Why I Think U.S. Health Care Needs Fixing

Three true stories.

Health care problems are in the news lately and I can’t help but think about the situation from my own very fortunate point of view. Fortunate because I have health insurance and the financial means to pay for care up to my $3,000 deductible. Too many people simply cannot afford either coverage or the deductibles, even when subsidized by an employer. I consider myself lucky.

I want to share three real life stories from my past to illustrate what I think is wrong with our health care system. Maybe you have similar examples. While I don’t know what the solution is, I know that something has to be done. Remember, I’m fortunate. People who don’t have my resources are basically screwed.

Knee Pain

Years ago, when I was still in my 20s, I fell while ice skating in Rockefeller Center. I vaguely remember the fall — I landed hard on my left knee. But I was young and I got up and kept skating.

A year or two went by. I began having problems with my left knee. A lot of pain when I sat with my legs crossed “indian style,” which I usually do, even while at my desk. I had a “real job” back then and insurance. I decided to see an orthopedic surgeon to see what was wrong with my knee. I had no idea whether it was connected to my ice skating mishap and still don’t. But it’s the only “injury” I can connect with it.

This began a multi-step process that completely tapped out my $1,000 deductible (at the time) and cost my insurance company many thousands of dollars. Here are the steps:

  • Initial consultation. Tell the doctor what hurts and when it hurts.
  • X-rays. Inconclusive — except to show that I was already showing signs of arthritis that was not likely causing this problem.
  • MRI. This is the test that fulfilled my deductible. It was also inconclusive.
  • Physical therapy. Twice a week, I drove to a physical therapy place about 15 miles from my home. I rode a bike, bounced on a ball, and fiddled around with some kind of resistance machine. I did this for two months. My insurance company paid $90 for each visit.

When my insurance “ran out” for the physical therapy, I went back to the doctor and asked if there was anything else he could do. He seemed not to believe I was in pain. He finally said that they could open it up orthoscopically and take a look. I’m not someone who wants surgery, but if that was the last resort, I was ready. I was tired of wasting time and money. If there was something wrong — and there certainly seemed to be — I wanted it fixed.

More steps:

  • Hospital pre-admission. They basically sent me to the hospital to learn how to use crutches. What f*cking waste of time and money that was! Fortunately, I didn’t need to buy a pair; I could borrow them.
  • Outpatient surgery. My doctor put two small holes in my knee area while I slept on a table in the O.R. He poked around in there and found I had a torn meniscus. It was torn in the shape of a triangle with a pointy tip that was evidently jabbing me when I crossed my legs. He cut off the torn part, and closed me. up. I don’t think it took him more than an hour to do everything.

I went home the same day. My knee was swollen. I think they gave me painkillers; I don’t remember much pain. I used the crutches the next day, one crutch the day after that, and a cane the day after that. Then I was pretty much back to normal. I don’t even have scars.

This was my first experience with the health care system’s ability to diagnose and fix a relatively minor but annoying health problem. I realized that a cure wasn’t possible until as many part of the health care system could get a piece of the pie as possible:

  • Doctor – Several consultations and surgery.
  • Physical therapy – don’t even get me started on that.
  • Hospital – X-ray, MRI, crutch lessons (that still pisses me off), and outpatient surgery services.
  • Support staff for surgery – nurses, anesthesiologist, etc.

But I was “cured.” I was happy.

Back Pain

Fast forward to the summer of 2008. I picked up something heavy while seated at my desk. This “threw out” my back. The pain didn’t begin immediately, but it began in earnest a day or two later. It became unbearable on a flight from Phoenix to Seattle with my husband. So bad that I found clinic in the Seattle area and was able to get in to see a doctor within 30 minutes of arrival.

The doctor started out skeptical. I think a lot of people must go to clinics to get drugs. Although I wanted something to stop the pain, I had to fly my helicopter to Arizona over the next two days. I couldn’t take painkillers. I wanted to know what was wrong and what I could do to fix it.

The doctor was good. After hitting my knees with a hammer and surprising me with the results, she had me perform several movements while seated and while standing. She told me I probably had a herniated disc and that I should ask my doctor for an MRI when I got home. She gave me some muscle relaxers and told me not to take them while I was flying.

I was impressed. Unfortunately, I wasn’t going home. I was going to Page, AZ. I figured I’d find a doctor there and follow her advice.

