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Posts Tagged ‘health care’

Hold on…  lifts hand with index finger raised
Hold on…   I’m be with you in a minute — I’m just reading through these papers…  I’m choosing between some of these military protection plans.  I’ll be getting all the standard coverage of course: basic national defense, overseas campaigns, that sort of thing.  And I’m including all branches of the military on that and the Coast Guard as well.  But… do I want to add the foreign and domestic terrorism riders?  I mean, domestic terrorists could hit anywhere really, so I think I’m going to go with that, but…  do I think foreign terrorists are going to go for Western Pennsylvania?  Probably not, so I could save some money there.  Except, wait… the G20 summit is being held in Pittsburgh next month, so maybe I do need to worry about foreign terrorists.  And… oh, what’s that in the fine print?  The domestic terrorism rider does not cover terrorist activities of any person, foreign or domestic, who received training at any time lasting more than two months in any of the following countries: Pakistan, Afghanistan, Yemen… Hmmm, that complicates things.  I don’t know how likely…  Mmmm… Well, I’m not sure what to choose there…

Choosing the school options was much easier.  The girls are bright and I want to give them the best chance in life, so I went for the most comprehensive choices I could get.  I didn’t take the remedial tutoring option, of course — they won’t be needing that and I feel confident I can ensure that by taking a greater hand in their studies at home.  And I saved quite a bit by opting out of the school lunch option — with their allergies, they can’t eat the school lunches anyway, and I don’t want to be paying for anyone else’s peanutbutter sandwiches.  I’m only going to pay for what’s right for us!

Choosing the police coverage was pretty straightforward — we want full coverage there — and I chose the elite force even though it costs a bit more, because the faster response time is worth it.  Same with fire, although I did opt out of the cat-stuck-in-a-tree rider, seeing as we can’t have the cat with us anymore-.  For public roads, I went for all the entire local road network, and added the option for occasional roaming.  It doesn’t include the Erie-Cleveland network though — I can’t see us ever needing to go there…

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The response to my blog post on the NHS was overwhelming, and I found it fascinating to read the comments as they came pouring in.  It’s been equally interesting to Google my blog post and see all the various sites that have linked to it, and then read the comments that have been left there as well.  But time and time again, there have been replies from people who say that they like the current American system because they want “choice” in their healthcare.  They want to “choose the right plan” that suits their personal situation.   Being  covered for anything and everything that might happen in their lives doesn’t fit that scenario — they want to be able to specify exactly what ill may befall them and what benefits they’ll be entitled to.

Several people said they liked choice in healthcare because they didn’t want to pay for someone else’s maternity care or stomach-stapling operation.  It makes me wonder if they just don’t understand how the insurance they’re buying actually works.   If they’re getting major medical, of course they are paying for other people’s benefits, even the ones they don’t receive themselves or perhaps don’t want to support.  Insurance companies take everyone’s money — whether they’re paying a lot for comprehensive coverage or a just little for bare-bones coverage — and then put it into one big pot to use when they have to pay out on claims.  In choosing a plan, these people are only limiting the benefits they will receive, not controlling how their premiums will be spent.

But to the rest — the ones who do understand how insurance works and are still saying that, instead of being covered for everything, they want choose  a plan that will suit the healthcare they personally will need — to them I want to ask, how do they know?  Yes, major medical covers a wide spectrum and catches the most likely scenarios in its net.  And yes, there are armies of actuaries working out the probability that one person will be more likely to contract Disease A over Disease B, so that people can make “informed” choices.  But nature can (and does) defy even mathematical probabilities.  The unexpected does happen.  The unforeseen is… well, unforeseen.   Aside from the obvious probability that most single men and nuns won’t require maternity cover, it defies my understanding how someone can actually know ahead of time what kind of medical care they will need in the future.

The girls’ insurance does not cover seeing a nutritionist.  It’s a moot point as to whether I would have chosen a plan that did, because this was the single only long-term policy that I could find that would cover them under our circumstances, but if it had been a few years ago and I’d have been in a position to choose between several plans, I never would have even considered that we’d one day need — be desperate — to see a nutritionist.  I mean, I know how to cook, we have a varied diet, and we’re none of us really overweight.  What do I need a nutritionist for?  A few years ago, I’d never have guessed that I’d have a baby who would suffer from food allergies so severe that she’d drop from the 98th percentile to the 1st percentile in her first year, who would stop gaining weight for seven months and grow so thin I could count her ribs, who wouldn’t double her birth weight (something most babies achieve by four months) until she was nearly two years old.  And so, not knowing that, but guessing that we wouldn’t need a nutritionist, I would have happily foregone that option.  And though it wouldn’t have been a disaster in our case (nutritionists being at the more affordable end of medical care), it serves as an example that people simply cannot really know what kind of care they’ll need in the future.

