Married to the medication

[Gob]

It was around the second dose of fentanyl going into my IV bag that I stopped trying to control how much all of this was going to cost.


I had been arguing with every decision the caregivers at the emergency room were making – “Is this Cat scan actually necessary or is there another diagnostic tool?” “Is there a cheaper version of this drug you’re giving me?” – and reminding them repeatedly that I was uninsured, but either the opioids in my bloodstream, or the exhaustion of trying to rest in a room next to a woman who, given the sounds she was making, was clearly transforming into a werewolf, forced me to surrender.


I walked out of there four years ago alive, yes. And, as the doctors and nurses kept reminding me, if I had waited another 48 hours to discover I didn’t actually have the magical ability to self-diagnose and self-treat serious problems with Google and herbs, I might have gone septic. But all said and done, I was also walking home to a $12,000 bill, which was approximately half of my annual income as a single woman.

It took me several years of hardship, contributions from my friends and the assistance of the hospital’s charity program to pay off the $12,000.

Then, last month, it started again. I was at home. I turned my head a little, the whole world started sliding away from me, and I crashed to the floor. I tried to crawl back into bed, insisting, “It’ll pass, it’ll pass.” My husband, on the other hand, was raised in a country with compulsory public health coverage, so his first instinct upon something weird happening isn’t to lie down for 48 hours and see if it goes away. He immediately started plotting the route to a hospital on his phone.

I was back, but this time I was married. The whole hospital visit cost us $30, including the prescription. Everything was covered by his insurance. That’s when I realized I can never divorce my husband.

The first emergency room visit might have been an anomaly – a freak health problem that the nurse explained as “sometimes these things happen”. The intense vertigo was the result of the deterioration of the condition of my ears. It has been a problem since childhood, one left in “let’s wait and see what happens” condition until a weird virus last year – yes, I was the big idiot who caught a debilitating non-coronavirus virus during a coronavirus pandemic – forced me to a doctor, who discovered significant hearing loss and structural damage that will require lifelong treatment and intervention.

As a freelance writer who has tried and failed for years now to get a real job with real benefits, the costs of the surgeries and hearing aids and other treatments the doctor sketched out as part of my future would be suffocating. But almost all of it is covered by my husband’s insurance, making my health and ability to access healthcare dependent on his presence in my life.

While I convalesced from the virus last year, I watched the discussion about health insurance take over the Democratic primary debates. I had little hope that the bright, sparkly Medicare for All plan championed by candidates like Bernie Sanders would be made reality. But still I despaired of the excuses other candidates made for why they did not support guaranteed coverage for all. It angered me to see Amy Klobuchar, Pete Buttigieg and the eventual winner, Joe Biden, defend their plans to largely maintain the status quo – a system in which employment and marriage determine access to healthcare – as though they were protecting our “freedom” to “choose” coverage that was right for us.

The coercions built into American social welfare programs limit freedom, not preserve it. People who are not financially independent are forced to maintain ties with family members who might be abusive or violent unless they want to relinquish their housing, healthcare or other forms of support. And as outlined by Melinda Cooper’s Family Values: Between Neoliberalism and the New Social Conservatism, the dismantling of protections like food and financial aid in the 80s and 90s had the express purpose of increasing familial obligations in the name of “duty” and “responsibility”. Single parents seeking public support for their children’s wellbeing now had to first seek assistance through their partners, no matter how fraught or harmful those relationships might be. While politicians spoke of “strengthening families” and repairing the social fabric, one of the consequences of these policy changes was to limit the ability for people to make the basic decisions required to live the lives of their choosing, unless they had the money that in this country is our substitute for freedom.

It’s not just unhealthy families we are stuck in: a Gallup poll revealed that one in six Americans stay in jobs they want to leave because they can’t afford to lose their health benefits. Politicians on both sides claim to support innovation and entrepreneurship, but the cost of healthcare is a huge barrier for many, and something that could be easily resolved with a public option. It’s almost as if we believe people who are sick, unlucky or not blessed by inherited resources deserve to have their choices constrained and stay trapped in perilous circumstances. (That last part is a joke. We Americans definitely believe this.)

We have a Democrat-led Congress and a Democratic president, yet there is no public option or significant overhaul of our broken health insurance system on the horizon. As a result, when my husband got offered his dream job at an emerging non-profit startup, one so new that when the offer was made they could not yet offer health benefits, he hesitated. There would be a gap in coverage, of indeterminate length, and there was still that $12,000 emergency room visit in recent memory.