The flight to Arizona was painful, but not unbearable. It wasn’t until I was settled into my camper in a Page campground that the pain became more than I could bear. If I sat at my table for more than 10 minutes, when I got up I could barely walk. I was miserable.

I’d got the number of a local doctor from my health insurance company. But when I called, I was told that the earliest appointment was more than two weeks away. I set up the appointment, not seeing that I had any other choice. The pain got worse by the day. The only relief was when I lay flat on my back, and even that wasn’t making things better. I had to work. I couldn’t just lie around, waiting for a doctor’s appointment that might or might not resolve my problem.

One day, I simply couldn’t take the pain any longer. I found a clinic in Page and went. I signed in. Although the clinic was on my insurance, they wouldn’t accept my insurance. They wanted me to pay up front. There were at least a dozen people waiting in front of me to see a doctor. The wait would be at least two hours. The only seating was aggravating my condition. I was in so much pain that I was crying on and off. No one seemed to care. The other people waiting tried to avoid eye contact.

Finally, I got up and went across the street to the hospital emergency room.

Write this down: Page Banner Hospital. Now, under no circumstances, allow yourself to be taken to this place or any facility associated with it in Page, AZ.

There was no one waiting ahead of me, but I still had to wait 20 minutes to get help. I followed someone down a long hallway, struggling to keep up, since I could barely walk. A doctor came and asked what the problem was. I told him. He did a cursory examination — nothing at all like the doctor in the Seattle clinic had done — and found nothing. He thought I was there for drugs. I told him I wasn’t. I asked him to do a test — something that might shed light on what was wrong. I told him what the doctor in Seattle had said. He wasn’t interested. He sent me with a radiologist for an x-ray.

I was waiting back in the examining room, sitting on a metal chair instead of the examining table, trying not to cry, when I heard the doctor and another emergency room employee at the nurse’s station, chatting and laughing. The doctor told his companion how he liked to use some kind of drug to knock out unruly kids brought to the emergency room. They had a good laugh over that. It was as if I didn’t exist or I couldn’t hear them. They obviously didn’t care about me.

When I’d sat there long enough, the doctor came back in. He said he’d looked at the x-rays and there was nothing on them. He told me to go home and take aspirin.

This “service” cost me over $500. If I didn’t have insurance to negotiate the rates, it would have cost two or thee times that.

A few days later, I tried the clinic again. Ironically, I got to see the doctor I had an appointment for the following week. I gave her my story. She didn’t examine me thoroughly either. Instead, she signed me up for physical therapy.

I made two visits. The first one featured a piss-poor massage. I could have done better for about half the money at a good spa. On the second visit, they had me lie on my stomach and hooked me up to some kind of machine that put electric pulses through my body. Then they just left me alone in a room. After about 10 minutes, I started feeling sick. Five minutes later, I called for help. No one came. A bell rang and the machine shut off a few minutes after that. A few minutes later, someone came in to unhook me from the machine. I told her I didn’t feel well. She said it was because I’d been lying down. Then she left me to leave on my own. I got as far as the appointment desk before I had to sit down. If my back still hurt, I didn’t know it. It was all in my head — dizzy, lightheadedness — I can’t describe it. I asked someone to take my blood pressure. You think I’d asked them to give up their first born! They made me walk to an examining room where they hooked me up to a machine. I was at 180/110. So wonder I felt so bad! But did anyone there seem to care? No. The person who took my blood pressure simply said, “You should get that checked.”

I didn’t show up for the next visit. When they called, I told them they were making me worse. I nearly dropped dead the following month when I saw the bill for the two visits: over $500.

I started dosing up on ibuprofen. Three and four at a time. It kept me functional. I switched from megadoses of ibuprofen to tylenol and back. At night, if I knew I didn’t have to fly the next day, I’d take the muscle relaxants I’d gotten from the doctor in Seattle. The only time I didn’t have painkillers in my system was when I had to fly. But as soon as I was done, I’d dose up again.

This went on for about three weeks. Then, one day, the pain was a lot less than usual. And within a few days, the pain was gone.

Did I have a herniated disc? Had I somehow “fixed” it myself through normal movement? I don’t know. I’ll never know.

All I know is that I spent a lot of money for absolutely no assistance from about a half dozen medical professionals. I spent about a month in serious pain, frustrated that I was unable to get help.