Or even that they’ll need care.  When we were preparing for our move and I was speaking to insurance agent after insurance agent (before I realised that none of their policies could cover us due to residency requirements), they all asked me the same questions: “Are you generally healthy?” and “How often do you feel you’ll need to the see the doctor?”  I hardly knew how to respond.  The first question implied that past performance predicts future results — in which case I’d have made millions in the stockmarket — and the second assumed I could see the future — in which case I’d have made sure I’d won the lottery by now.  But we were relatively healthy and we didn’t see the doctor that often, and that satisfied the agents.  “Then you probably won’t need very extensive cover,” they all predicted, and suggested low-premium high-deductible plans.  And then we immediately turned all that on its head by developing significant health problems as soon as we arrived, and running up thousands in medical bills within a couple of months.

Now I realise that most of the time, when people talk about choosing a plan, the “needs” they are talking about are not the diseases they think they’ll get, or even the structure of their care, but the premiums and deductible they can or want to pay.  They are not making choices about their care — they are weighing up their probable future health against what’s in their wallets and then hoping what they’ve bought will align with whatever may befall them in the future.  And therein lies the unappealing truth that we all know: in the choice between care and money, we tell ourselves that it’s all about care, but the system — and thus the choice — is all about the money.  The idea of having that choice, of picking amongst a series of plans — with varying (and often confusing) benefits, various (and confusing) restrictions, and a range of prices — is appealing because it gives people the feeling that they are in control, they are tailoring their coverage for themselves.  And it blinds them the fact that the NHS system that I described — and so many disagree with — gives no such choice because it’s simply not necessary, because the system’s mission is to cover everything, for everyone, for their entire lives — and that where it is restrictive, it is no more restrictive than the insurance companies who take their money and then decide — sometimes retroactively — whether their claims match the fine print.

We fund the police, the military, and our public schools in a collective, socialised way, and we accept that when we receive the services they provide, they will be comprehensive — we don’t pick and choose the “package” we want because we know they will cover (or attempt to cover) whatever needs may arise.  In fact, the concept of trying to anticipate our potential future needs to these services and limiting our access that way just might look a little silly, if someone were to write it out.

Does it make a person lefty to support comprehensive universal health?  No more than it makes a person lefty to support their local schools, their police and fire departments, or our military.  These are socialised institutions that have been in our midst for generations, and which we have chosen to support and fund this way because they are so vital to the fabric of our society that we are willing to work collectively to ensure these key services remain in place.  And yet our national character has survived!  Having a public schools, collectively funded police and fire services, and socialised military has not wrought havoc on the nation — our country has remained capitalist.  Healthcare — with its ability to bankrupt overnight; with its ability to create a life-sentence of astronomical on-going costs; with its central role in the health of the nation and of its workforce and its economy — is one of these same essential services.  We have ignored that fact for too long and now that we face this rare opportunity to reform healthcare, it’s essential that we see the situation for exactly what it really is.  A public healthcare option — like public schools, like our police and military —  is not something to be feared as some sort of Great Socialisation of America.  It is simply a logical step that will ensure this one other essential service is accessible to all Americans — for the betterment of our countrymen, our businesses, our economy, and our country.

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A letter came in the post last Friday and after I read it, all I could do for a few minutes was stare at it in shock.  I sat down and put my hand on the couch to steady myself, and then read it again.  It wasn’t so much the news that it brought — though that was bad enough — but the way it made me feel: vulnerable… so, so very vulnerable and out of control.  The letter was from the girls’ insurance company and it informed me that, due to “increasing [insurance company] financial losses”, the premiums for their cover will be increased from October by 350%.

The girls are covered by the state’s CHIP programme — the only long-term cover I could find that they qualified for when we lost our health insurance because M was suddenly laid off three months after we arrived in the US.  Because the girls are US citizens, they did not qualify for the insurance policies that are usually offered to incoming immigrants.  And because we had just moved from abroad, they did not qualify for most normal insurance policies which, I discovered to my utter bewilderment, all seemed to have “residency requirements” that disqualified anyone who had not lived in the US for the last 6 to 24 months.  My daughters had both been recently diagnosed with potentially life-threatening food allergies (my elder daughter to eggs, my younger daughter to no less than eight foods, which later rose to 12) which had had a huge impact on our daily lives, and I was desperate to get them onto a good, long-term policy that would give us some peace of mind.  We were still reeling from a string of devastating events that had begun almost as soon as we arrived and had consumed nearly all our mental, physical, and financial resources (besides M losing his job and our insurance, I suddenly developed incredible pain that debilitated me for months before we got on top of it, the medical bills started rolling in and  ate up half our moving fund, we found we had to pay the IRS a huge sum which wiped out the other half of our moving fund, the house we were renting was put the market, we were going through  all the stress, isolation, and disorientation that an international move almost always brings, and it felt like we were doing everything wrong).  Looking for insurance under these circumstances was turning into a nightmare and when I found out the girls qualified for CHIP, the relief  was so strong I burst into tears.

