Posted by: mutantpoodle | August 17, 2009

The Black Hole

Public OptionI’ve shared a rant about my health care history, which is, of course, unfinished, and a more temperate analysis here.  And now, from the official mother of Mutant Poodle, her own story, from her column in the Suffolk Times (subscription, so no link):

I once had a friend who remembered her doctor father making his rounds in a horse and buggy. He carried what he needed in a small black bag – instruments, medicines, bandages. He was paid whatever his patients could afford, on the installment plan.

Except for the horse and buggy, the delivery of medical care wasn’t much different in my childhood or that of my children I’m not sure when it changed, but in the early 1980s I was diagnosed with an autoimmune disease and was stunned by the thousands of dollars billed to my insurance company for the necessary tests – amounts I couldn’t imagine paying myself. I realized then that seeing a doctor was only part of my health care cost and that insurance was a necessity. I also learned that to an insurance company , I had become Typhoid Mary – I’d acquired a pre-existing condition.

Working for a small nonprofit in Washington, D.C., I was able to get insurance, but I was the one who put our group’s rate up. My payments steadily escalated as I grew older, and soon they were more than my rent. I began counting the years before I was eligible for Medicare. Eventually I solved the problem by joining an HMO. But now I could no longer go to my regular doctor, and when I needed to make an appointment, I had to call the branch in Virginia to request permission from not one but two “nurses” – one to route the call and the other to approve my request. Naming my doctor was part of my identification. When the HMO ownership changed many doctors left, mine among them, and I found myself sick but with no way to make an appointment.

That in-between age, 55 to 62, is critical for many people. They are likely to be diagnosed with a chronic illness that, although not life-threatening if treated, makes insurance unobtainable or cost prohibitive. I think of what a cliff-hanger it was for me at 59. These days a healthy friend who’s 60 pays an insurance premium that’s more than her mortgage. And I’m not even touching on the special difficulties of younger people and children.

Working with the frail elderly, I knew Medicare was there for them as a backup, but many times I met people who hadn’t reached the magic age and who either were not sick enough to be considered eligible for medical disability or were caught up in the backlog of pending cases, just as bad today as it was then. Public resources offered patients only trips to D.C. General, a long distance to travel, long waits, more travels and waits for diagnostic tests and medicines. They never saw the same doctor twice.

At work I sometimes collaborated with a free medical clinic where doctors, students, nurses and other volunteers cobbled together free health care for people who couldn’t afford to pay. It was a living, working diagram of the complexities that have come with medical progress. A measure of the clinic’s struggle was that a core founder eventually resigned to become a contemplative nun , believing she could do more good in that role.

Now, as the health care bill is being shaped in Congress, scary scripts advertise that anonymous bureaucrats will dictate our care if we have a government option. I wonder what world the people who write them live in. I have been on Medicare for over 13 years, and the only time anyone dictated to me was when I subscribed to a Medicare “Advantage” program through an insurance company. These days, on the East End, we are seeing an insurance company using its clout to try to shortchange our local hospitals, using the people who rely on its insurance as bargaining chips.

I am still waiting for the conservative solution to all this.  Is it permanent access to COBRA?  Access, to any citizen, to the US Governments’ (privately provided) health care plans? Is it dropping the age requirement for Medicare?

Tell me it’s tax cuts, and I’ll laugh in your face.

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