In my honest opinion, the number one reason people should avoid moving to Page, AZ is the absolutely dismal health care available there. If the medical professionals there know what they’re doing — which I doubt — they definitely don’t care.

Maybe I should have given up and gone home to get help. Even if I couldn’t have gotten help in Wickenburg, I could have gone to Phoenix. But I wonder — how many doctors and hospitals and physical therapists would I have to have seen to have the problem diagnosed? How long would I have been in pain — and how much money would I have had to spend?

Chest Pain

Late last year, I began having mild chest pains. The pain would manifest itself in the middle of my chest, at the bottom of my sternum, when or right after I lifted something heavy. At night, I’d sometimes suffer from heartburn or acid reflux, which would wake me with nausea.

I’m in my 40s now and am starting to think seriously about my health. A minor health problem that I would have ignored 20 years ago is now something I should look into. So I started seeking help.

I began with a digestive specialist down in Phoenix. She asked for my symptoms and I told her. She told me to take an over-the-counter remedy for heartburn. Then she listened to my heart with her stethoscope, made some notes on a fancy tablet computer, and left me. I wrote a check for $119.80 against my now $3,000 deductible.

I don’t believe in treating symptoms. I believe in finding causes and treating them. I believe in curing a health problem, not hiding it with medicine.

So I began seeing a local family practitioner, figuring I could start with a basic doctor and work my way up to specialists if I needed to. I told her my symptoms and what I thought it might be: a hiatal hernia. But she zeroed in on the phrase “chest pain” and, after changing my blood pressure medicine, began ordering a bunch of tests:

  • Blood tests (3 of them)
  • Chest x-ray
  • Electrocardiogram
  • Sonogram
  • Echocardiogram

One of these tests showed a tiny abnormality. That sent me to a cardiologist who set me up for a stress test. I passed the stress test with flying colors. There’s nothing wrong with my heart.

I never thought there was.

I still have the same problem I started investigating in January of this year. It’s now June. I’m in Washington now, away from my doctor. I avoid the problem by simply not lifting anything heavy. When the acid reflux flares up, I take Tums.

I’m not done with this. When I get home, I’ll keep pushing. Maybe some medical professional will take a real interest in my real problem and help me find out what’s causing it. I don’t think I’ve found that person yet. Maybe I’ll get the test I need to determine whether I have a hiatal hernia. I don’t care if the answer is yes or no: I just want to know the answer so I can move forward.

I should mention here that the tests I’ve taken for this “chest pain” problem have completely wiped out my $3,000 deductible. That’s three grand out of my pocket — and the problem is not resolved. All I know is that I have a healthy heart. I guess that’s worth something.

But what of the people without health insurance or an extra $3K in a medical savings plan? How would they have shouldered this burden? Would they be convinced they were on the verge of a heart attack?

This is Wrong

Health care shouldn’t be like this. Doctors should listen to symptoms and do what they can during initial consultations to find out what the problem could be. Of all the details I listed here, there’s only one doctor who seemed to have a clue — the clinic doctor in Seattle. No one else was interested in listening to my symptoms or finding the cause of my pain.

Too many doctors assumed I was just seeing them to get drugs. The truth of the matter is that I have enough old bottles of Percocet and Vicodin at home to last a month. I don’t want or need painkillers. I just want to be heathy and feel that way.

One of the current complaints about the health care system is that doctors order too many tests. I can concur with that. Not only are they ordering too many tests, but they’re apparently not ordering the right tests. Tests that can provide conclusive results. An x-ray is not going to show a herniated disc. An EKG is not going to show a hiatal hernia.

Do doctors come into a conversation with a patient with preconceived notions about what a problem could be and then test for that? If a patient has five of the seven symptoms for a problem, do they not test for the problem because two symptoms are missing? Do they choose tests based on how easy they are to get, how much they cost, or what they can reveal?

The health care system in this country is definitely broken. I’d like to see it fixed in my lifetime.

7 thoughts on “Why I Think U.S. Health Care Needs Fixing

  1. Your self correcting back ache sounds like my experience with kidney stones. About six months ago I had my second episode with these, previous episode was about 10 years ago. I’m not the sharpest tack so when my wife came home and found me writhing on the floor with serious back pain she said remember the kidney stone? She took me to the emergency room. Big city, and a Kaiser hospital must make a big difference. I got good care and the problem corrected itself before surgery was required. Lucky again.

