Defying the Insurance Company Actuarial Tables

This has not been my year, medically speaking.

Of course, it could have been worse. I'm not dead yet.

It started right at the beginning in January. As I wheezed my way onto the examination table, the doctor listened to my lungs, diagnosed pneumonia, and took an extra listen to my heart. Noticing some swelling around my ankles (edema) and a somewhat alarming high blood pressure, he asked if I would mind if he did an EKG as well. In my feverish stupor, I was barely aware of what he was doing, let alone in any position to argue or question.

After a typically long recovery from pneumonia, two visits to a cardiologist (and all of the delightful related experiences dealing with insurance companies, lengthy referral processes, and lackadaisical doctors' office staff who didn't give a shit about whether my life was in danger), I ended up in the Rose Medical Center Cardiology Unit where it was discovered that my major left artery was 80% blocked.

No wonder I was always winded after climbing the stairs to my office on the second floor. I just thought I was in terrible shape. I was, of course, but anyway ...

Major heart attack and possible sudden death averted, a stent was inserted and I was prescribed several weeks of cardiac rehabilitation which turned out to be three visits to the hospital per week where nurses hook you up to an EKG machine and take your blood pressure while you exercise. Some of the nurses have extra training in torture as they push you to exercise harder and harder while criticizing your diet and general lifestyle.

By the end of the summer, however, I was able to bound up the stairs to my office without running out of breath. Yay!

Thinking that everything was under control and that perhaps I would survive my 50s after all, I woke up one night to discover that a mole on my back had decided to erupt in a bloody mess. Naturally this happened on a Friday so I had all weekend to worry about it before my doctor's office opened Monday morning. But I was on that familiar exam table by Monday afternoon and the results of the biopsy came back on Thursday - so I only needed to push away "worst case scenario" trains of thought (chemo, end of life directives, death ...) for four days.

The results were not benign, but neither were they of the terminal variety. It was basal cell carcinoma, a slow growing skin cancer that is merely annoying, not fatal. It did, however, require minor outpatient surgery, which I had on Friday. There is now a big crater in my back which because I can't reach it, Clyde has to clean and bandage twice a day. This is the part of marriage that they don't show you in the bridal magazines.

So I'm back to assuming I'll make it through my 50s, though I keep imagining the insurance company's actuarial tables which must show my ever decreasing predicted life span.

I realize that 100 years ago, and in many other parts of the world today, I wouldn't have survived long enough to even have these problems. Many men got into their 50s, had heart attacks, and died. I sometimes try to remind myself that beyond a certain point, every day is gravy and that I should be thankful for it. I have things pretty good, after all: happily married, good home, comfortable life.

I keep remembering my dad who because of a heart condition, was given six months to live around the age of 70. He was 86 when he died. I take after him in a few other ways, so maybe I can look forward to a long life in spite of some health issues.

Guess How Much My Recent Heart Procedure Cost

The whole procedure took less than an hour. It prevented what could have been a major heart attack.

I recently had a stent put in an artery near my heart. This stent opened up the artery which was clogged so that blood could once again freely flow through. I was in the hospital for one day, not overnight. A tube was inserted in my wrist, directed through arteries up to my heart where a camera took a look at what was going on and installed the stent.

I was in recovery for a few hours after that. I am in cardiac rehabilitation for three months.

There is no doubt that it was a remarkable procedure. You could even say that it was a miracle of modern medicine. You could argue that it prolonged my life for many years.

Here's a fact that you can't argue with: the cost of having this done was over $74,000.

Here are my thoughts after seeing that figure on my insurance claim:

• I'm lucky I have health insurance through my employer.
• I'm lucky I could swing the nearly $2,000 copayment.
• If I didn't have insurance I would have been financially wiped out by this one, single medical event because in the United States, not everyone has the right to health care.
• If I didn't have insurance, I probably would have opted not to have this procedure done. I would have taken my chances, risking a heart attack or a stroke later on.
• If I didn't have insurance, I would have ended up in an emergency room with a heart attack or a stroke, leading to my own bankruptcy, and/or costing someone (either taxpayers through public subsidies or the hospital resulting in higher health costs for everyone who can pay) much more than if I had been able to receive the less expensive earlier treatment in the first place.

I still don't know what the cardiac rehabilitation is costing. But I think it's worth it because it will help prevent future cardiac events. Fortunately, I'm in a position where I can work my schedule around the three times a week appointments, and I'm fairly certain I'll be able to afford the co-payments. 

But I've said it before and I'll say it again: I don't know what poor people are supposed to do. Just get sick and die I guess.

National Health Care Couldn't Be Worse Than This

When I call, I'm always put on hold. Then, I can't get an appointment for a month because the specialist is just too busy. Once I get into the doctor's office, I have to show the special card with my identifying number. People who don't have a card get turned away. I've seen it happen. When my name is finally called, I see a technician who takes my vitals and reviews my history, followed by a nurse who does a test, and a nurse practitioner who does a preliminary diagnosis. Finally, I am seen by a doctor who reviews everyone's notes and makes a final pronouncement before I'm hurried out the door.

Is this the nightmare of a government managed, single payer, national healthcare system?

Nope. This is my private, state-of-the-art, all-American, employer subsidized insurance paid, health care provider.

After the appointment, when the test results are in, I'm telephoned by an administrative assistant who reads the results to me but who isn't allowed to interpret them and is unable to answer my questions. It's a little more personal than the other doctor's office which refers me to the lab's website so I can read the results myself, regardless of whether I understand them.

The pharmacy does not have the specialty drug I've been prescribed. They can order it, this one is on the list of insurance approved medications, but I'll have to wait, and it will cost me the higher copay.

Endless paperwork. Limitations set by insurance companies. Overworked professionals.

As a regular consumer of medical services, I honestly don't believe that a government run health system could be any worse than the one I have to deal with. Is a faceless, soul-less, government-run bureaucracy that considers you a number and doesn't really care about you any worse than an insurance company that considers you a number and doesn't really care about you, and in addition, seeks to make a profit off of you?

I don't blame the individuals, usually, who provide the care. I blame the insurance companies who dictate the kind of care that can be provided.

I am luckier than many Americans. I at least have health insurance through my employer. I have some choice in who my doctors are. My prescriptions are covered (sure, I have copayments, but it's a tiny fraction of the actual costs). Most common tests and treatments are readily available to me should I need them.

Plus, I'm relatively healthy. I usually have the strength to assert myself through the maze of receptionists, insurance bureaucrats, answering services, and technicians to eventually get what I need.

I've asked before and I ask again: how do really sick people navigate the system? What do people do who are weak with cancer or AIDS? What if you can barely hold the phone, let alone speak up to someone who is giving you the runaround about a bill or information about your treatment?

I don't want to hear about how our health care system is better. It's not. It's at least as broken as your average government run system. It has to be. All things considered, I'd just as soon put my trust in a universal government run system, which would at least guarantee the same healthcare for everyone.