The coverage was excellent; the price surprisingly affordable.  The programme is funded by the state, but administered through a choice of several large insurance companies.  I picked the one that we’d been on with M’s previous job, out of sense of familiarity more than anything, and got the girls signed up as fast as possible.  Each month a bill arrived with bold letters telling me that one missed payment would result in permanent cancellation of the policy — I began sending the premiums in two months in advance just to make sure I never paid that price.  In a world that felt like it was falling apart, knowing the girls had such excellent coverage gave me a sense of stability that I clung to like a rock in a stormy sea.

So as I read that letter — and reread it, and then read it again — all that stability seemed to drain away and the horrid, terrifying, desperation of a year ago rushed in to fill its place.  Could they do this?!?  Could they just casually send me a one-page letter which matter-of-factly stated they were increasing the premiums not once, not twice, not three times, but a full three-and-a-half times what they were now?  No warning, no alternatives, no choice…  This is our only option, this is our salvation!..  Could they do this?!? I rang M up at work and he listened patiently while I told him the news, then began to cry, and then composed myself and told him I’d be alright and thanked him for listening.  My tears were more out of fear and uncertainty; we will  be able to make the new payments (just, and with sacrifices), but it’s what they represented — the lack of control — that put me over the edge.

When I told my mother, she was shocked, then horrified, and then began to rant.  Was this what Obama had in mind for the middle and lower classes?!? Or was it the Governor’s doing?!?  It didn’t seem ethical!  I pointed out that it wasn’t Obama’s doing — his reforms haven’t even taken shape yet, let alone been enacted — and it wasn’t the Governor’s either.  It wasn’t to do with the CHIP programme itself at all.  It was the insurance company’s doing: they take the money the state gives them and then set their price within an approved range — but times are harder now than were before, there are these “increasing financial losses”, and so they’ve raised their price.  And, no, I told her, it didn’t seem ethical… but I don’t know that I think ethics plays any part in this.

I have to admit to feeling rather annoyed with her, to harbouring some deep-set and mostly unjustified feelings of blame.  I had been concerned about healthcare before I moved back to the US… concerned… afraid… frightened…  But my mother and my father and my sister had all assured me that I was making a mountain out of a molehill.  It’s fine, they told me.  It’s a system!  It’s not the system you’re used to, but it’s a system.  As long as you work hard, you’ll be fine.  My husband, I thought to myself, does work very, very hard.  And I do too, in my own way.

My had mother added that she didn’t know anyone who had a healthcare problem.  What about my sister?, I asked, pointing out that she’d gone for years without health insurance, avoiding going to a doctor even when she needed one.  “Oh… yes… ” my mother’s voice trailed off, and then came back again with strength, “But she never had a problem!”  I felt misgivings at that, paused, and then… brushed them aside.  It would be fine.  It would be fine.  …And so if there is blame to laid, perhaps some goes to my mother for closing her eyes to the problem, but some goes to me too for choosing to believe.

There is series of ads for one of the largest insurance companies in the region which they run on television all the time.  It shows someone walking a dog, or jogging, or riding a bike.  At some point the camera closes in on the person, and they look directly into it, before raising a hand and pressing it with palm forward and fingers spread, so that it appears to be just on the other side of the glass of the television screen.  And as the person fades out of focus, the handprint remains, glowing blue and pulsing gently, and a warm and reassuring voiceover says, “Giving you a greater hand in your health.

As I sat there staring at this letter, with its incredible, horrible news, I had to wonder: is that hand meant to be pulling us up… or pushing us away?

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As the healthcare debate picks up pace, I find myself being asked with increasing regularity what I think of Britain’s healthcare system.  Six months ago, I’d have jumped into the answer with gusto, but these days…  I don’t know, I am just so fatigued by all the fear-mongering and hysteria, the ignorance and the downright idiocy of the current debate that I can hardly summon the energy to add my voice to the cacophony.

But the other night when a friend of my mother’s emailed me and asked that now-familiar question — what was my experience and what did I think of British health care? — and I was surprised to discover that, once the initial weariness had worn off, I found myself turning her question over and over in my mind, composing my answer.  When I sat down last night and started my reply, the words fell out me, my fingers tapping rapidly at the keyboard and my mind so engrossed in the assignment that I was stunned when I finally looked at the clock: it was 2.30 in the morning.  I had been so consumed because what I had to say had been bursting to come out, an outraged truth that was tired of being bottled-up and was begging to be told.

