebrate, our first real trip to a real Pacific beach (although we’d been to smaller beaches to wade and such before).

What did kinda fun stuff did I do this time? Well, I took The Rose to have some blood drawn. Yay!

I’d heard great things about the San Diego Children’s Hospital. Those must be about their outstanding in-patient services. Because I am most assuredly not impressed so far.

We’ve tried to make appointments with a plethora of different doctors and in each case there’s been a considerable wait. Most vexing is their cardiology department. In order to get an appointment, you need to leave a voicemail with the patient’s name and other pertinent info. Then, at some point, they call you back and tell you when your appointment in. That’s right, tell you. You have no say in the matter; they simply schedule it for you. If that time doesn’t work for you? You call back and leave another voicemail and someone will eventually get back to you with your new appointment. Needless to say, but I’ll say it anyhoo, these appointments are generally several months away.

Today wasn’t that big a deal. The Rose saw a dermatologist who wanted some blood work done, and insisted it be done at the hospital. So I took her and The Boy to the outpatient lab—no appointment necessary.

Leaving aside Mapquest problems which can’t be blamed on the hospital and some really lousy signage—which, I’d argue, can—we park and find the lab with little difficulty. I’m surprised by just how small the waiting room is, giving the size and niceness of the entire hospital complex, as well as how little kid stuff there is: a couple toys…and by “a couple,” I mean “two.” But I decide that maybe that’s a good sign; they have such rapid turnaround that kids—the exclusive patients here—don’t even have time to get bored.

What’s not such a good sign is how few chairs there are; the three of us had to share one chair for the first fifteen minutes, until finally the sulky fifteen year old listening to his iPod and sporting a tasty “Eat the Rich” t-shirt was called.

Thirty-five minutes later we’re finally called…and we’re only the third folks called. Speedy this joint innit. But the tech couldn’t have been more awesome, so that’s good. Still, that was a fair-sized wait in such a small and featureless room for such a simple procedure.

As I’m walking out, the receptionist asks if I want my parking validated, and thank Allah for that; I’d meant to ask a half-dozen times but forgotten and would I have been upset had I not had it done? I would have.

Which is why I was less than entirely enthused when it turned out that I still had to pay three bucks to park for less than hour. What would it have been without validation? Two bucks…every fifteen minutes. And, no, there are no other options when it comes to parking; this garage is the only game in town.

That did not make me happy.

My point, from which I’ve strayed a bit, is this: I’ve been fascinated to see in the past week a meme rocketing around Left Blogistan, as one writer after another seems to have picked up on the exact same and utterly irrefutable argument in favor of changing our current health care system.

For years, whenever folks talked about universal coverage, the immediate rejoinder was always: “socialized medicine! Horrible wait times in Canada and the UK! No choice of doctors!”

Which may or not be true. The fact that they spent roughly half as much as we do per capita and get far superior care in return is unquestionably true. Still, who wants to wait? We’re Americans, dammit. We want the world and we want it now.

But the thing is, we do have to wait for appointments. Today’s experience wasn’t terribly onerous—in fact, it pretty damn easy compared to our family’s average experiences.

Every time I’ve called for an appointment in the past ten years I’ve had to wait. If it was an emergency, they’re almost always able to squeeze me in that day. But for New Patient appointments or even just a yearly check-up, I often have to wait up to three months. And this is the argument that has suddenly come into vogue. And with good reason. I’m not sure why it wasn’t made before, but there ’tis.

I’m not sure I understand why socialized schools and socialized roads and a socialized military are inherently good things, if imperfect, but socialized medicine is supposed to be bad. Actually, I know why. Because Big Bidniz knows they’ll lose billions of dollars for doing nothing—literally, that’s how insurance companies make their money, by doing nothing, rather than providing the services required, which loses them money—if they don’t fight it tooth and nail. So they do, and their lapdogs in Congress and on rightwing radio and television parrot these talking points and Americans just swallow it.

Or at least, they used to. But I don’t know anyone who’s really happy with their insurance company. I have outstanding insurance, thanks to the aforementioned megacorp, and even so, they keep trying to get me to pay for the MRI that, I was assured, was completely covered and done in network. But they’ve been sending me bills for four months now and once again threatening a collection agency. And I’d guess I’ve got better insurance than 97% of Americans.