    Last fall I ended up in a non plan hospital with chest pain and worried I was having a heart attack. The hospital in Eureka, Ca provided excellent care and Kaiser took care of the bill without a fight and no payments that I had to recover.

    We haven’t always been so lucky both with earlier experiences with Kaiser and Blue Cross. Patient experience does vary, and shouldn’t.

    I do worry about how convoluted the system is with private plans, Medicare (A+B) all requiring the patient to be too knowledgeable about the system rather than being able to concentrate only on getting better.

    We really need a universal one payer no arguments health care system. We also need to take the profit motive out of the health care system and treat health care like a public utility. Just my thoughts.

  2. Interesting post Maria, especially for those of us outside of the USA. If you regard yourself as fortunate then I am a very very lucky man indeed. Not sure if you are aware how our health-care works in the UK, but its basically free so long as you’re a British citizen. The only exceptions are dentistry and optical care, but if you are on low income, a pensioner, pregnant, or a child then these are free too. If we need drugs then we pay a nominal $10 per drug prescription charge (irrespective of drug’s cost). Most of Europe operates similar systems, and when I travel in Europe I have a card which allows me the same treatment as a local of the country I am in would receive.

    I’m not normally one to advocate more taxation, but our National Insurance scheme does seem to work well (it also pays a state pension, but I expect that will be abolished by the time I need to claim it!). Mind you, it costs nearly £100bn a year to fund the National Health Service for our 60m population!

    On another note though, I wouldn’t hold your breath of getting your system fixed in your, or any other, life time. Even with our system people are always describing it as broken or in need of fixing!!

    • Thanks for this wake-up call. While I’m usually in a high “tax bracket” here in the U.S., I do realize that Americans, in general, don’t pay enough taxes to cover the cost of the services they want. But taxation is a difficult subject here. No one — including me! — WANTS to pay more taxes. And with a particular political party having nearly half the population convinced that we can improve our economy and remove our enormous decifit by CUTTING taxes, it isn’t likely that any necessary tax increase will be passed.

      I do consider myself lucky. I’d like to see a government-sponsored alternative to give uninsured people the ability to negotiate doctor and hospital charges and reduce prescription costs. That’ll at least bring their costs down to earth.

      My biggest fear — which I’m sure is shared by many middle-class Americans — is having a catastrophic health issue such as a need for major surgery or a disease that needs long-term treatment. This can — and HAS — bankrupted many Americans. My high deductible is my way of reducing costs. I’m generally a healthy person and seldom go to any doctor. I don’t mind paying $3,000 out of pocket every year if that’s what it costs to have affordable health insurance to protect me from financial ruin in the event of catastrophic illness. But is that really the way it should be? I don’t think so.

  3. The New Zealand health system is probably based on the one in the UK. If a NZ citizen has health problems a visit to the doctor is around NZ$30. These days a prescription costs around NZ$3. Yes, that’s three. The rest is subsidised by the taxpayer.

    Those on very low incomes can get reduced rates for the doctor’s visit too.

    If we need to have hospital treatment then that’s free too, though unfortunately there are sometimes quite long waiting lists for non-urgent surgery.

    I’m not sure about purely optional treatments, such as cosmetic surgery not prescribed by a doctor. I think you just have to go ‘private’ for that and pay all costs yourself. I’ve never had occasion to be involved with that kind of thing.

    We always have the option to go ‘private’ and pay for hospital surgery and care, if we can afford it.

    Dental work is an entirely other matter and tends to be expensive. I think kids get free dental care up to a certain age.

    There are plenty of things wrong with our health care system, but every time a politician starts suggesting we should look at the American system for ideas we all cringe.

    • What you’re saying sounds reasonable to me. Required healthcare at an affordable cost, subsidized by the government through taxes. (Yes, I did say taxes.) Optional healthcare, such as cosmetic surgery, through a private provider. If you don’t like the government-sponsored options, you can go private. This makes a lot of sense.

      You definitely DON’T want a healthcare system that follows our model. Yes, our taxes are probably lower than yours, but healthcare can be expensive for uninsured individuals and insurance costs a fortune.

      Interesting to me that the only people reading and replying to this post (so far) are those living overseas.

      I hear the French healthcare system is very good.

What do you think?