When I lived in the UK, I railed against the NHS (the National Health Service).  I cursed every delay, every perceived inconvenience, every way it differed from the care I had received in the US.  But I moved to the UK only a few months after graduating from university and, until then, I had been covered on my parents’ very generous insurance so I had experienced American healthcare only as a dependent.  I was judging my British experience from a lofty and privileged position of someone who’d always had gold-plated insurance.  And I was naive, because I’d never had to pay for it, never had to worry it wouldn’t be there, never really had to deal with the paperwork.  I never really understood what I was comparing the NHS to at all.

I also realise with hindsight that a lot of what I held against the NHS had nothing to do with the system itself and actually were issues that could happen in any system.  I blamed the whole system when the loo in my local doctor’s office or hospital wasn’t clean enough.  I blamed the whole system when the only space I could find at the hospital carpark was miles away in the very furthest corner.  I blamed the whole system when the doctors’ receptionist was grumpy or I didn’t much like my doctor’s manner (or his diagnosis).  But the truth was that I believed in the healthcare system I had grown up in and I didn’t like the idea of socialised medicine — I didn’t like socialised anything — so I saw problems with it where-ever I chose to look.  And I held onto that belief right up until I arrived back in the United States, and discovered that grumpy receptionists and dirty hospital bathrooms and annoying carparks can happen in any system — because they have nothing to do with the system itself.  They’re management issues, human nature issues, and they happen everywhere.  And a lot of the fear that Americans have about change in their healthcare actually center around these kind of issues that have nothing to do with the system itself, be it socialised or for-profit.

So my return to the US and my sudden immersion in the American healthcare system was a rude awakening for me and it made me look at both systems a little more realistically.  There are great things about healthcare in the US — great things — and I truly do believe that the quality of the care here is second to none.  But there are great things to be said about Britain’s system as well and the trouble is that, at present, far too few people are saying those great things and far too many here in the US are beginning to believe utterly ridiculous things about the NHS.  Let me play a small part in putting that right by outlining my experience of the British healthcare system.