But that’s nothing compared to the following story. You’ve seen the bumper sticker that reads: “If you’re not outraged, you’re not paying attention.” Well, if you’re not sick with fury and frustration when you’re done reading this story, you haven’t read the story.

This is our current system. It is broken. We need a new one. We need universal coverage. It’s the only morally-acceptable choice. Moreover, it’s the fiscally prudent one. There is no reason not to do it. Except that Big Bidniz doesn’t want it. And what they don’t want, they almost never have to get. Let’s hope this is a rare loss.

Here’s a large excerpt, but you should really click through to read the entire thing.

Now that Michael Moore’s SICKO has raised again the question why the Canadian health care system functions so much better than ours, supporters of the current mess have gone back to chanting

Hip replacement! Rationing! Hip replacement! Rationing! Markets! Markets! Markets! Markets! Sis, boom bah!

or words to that effect.

The response, of course, is that rationing, including rationing by queuing, is just as much a feature of the U.S. system as it is of competing systems. And while waiting for a hip replacement sounds pretty bad, there are worse things to have to wait for. Take it from me.

In the spring of the year 2000, after several months of what in retrospect was intolerable negligence both by me and by my internist, I was diagnosed with cancer. I had fancy-dancy health insurance through my employer, which as it happens also owns one of the world’s dozen best medical centers.

The diagnosis of cancer, based on symptoms plus the chest X-ray that should have been done several months earlier, was made very early in May. By then, I had dropped forty-some pounds, had almost no voice, couldn’t walk more than 30 yards without puffing, and had a resting respiration rate of 20 breaths per minute. My friend Gary Emmett, who made what turned out to be the correct diagnosis a month earlier just by listening to me on the telephone, came out to visit, and told the rest of my friends that if they wanted to see me alive they’d better make their plane reservations in a hurry. (The technical term is “Stage IV-B.” Not good.)

But of course you can’t treat “cancer.” You have to treat some specific cancer. And you can’t treat it until you figure out what it is.

That process took just about one full month, a month during which my chances of survival were dropping fairly steadily and the intensity — and therefore the side-effect profile — of the treatment that would be required if we ever got the damned thing figured out was rising in parallel. It would have taken longer — quite possibly fatally longer — if Al Carnesale, whom I’d known when we were both at the Kennedy School, and who by then was the Chancellor of UCLA and thus at some ethereal level responsible for both me and the hospital, hadn’t sent a note to the guy who runs the entire UCLA medical area (hospital and medical school). The note politely hinted that it would be at least marginally preferable if my department didn’t have to go through the hassle of recruiting a replacement. After that, things speeded up somewhat.

What absorbed that month? Mostly waiting.

After the chest X-ray, I needed to see an oncologist. I couldn’t make an appointment until I had the approval of the insurance company for the referral. That took a few days. Getting on the oncologist’s schedule took a few more days.

After the oncologist saw me, he wanted a bone marrow sample to send to the pathologists to figure out what the cancer might be. I couldn’t make an appointment for the bone marrow procedure until the insurance company approved it. Then I had to wait for the bone-marrow extractor to have time on his busy schedule.

When it turned out that there wasn’t enough marrow to test, I needed a lymph-node biopsy. More waiting for an insurance approval and more waiting for an appointment.

Having seen the head-and-neck surgeon who was going to do the biopsy, I couldn’t have the biopsy right away because the insurance company wouldn’t approve it as an in-patient procedure and there was queue for outpatient biopsy operating room time. Anyway, the guy who had seen me didn’t have any time free on his dance card for the next several weeks, so he sent me to another surgeon to actually do the procedure.

When I showed up for the outpatient biopsy, the anaesthesiologist took one look at my chart and flatly refused to put me under for the procedure except in an in-patient setting, on what seemed like the reasonable grounds that otherwise I could easily die on the table. That meant, of course, more waiting for another approval and another appointment.

