We noticed the minor skin blemish on my son, but didn’t think much of it at first. I was thinking it’d go away on its own. But when it didn’t, and over the course of a few months seemed to change and then seemed slightly infected, my husband finally took him to the newly opened urgent care clinic within walking distance of our home.
At least two caregivers at the clinic examined him, but couldn’t do much beyond that. We needed a specialist to look at it, but all the dermatologists at our local in-network hospital system were booked for months. Because of this, we were told, insurance companies were allowing patients to schedule with out-of-network doctors at the in-network rate. They recommended we call our insurance company to confirm and then make an appointment.
The woman I talked to at Blue Cross/Blue Shield might has well have been a robot for how much she adapted her responses to my questions. As if reading from a script, she simply noted that services provided by out-of-network doctors were covered at 60% and there may be additional costs beyond that that we would be responsible for. Huh? So, 60% of some of the potential costs, but not all. So not really 60%. I got the feeling that asking whether BC/BS would let us see an out-of-network dermatologist on in-network terms would be futile. Instead, I asked whether the doctors I had found in another nearby hospital system were in-network. Luckily, they were, so my husband called one of them to schedule an appointment, but it was still going to be more than a month away. Dermatologists everywhere, it turns out, are in high demand. He asked to be put on a waitlist in case of cancellations, and when he called back explaining that we thought it needed to be looked at quickly because there might be an infection, the woman on the phone said she would put us on her special waiting list, which is how we found out there are different tiers of waiting. Meanwhile, my husband was getting increasingly worried, so we went back to the urgent care clinic together.
A different caregiver this time. She suggested it might be a wart, but couldn’t say for sure. And even so, they wouldn’t be able to treat it at the clinic. Hearing about the long waits to see a dermatologist, she said, honestly, you might be better off going to the emergency room. The last time we’d gone to the ER on a weekend was when my son was a toddler with a days-long high fever who couldn’t keep anything down. We waited for hours as case after case of more urgent needs were seen first, until finally a nurse came out and suggested we take our sick child home and try popsicles to keep him hydrated, which is what we did. The waiting room of the ER did not seem a promising option. Seeing our reluctance, the medical technician finally offered to take a photo of the blemish and send it to the dermatologist on call at the hospital.
In the end, in that shiny, brand new clinic with the sleek modern furniture, a cell phone was the necessary diagnostic tool that got us 1) an antibiotic prescription to treat the infection and 2) an “urgent referral,” not just a regular referral, which was the key to meeting with an actual dermatologist who might finally give us an answer. As she circled the phone number to call, the technician explained that the urgent referral meant they had to get us in within 2-3 days. Different tiers of waiting. Different assessments of “urgency.”
I took a weekday morning off from work and drove my son to a busy waiting room. Acne? Mole removal? Botox? I tried to guess what each person was there for, until we were finally led in to meet the doctor, a young, petite, and brisk but friendly South Asian woman, who examined my son, determined it was a cyst (quite common, she said), and that it was infected. She gave my son a shot of local anesthetic, expertly cleaned out the site of infection while getting a sample for the lab, asked her assistant to clean and bandage him up, recommended he take the full course of antibiotics and come back for a follow-up. All that waiting and we were in and out of the appointment itself within 20 minutes.
This, ladies and gentlemen, is the madness of the American healthcare system. In the moment, I was so happy and relieved that it was nothing serious, that we had a diagnosis and a resolution, and medicine in hand. But, reflecting on this experience with the U.S. medical system from beginning to end, I thought, my god, that was when everything went well.
I think it was the call with the insurance company that sent shivers down my spine, giving me a terrifying glimpse into what it means to try to get medical care in this country when you actually need it and you have the wrong coverage or no insurance at all. The language and logic of health insurance – “who will be responsible for any charges to this account?” I’m asked every time I make an appointment – are so disconnected from the practice of care, the human connection between doctor and patient, where an attentive ear and a reassuring word can assuage our fears even in the face of serious illness. Even with good insurance and the privileges of race, class, education, and flexible schedules, it wasn’t easy to get to that point of care.
My husband and I have access to private health insurance, because we both work for a large organization that can negotiate a good benefits package on behalf of its thousands of employees, many of whom, by virtue of being educated and employed, are a relatively low risk pool. The cost of the monthly premium to the employee is calculated on a sliding scale based on salary bands, and although our premium for family coverage is not insignificant, it’s not a hardship. When I look at my paystub, I see that the University pays over $1400 per month on top of the premium, co-pays, and deductibles that I have to pay. Dental and vision plans are separate, but preventative care is low cost. It’s when something’s wrong that you see how the system is not set up for the sick.
Our total out-of-pocket cost was about $400. What if we hadn’t been able to pay even that? What if we’d had crappier insurance that passed more of the cost to us? What if we’d had no choice but to go to the emergency room? What if we didn’t have paid sick days to use for the appointments? What if the skin blemish had been something much more serious? Our what if’s are the reality for millions of Americans. Nearly 2,000 part-time Whole Foods employees just lost their health benefits. 44 million Americans have no insurance at all; an additional 38 million people have inadequate insurance. Having seen both my late father and my mother through serious health episodes, I understand that most of us are just a catastrophe away from the healthcare nightmares that are regularly in the news – the system’s inadequacies, its cruelties, its GoFundMe pages of heartbreak and desperation.
So, I’m open to all the radical ideas, the so-called “hard left” positions on Medicare-for-all and single payer. If we have to compromise and settle for a public option let’s try that. Let’s not wait anymore.
Years ago, when I was a graduate student, I joined my boyfriend in Paris where he was in a fellowship program for the year. Shortly after we got engaged, as if to test his mettle, I got terribly sick with a stomach virus. My fiancé found a doctor and we took the metro there. What stands out in my memory is that the office looked like a sitting room (carpet, upholstered wood chairs, drapery on the windows), warm instead of cold and antiseptic; no one asked for my insurance card and I never saw a bill; the doctor was soft-spoken and kind; we got anti-emetic medication from the pharmacy downstairs that almost instantly made me feel better. And that was it. It was so easy and humane. We could have that here if we wanted.
But why, some proud American individuals ask, should I have to pay for somebody else’s care?! Why should I pay into something I may never use? To which I say, because what you get in exchange for paying into but not ever needing expensive, cutting edge medical equipment and treatment is your health, your longevity uninterrupted by cancer or chronic illness or debilitating accidents or unexplained symptoms for which there is no cure. Because if all you ever have to do is take your child in for check-ups, flu shots, and the occasional sniffles, you should count that as a daily miracle for which you gladly tithe. The most important thing is your health, my mother would say as she pushed more vegetables onto our plates. You can’t do anything without your health. I didn’t get it then, but I get it now.