  • First, I’ll start by pointing out that the NHS is truly one of the most socialist — almost Soviet — healthcare models that a country could possible choose.  Unlike the health systems in France, Germany, and most of the rest of the developed world, it is totally government-run, almost totally centrally-controlled, and supported entirely through taxation.  It is mammoth — the single largest employer in Europe, which is incredible when you realise it serves a small country with only 60million people.  And with that kind of size come huge problems — consultation times are too short and it takes too long to get test results, amongst other things.  It is not a perfect system by any stretch of the imagination.  But it’s important to realise that when I talk about my experience, I am talking about the kind of system that truly is the very far extreme of what the nay-sayers are claiming will be the end result of public health provision in the US.  The British system is the very stuff of their nightmares and yet, the truth is, it’s nothing like what they imagine.
  • My healthcare in the UK was never dictated by a bureaucrat.  Decisions were made by me and my doctor alone, and whatever we decided was the right course of action was the course that was taken.  The scope of care available to me was far, far wider than what is covered even by the ‘very good’ insurance policies I’ve had here in the US.  There were no limits on the number of times I could see my doctor, or the number of tests/procedures/consultations/etc that I could have in a year (or month or lifetime…)  Whatever was deemed medically necessary by my doctor was covered — period.  In fact, I’ve experienced a lot more limitations on my care since I’ve moved back to the US — the most memorable of which was when I had to beg the insurance company to cover a single visit to a nutritionist when E2 was diagnosed with 12 food allergies and was severely underweight.  That simply never would have happened in the UK — if she needed it (and she did), she’d have got it (as her sister did after being diagnosed with a single allergy). To illustrate the point further, when I gave birth to E1, I stayed in hospital for five days because she had problems with breastfeeding — and that was entirely my decision.  I was free to leave hospital whenever I wanted, be that after one day or after a week, and I had the full support of the midwives to stay until they were sure we were breastfeeding properly and ready to leave — no administrator/bureaucrat/insurance company made that decision for me!
  • There are delays — there are delays — but to be honest I have experienced delays just as bad here in the US.  In the UK, I might have to wait weeks or months to see a specialist if my case was not urgent, and that was frustrating.  Here in the US, when I was in excruciating pain last year (so bad that I lost control of my bodily functions when the pain hit), I was referred to a breast surgeon by the ER doctor (7 hour wait in ER) — but the trouble is that we had to call five medical centers before we could find a surgeon who could see me any sooner six weeks, and even then it was only because they had a surprise cancellation.  And the last time I needed to take E2 to the allergist here in the US, the earliest they could fit me in was two months later.  There are delays in both systems.  And by contrast, you can get very speedy service in the US… and you can get it in the UK too.  When I needed to see my GP in the UK, I rarely had to wait until even the next day.  When I thought I’d found a lump in my breast, I saw the doctor the next day and was sent to a specialist within the week.
  • I had my choice of doctors.  My small rural town had two GP offices (a GP is a General Practitioner, a family doctor) with about 5 GPs in each office — I could choose either office and any GP in that office I chose.  I could choose to go to the GPs office in a neighbouring town if I prefered (though some offices limit the regional area they’ll cover).  I could change GPs at anytime for any reason, no questions asked.  When I had my babies, I had my choice of any of the hospitals in the region, or a homebirth (the midwives in my area loved doing homebirths!).  When my GP referred me to a specialist, he’d send me to whomever he thought best, but if I wanted someone or somewhere else, I could request that, no problem.  And I always had the option of a second opinion, either through another NHS doctor or a private doctor.
  • I never once received a bill in the UK.  There are no copays, there are no deductibles, there is no such thing as max-out-of-pocket.  I have an NHS card which I showed at my GP’s office when I registered, and from that point on, I never had to fill out any forms or show any ID ever again. In fact, I think I lost my NHS card years ago — I have no idea where it is. It doesn’t matter — I don’t need because I am covered for everything once I am registered with my GP.  When I stepped on a piece of glass and sliced up my foot, I went up to the local hospital, was seen immediately (rural hospital on a Tuesday afternoon), they took note of my name and address, patched me up, and I went home — simple as that.  No bills, no paperwork, no hassle.  Yes, Brits pay to cover it in their taxes, but the cost spread across the entire country and so it isn’t nearly the burden that insurance is for Americans.  In fact, Brits spend only 8.4% of GDP on healthcare, compared to the 16% of GDP spent by Americans and what they get back is a system beats the US on so many basic measures of healthcare results.  This is good quality care.
  • Brits believe that healthcare is a human right and are happy to have a system that covers everyone, all the time.  They are HORRIFIED when they hear stories of Americans who have to hold fundraisers to pay for desperately-needed operations.  It blows their minds that anyone goes bankrupt or loses their home because of medical bills.  The idea that someone would lose their coverage because of a pre-existing condition or because they are so sick they can’t work is totally alien to them.  These things simply do not happen in Britain.
  • Even with a comprehensive healthcare system that is available to all and completely free (at the point of delivery) the UK still has a healthy private system running alongside the state system.  There are numerous large private insurance companies providing private health insurance to those who’d like to have it (or whose companies want to offer it).  There are private hospitals up and down the country.  Most specialists practice both within the NHS and also privately (they split their weeks).  You can pretty much get your healthcare however you’d like — on the NHS, through private insurance, or paid out of your own pocket.  I hear people in the US saying that with in the British system, you can’t see anyone but your government-assigned doctor, but that is totally untrue.  And you can chop and change your care as it fits your life — I’ve had my care for an medical issue start on the NHS, and then switched my care to my private insurance if it suited my needs better.  I’ve had other medical issues that I stayed with the NHS for the whole way.  And when my husband had an elective medical procedure done that was covered by neither the NHS nor insurance, we simply paid for it out of pocket.  It’s a flexible system and the private sector has not been quashed by the fact that there is a comprehensive, free public system running alongside it.
  • Because healthcare is not tied to employment, companies are free to focus on their core business and people are free to make career decisions (and life decisions) based on what is best for them instead of what preserves their healthcare.  Brits never worry about keeping their healthcover — they never worry about pre-existing conditions; they never worry about continuity of care if they change jobs; they never get trapped into a bad-fit job because they have to keep their healthcover. They are much freer to be entreprenuers than Americans, because their only worry is whether their business will succeed, not how they’re going to provide healthcover for their families when they’re self-employed.  Companies, particularly small companies, are free to focus on their core-business because they not burdened by the administration of healthcare for their employees — they never have to pay someone in HR to manage health benefits; they don’t have to juggle insurance companies and negotiate lower premiums; they don’t lose employees because their healthplan isn’t as good as some other company; they don’t see their bottom line rocked by a sudden rise in premiums.  Decoupling healthcare from employment is hugely freeing to both individuals and employers, and can actually a very good thing for the economy at large.
  • When things go wrong, the government answers to the people in a way that insurance companies never do.  For example, there was a cancer drug called Herceptin which was not covered on the NHS because of the cost.  A group (led by Ann Marie Rogers) began a campaign to change this, suing their local health trust, and gained huge public support.  They ultimately won their case and got their local trust to offer the drug — but because of the political pressure this campaign had created, the government extended the drug to the entire country.  Imagine trying to convince an American insurance company to cover some expensive drug that they don’t want to cover, and then having that decision convince every other insurance company to do the same.  And again, when I moved to the UK fifteen years ago, wait times in the NHS were much worse than they are now — but the public got fed up with it, made their voices heard in the General Election, and the new administration made cleaning up the NHS one of their highest priorities.
  • There is an emphasis on preventative care and the simplest way this happens is that people actually go to see their doctor when they are sick.  Because there’s no cap on visits and no copay and everyone is covered, hardly anyone hesitates to go to the doctor when they need to, which gives them a chance to catch little issues before they become big issues and spot contagious diseases before they spread to the rest of the population.  And here’s another way the focus is on prevention: when I had my babies, the midwives came to my house to check on us every day for the first 10 days after the baby was born, and then the Health Visitor (a community nurse) came to the house once a week for six weeks, and then I could go to her clinic (held once a week in town) for as long as I wanted after that with any concerns I might have (as well as being able to see a doctor — my choice).  It’s all done to ensure the mother and baby are healthy and well, to support breastfeeding, and to catch problems as early as possible.  I was utterly shocked when I found out that most new mums in the US are simply sent home with their babies, with no follow up in the first six weeks, and left to muddle through as best they can!
  • None of this actually tells you anything.  Isolated anecdotal stories (like these) don’t actually give anyone the information they need to decide the merits of one system over another.  All it does is tell you whether my particular doctor was good or bad, whether the nurse I encountered was having a good day or a bad day, whether the receptionist liked her job or hated it.  There are good stories and bad in both systems, and it just depends on who you talk to.  It’s much like public schools. You could ask parents across the US to tell you what they think of their kid’s school and you’d get a whole spectrum of answers: some schools are good, some are bad, some districts are rich, some are poor, some teachers are passionate, some have lost the will to live. But none of these things tells you whether the overall concept of publicly-funded schools is a good or bad one. If you drew your conclusions based on a bunch of stories from a handful of people about their personal experiences, you’d only be getting part of the story. And it’s no different with the concept of public healthcare.