In the end, simply by luck, the startup found a way to enroll employees in a health program that left us with only a one-month gap in coverage. I am lucky to be married to someone I like, who I am not afraid of, who I do not want to leave. This hasn’t always been the case for women in my family, or even myself in my 20s. For now, and for the foreseeable future, my access to doctors is tied to my partner, and his to his employer. Land of the free indeed.

Jessa Crispin is a Guardian US columnist

[BoSoxGal]

I saw my doctor yesterday - she’s pretty good which is nice after years of struggling with some real duds. I feel like I’m making some forward progress toward better health.

In America you can have excellent health insurance coverage with access to some of the best doctors and diagnostic services in the world and still have poor quality care because our system expects physicians to see 4-5 patients per hour - that’s what the billing is based on.

Imagine trying to manage somebody’s health seeing them 1-3 times per year for 12-15 minutes. No wonder we have a crisis of poor health in America.

And what’s the point of this? MONEY. GREED. We could easily build a whole lot more doctors and provide a whole lot more quality medical care, but then all those doctors wouldn’t make 6 and 7 figures. The medical profession has a huge stake in the status quo and that’s a conversation that just isn’t had and really should be.

[ex-khobar Andy]

I had some lab work done recently. I got the results in a day or two and my doc looked at it and said good for you, you're taking your meds, all OK, keep it up. And of course they give you, on the results sheet, the normal range for everything, preprinted.

I thought no more about it until I got a bill, a few weeks later, from a doc I'd never heard of (but apparently coming from the hospital) for $122.56. I looked up the billing code. Apparently this doc had spent 30 - 39 minutes looking at the results. I called the insurance company. They of course were no fucking help. So long as they were not being asked to pay it, why should they care? I called the hospital billing department. Someone in a cubicle told what the bill was. $122.56. Yes, I can fucking read (I wanted to say but didn't).

In the end I paid it. I have a 800+ credit rating and want to keep it that way. (Not sure why - I'm not applying for any loans in the near future, AFAIK.). I shall talk to my doc when I next see him to see if he has any insight into what might take 30 to 39 minutes of some doctor's time to figure out that everything appears normal.

[Big RR]

This was for lab work done in the hospital? I'm not sure of the total extent of it, but as I understand it, when you are admitted to a hospital you are no longer in the care of your private physician(s), but a doctor(s) employed by the hospital (hospitalist(s)) who see to your care and bill you for their services. My guess is this is one of those physicians. I have had friends who were in the hospital for heart attacks, etc. who were cared for by a number of physicians (cardiologists, internists, etc.) that they never met before and who they had no choice in deciding to engage or not.

While it might be easier (and more lucrative) for the hospital to embrace this model, IMHO it is likely much worse for the patient. I know that I have usually had to look for a long time for physicians I could trust (and with whom I had a relationship), and I would not respond well to someone I never met before calling the shots for my treatment (one of my friends had a couple of his meds changed, his doctor put him back on the old meds after he was discharged).

[ex-khobar Andy]

I said 'apparently coming from the hospital' - what I meant was, from the medical group which includes the hospital, many of the doctors in the area, the lab etc. So I wasn't in the hospital. The blood was taken at my doctor's office and on his instructions, and he looked over the numbers and said it was all fine. So I do not understand what this other doctor did for $122. Most doctors, like most cops and most people, are honest people. Just as the cops need to do a better job weeding out the assholes who should never have a badge let alone a gun, doctors need to do a better job removing the ne'er-do-wells and the I-don't-care-so-long-as-I've-got-mine types.

My doctor may well point out something that needed to be addressed that is not obvious to me, which is why I will ask him.

[BoSoxGal]

Are you sure it wasn’t just a labs fee? That amount sounds right for standard lab work - no doctor involved, just the techs at Quest or a similar facility. Like a CBC, CMP, and lipid profile which are the usual ‘is anything out of whack’ blood tests most GPs run routinely.

[ex-khobar Andy]

The lab fee ($250 or so) was totally paid by my insurance.

[Joe Guy]

The lab fee ($250 or so) was totally paid by my insurance.

Doesn't your insurance send you a statement that explains what a service is and why is isn't covered? You shouldn't have been billed without an explanation. Also, I've had things like this happen and found out by calling my doctor that the original coding was done incorrectly by my doctor's office staff and I was billed for something in error.

[BoSoxGal]

Yes you should be able to get a more detailed explanation from your primary physician about why that kind of test has to be reviewed by a doctor off site. He can also tell you if that fee is standard, however overpriced it might seem and most medical fees are. It’s an elaborate con which is why we need single payer national healthcare.