All this, let’s recall, with the Chancellor breathing down the neck of the boss of the medical area on behalf of a full professor at the university that owns the hospital. So my experience with the system was probably about as good as it gets except for corporate executives using places like the Mayo Clinic or family members of people on the boards of directors of hospitals. (Apparently it’s generally understood that if you stump up enough in the way of contributions to get on the board of the hospital, you’re entitled to priority care; that’s how not-for-profit hospitals raise capital.)

It was only later that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to “Tier II,” which would have meant higher co-payments. The process is designed to get very sick or prosperous patients to pay to jump the queue.

I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero. As I say, in my case it was a damned close-run thing. (Fortunately, the eventual diagnosis was of a curable cancer, and the actual treatment I got once the diagnosis was made was prompt, well-executed, and entirely successful.)

That’s on top of the procedures the insurance companies simply refuse to pay for at all because some clerk decides they aren’t “medically necessary,” which for most people means that the queue for that service is of infinite length.

So can we hear at little less about how long Canadians wait to get their hips replaced?

We can’t let this continue.

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About the other scott peterson

Writer of comics and books and stuff.
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5 Responses to The Doctor Will See You…Eventually

  1. Mary says:

    Oh Spot…
    You should go to my blog and read my Mammogram post about What percent of 100% is 100%?
    I, too, am still getting billed for a procedure that my insurance says it covers at 100%.
    Ay yi yi….
    Mary

  2. Ed says:

    As someone who works directly in healthcare, I have a view of the flip side: trying to help patients through the mess, all the while knowing the delays are costing them precious time that is charged to their life account.
    I am glad to be in relatively good health, don’t take daily meds, neither does the wife or kids. Working for a hospital does provide a bit of more direct access to MDs, but only up to a point.
    But more importantly, what I have found is that having lived abroad, as well as in various locals of this great nation of ours, you get better care, at a much more reasonable cost, with far more rapid access, when you live in a rural setting.

  3. KC says:

    We receive military healthcare. Sometimes I feel it’s the closest to universal healthcare as it is something the US government provides. I don’t know the ins and outs of the Canadian system so I can’t comment on that. Our healthcare is bid to the lowest bidder (insurance company). They do whatever they can possibly do to not pay. Appointments can be impossible sometimes. Even when you have an emergency, appointments are not available. The only recourse can be the ER which is then overburdened, etc.
    I’m not articulating it well but I would be hardpressed to want any sort of healthcare the government provides. It would have to be a well laid out plan.

  4. scott says:

    Right, but KC, if I’m understanding correctly, the thing is, the government ISN’T providing you your healthcare—they’re farming it out to a private insurer. You may not be paying for it, per se, but you still have private insurance, essentially. Consequently, your healthcare sucks. Just like pretty much everyone else who has private insurance, no matter how good.

    They do whatever they can possibly do to not pay.

    Right. That’s how they make their money: by denying you procedures you need. Paying for those procedures is expensive and loses them money. They can only make money if they don’t give you what the doctor ordered. Amazing system, innit? No wonder Big Bidniz wants to keep it. Unfortunately, at its heart, it’s really immoral.
    The healthcare in this country is more expensive than in other nations and not as good. This is another fine example of exactly that thing.

    I would be hardpressed to want any sort of healthcare the government provides. It would have to be a well laid out plan.

    A nation that’s able to produce the amazing military our great country has can surely produce a system that makes sure all its children have healthcare.

  5. Ed says:

    KC,
    A comment on the military healthcare system: Here on Kodiak the facility I work for is the only medical facility available to the USCG and Navy personnel and their families, other than a very limited clinic on base. Yet Triwest decided to reduce our reimburseables by over $1,000,000 a year based on lack of funds in the coffers due to the mess-o-potamian disaster. So that puts them under medicare/ caid for rate of reimbursable.
    This being a not for profit hospital, we will of course continue to welcome these people, but at the same time, being such a small hospital the money that was arbitrarily held back is a big hit to absorb every year.
    When these Triwest beneficiaries are in a more competitive market, say San Diego, their options are very limited outside the military clinics, as many providers are expecting for them to make up the difference, or simply refuse to provide services.

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