I can sum up my experience of the British and American healthcare systems in one simple sentence:  given a choice between the two systems, I’d choose the NHS in a heartbeat.  And though this is the experience of only one single person out of millions, unlike so much of the propaganda and hysteria surrounding the current healthcare debate, it is the absolute Gospel truth.

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Addendum:  This is an incredibly important issue with a lot of misinformation flying about.  If you have experience of both the US and UK healthcare systems, I invite you to please leave a comment here and let us all know what you think of both systems.  This debate needs more voices of experience and a lot less uninformed fear.

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An envelope arrived today from the insurance company and I knew immediately that it would be the paperwork for E2’s trip to the Emergency Room. Every time we’ve got one of these envelopes before, it’s always been bad news — thousands of dollars worth of bad — and so my hand nearly shook as I began to open this one. I quickly scanned past line after line of itemised costs and focused on the big number at the bottom…

Just over $3000.  My heart stopped.  $3000 in one night!

And then I looked over to the box marked “Amount You Owe Provider”. It said $25. I closed my eyes with relief and lent my head back against the wall, and thanked God in his heaven that my kids are covered by the state’s CHIP programme (the only policy that I could find in the entire marketplace that they qualified for). To owe so little for a bill so high is really quite extraordinary here in the US.  Even most “good” policies here would require me to pay a percentage of that amount and the most common split I’ve seen is 80/20. That would put our portion of E2’s impromptu night in hospital at $600 and — with a gas bill that was higher than that last month and M’s hours ever fluctuating — even that reduced amount would have been a crippling bill for us to pay.  And if, God forbid, we’d been uninsured…

This is why I believe, wholly and completely, that the US healthcare system is fatally flawed and needs to be overhauled entirely.  I have heard the arguments for the status quo — argued with passion, most often, by people who have never been in a position of being trapped by their (un)insurance.   I understand the concept of a person neatly choosing the coverage they need, of deciding how much deductible and max-out-of-pocket they want to budget for.  But the reality is simply not that neat.  Most people can’t choose the coverage they want, because their healthcare options are dictated by their employer.  And buying the policy that suits your pocketbook best simply doesn’t work once you have a pre-existing condition — and we will all have one eventually — and so you can no longer pick and choose freely in the marketplace.  And even when you can, the cost of buying that coverage outright is completely prohibitive for most people on average wages.

Buying healthcare coverage is completely unlike any other purchase a person usually makes in their entire lives.  Nothing other than healthcare is so fundamentally compelling — truly life and death — and yet has such devastating potential to create skyrocketing and utterly unmanageable costs literally overnight.  Healthcare provision is quite simply in class by itself and, as such, it has to be treated differently.  To leave to the marketplace as if it were any other ordinary commodity is…  well, is to create an unacceptable situation like the one we’ve got at the moment.

And it’s unacceptable because of this horrifiying thought:  if, when that on-call doctor told me to take E2 to the Emergency Room… if I’d had to think about what 20% of that trip was likely to cost, then I might not have been hesitating solely on account of the snow and my mistaken belief that things weren’t yet that bad.  I might well have been weighing up the doctor’s advice — and my daughter’s well-being — against my wallet.  And if — as so easily could have happened to us — we’d been completely uninsured, I think it’s quite likely that I would have followed my own flawed judgment and waited to see how the night went, and thus brought on all the unthinkable consequences that could have created.

It was not us that night, but there are 47 million others.

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Today I am grateful for:

  1. The very good news that the girls will at last be covered by the state CHIP program come August.  Now I can focus on getting M and I sorted.
  2. A lovely newsy letter from a friend I haven’t heard from in a while.
  3. The peaceful house at naptime.

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It was only when I was tidying a cluttered windowsill today and came across a ticket stub from our flight over that I realised we’ve been in the US six months today. I was more than a bit shocked — I would have thought that today would have loomed larger in my consciousness, but it very nearly slipped by unnoticed. I stopped my tidying and sat down to look at it, feeling that I ought to reflect for a moment to commemorate the milestone.

Except that when I tried to think deep thoughts, I found I didn’t want to.  Not that I couldn’t — that I didn’t want to.  I feel the same way now — I feel like I ought to write a really deep and insightful blog post that will do justice to such a significant day, but I really don’t want to. I don’t want to think about today at all. I just want to let the day go on like any day and then disappear into the past. And… I’m not quite sure why.

I guess the obvious answer is that the last six months have been hard and, if I spent time reflecting on them, I won’t be going over much that brings me much joy.  In the last half-a-year, I’ve spent two-thirds of it in the most incredible pain I’ve known other than childbirth; been poked and prodded by half a dozen different doctors; run up thousands in medical bills; had to restrict my diet so severely to control the pain that I cannot eat out anywhere — indeed, I barely eat at all these days, all the joy has gone out of food, and I lost a stone in about a month; ended up having to skip most social events I’ve had the chance to go to because they take place either in restaurants or in food-centred settings — and therefore have really had trouble making new friends; found out that E2 has multiple food allergies, severe enough to be life-threatening, which further restricted not only her diet but the rest of ours as well; M was laid off; we lost our health insurance;  the two insurance companies we were covered by at the same time began (and still are) arguing about who was primarily responsible for the bills, which resulted in a mountain of paperwork for us several inches deep and a situation that I am having to spend quite a bit of time managing in order to stay on top of; discovered I’d been doing out taxes wrong for years and got hit with a massive tax bill which tore a hole in our house deposit only a few weeks after we arrived; our househunt, which had been centred in one area of the city, came to a complete halt when M was made redundant and then had to be started from scratch all over again in another area of the city when he found another job; we had really frustrating troubles organising a mortgage because our credit histories wouldn’t transfer from Britain; I’ve had no transport of my own and no way of getting anywhere for most of this time and have been completely dependent on my mother; I lost us money just because I didn’t know what I was doing; my mother told me she has skin cancer; and the whole time, the house we’re renting has been up for sale, with prospective buyers trouping through to look at it and the very real possibility that it might sell at any time and we’ll have to scramble to get another roof over our heads.  Looking back, that’s a lot to deal with in such a short space of time.  Combine all that with the upheaval and disorientation of a move as big as we had just done, and all the emotional turmoil that is bound to come with it, and that makes for a six-month period that I’m not much inclined to sit back and reflect on.

But I suspect an even more accurate reason is that if I reflect too much on where we’ve been these last six months, then it begs the question of where we’re going in the future, and I just don’t know and it frightens me to contemplate that. The plan was to move here permanently — to come home at last and put down the roots I’ve been longing for for so many years. But almost immediately we got here, that felt wrong wrong wrong. The place just doesn’t feel like home to M or — much more worryingly — to me. And though I know that’s a classic expat feeling which is to be expected initially, and which will have only been exacerbated by all the things that have gone wrong, it’s left us both feeling more unsure about our future direction than either of us have ever felt in our lives. This was not what was supposed to happen! This is not why we spent all this energy and all this money and made this move! We did this to feel more certain about our future, more settled — not less.

To be fair, there has been a lot of good in the last six months as well — a lot of little moments that have been wonderful.  The girls have grown and changed and filled me with wonder so much in the time we’ve been here.  M has had me in hysterics over and over again as he tries to come to grips with his new country.  We are still together as a family, and — thank God — dealing with all this stress by coming together rather than pulling apart.  And M is changing, as the challenges he’s faced have really stretched him and he’s responded by growing into a stronger and more capable person.  I expect I’ve changed as well, though it’s hard to see in oneself, and don’t know if I’ve handled things by becoming more capable …or more snappy and shrill.

So, there it is — the first six months are over.  No matter what happens from this point, those six months are what they are and nothing will change them.  We can fold them up neatly and put them in our pocket, as experiences both good and bad that we will always carry around with us and which will always be a part of us.  And having finished with them and put them away, I think perhaps we should resolve to simply look to the future, uncertain though it is, and hope that it brings good things.

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When we got home from the hospital, I asked my husband if he wanted the good news or the bad news… or the other good news… or the other bad news. He asked for the bad news. You, dear reader, get the whole story.

After ringing five breast surgeons on Tuesday, we were relieved to find one that could squeeze us in on Thursday. I met with the surgeon’s assistant first, who took my vitals and went over the situation with me: describe the pain… when does it come?… how bad is it?… do I eat much chocolate?… do I drink much caffeine? (no and no)

Then I met with the surgeon’s resident doctor, who when through the same things but in more detail. She asked if I drank much caffeine or ate much chocolate. She gave me a breast exam and said that my breasts felt remarkably lump-free, especially given that I am breastfeeding. Then she paused and said she thought she felt a possible… something.

The surgeon came in and examined me as well. The resident doctor showed him the something she thought she’d felt, but he did not think it was anything worrisome. He asked when the pain came, and how it felt. He also asked if I took in much caffeine or chocolate.

He was baffled as to what the pain might be — both he and the resident didn’t have any real guesses. He decided he wanted me to have a mammogram, and an ultrasound, and a possibly a breast MRI, and felt that those would shed some light on things. His office got me an appointment for later that afternoon, and my mother and the girls and I went off to find some lunch.

I had heard bad things about mammograms, but it wasn’t nearly as bad as I’d feared. The hospital had seemed to take special care to make the process as pleasant as possible. The whole place was beautifully appointed — it had a bright atrium lobby, more like a hotel than a hospital, with a grand piano that played itself to create a calm and pleasant atmosphere — and that thoughtful design extended to the mammography department. I might have been at a spa rather than a hospital. Everything exuded calm: the carpet was plush, the wood accents were richly toned, the flowers were tasteful. I got changed into my gown (heavy cotton, nicely patterned, big enough to keep me dignified) and a lady called my name. She was Linda, my technician — my personal technician, as she explained — and her remit was not only to conduct my mammogram, but to stay with me and hold my hand throughout the entire process. She asked me to explain the pain, and I walked her through the situation as I had the all others before her. She examined my breasts and remarked how smooth the were, and asked me the usual questions: did I eat much chocolate or drink much caffeine?

She took four mammogram shots (photos). I’d been told that mammograms really hurt and was nervous. But compared to the various physicalities I’ve experienced in the last 12 months (childbirth, breastfeeding, a biting baby, and these unbelievable mysterious breast pains), it was a walk in the park. Linda poked and pulled, I held the convoluted positions she shaped me into, the plates squished and compressed, the machine whirred and beeped. After examining the initial four shots, they requested three more.

The radiologist was pleased with what she saw on the screen during the ultrasound: my breasts were very dense, but the ducts were clear and clean, and she saw no lumps or cysts. She asked why I’d been sent in, and I explained the whole situation again. She didn’t have any answer — there was nothing on the mammograms or the ultrasound to explain what I was describing. She asked, like everyone before her, those same questions: did I drink much caffeine? Did I eat much chocolate?

But then she asked another question, “Do you eat much soy, or soy products?” I was surprised, and repeated her question back to her. Did I…? “Yes,” she said, “It’s well-known that eating soy products can cause extreme breast pain. I get pain if I have even a little soy-milk and my breasts aren’t all active and hormonal like yours are.” I couldn’t believe what I was hearing. I had changed to soy-milk when we realised that E2 has a dairy allergy. I have it every day in my cereal and all day long in my tea. No one had said anything about this to me before. “Well, I bet that’s it!” she said. It seems very likely — even down to the fact that this intense pain flared up a few days after we moved to the US, perhaps because the soy-milk here is of a different concentration than I got in the UK. She was confident this was the probable culprit, “Cut out the soy milk and see if that helps. It will take about two weeks to exit your system, but I’m guessing your pain will clear up.”

So, there you have it. The good news is that my breasts are clear of cysts and lumps and irregular shapes. I am massively relieved. The bad news is that it means that no one was able to actually diagnose anything. The other good news is that I think perhaps we may have our diagnosis anyway, and it’s simple and easy. I am incredibly excited at the prospect of ditching this pain for good. And, sadly, the other bad news is that this diagnosis — this spur-of-the-minute, coincidental, casual mentioning of a “well-known” fact that nobody seemed to know — came after I had to spoken to an ER doctor ($$$), an surgeon’s assistant ($$$), a resident doctor ($$$), a surgeon ($$$), had seven mammogram images ($$$), and two breast ultrasounds ($$$). I’m going to have to write a big cheque for something that could have come to light as easily at the beginning of all that as at the end.

Never mind. The soy milk is down the drain. I am surviving the continuing bouts of pain with renewed hope of future pain-free-ness, and an enormous amount of relief that it wasn’t anything truly serious. The money thing is a pity but, really, it’s not what matters. I am healthy and, it would appear, soy milk is… evil.

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