Tag Archives: American

A(nother) Short Story about the State of US Healthcare

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Who wants a “pre-existing condition” these days?

I thought I’d take a moment to share a few recent thoughts related to the healthcare situation in the United States.

I’m in my late 50s now and have, for the first time, begun spending a lot of time doing close work with my hands. Making jewelry with fine wire and small tools doesn’t put a lot of strain on my hands, but it apparently does work the muscles and joints more than I’m accustomed to.

Arthritis runs in my family. I clearly remember my grandmother on my mother’s side, who lived to be about 90, complaining about it once in a while. She had typical “old lady hands,” that included thick knuckles and crooked joints under wrinkled skin. She’d spent nearly a lifetime doing close work with her hands in a garment factory, starting work when she was as young as 13 and working until many years later when my grandfather had a stroke and she had to stay home to care for him.

I’ve had knee problems on and off throughout my life. They always got worse when I was heavier and disappeared when I lost a lot of weight back in 2012. But before they disappeared — back when I had a lot of disposable income and a decent health care plan — I went to a doctor about it. Arthritis, he said, pointing at the x-rays.

Handxray
X-ray of a hand from Wikipedia. I’ve got my own x-rays around here somewhere.

More recently, a fall off the back of my truck that sprained an ankle apparently fractured some bones in my left wrist, which I’d landed on. While trying to diagnose the occasional swelling and severe pain (caused by “floating bodies,” we later discovered during arthroscopic surgery that removed most of them), the doctor took x-rays. He pointed out the early signs of arthritis in my wrists and hands.

So yeah. I have arthritis.

It’s gotten to the point that it’s starting to bother me enough to seek medical solutions that don’t necessarily include painkillers. (I can take Vitamin I (ibuprofen) without a doctor telling me to, and I’m not interested in anything stronger.) Would exercises help? CBD creams (as everyone keeps telling me)? Heat or ice therapy? Vitamin supplements? I’m not interested in querying Dr. Google because we all know that there’s enough bad advice there to drown out the good advice. I want to visit a doctor, have her take new x-rays, and tell me what I can do to slow the progression of this very common problem.

And here’s the rub.

If I go to an arthritis specialist — provided I can get an appointment with one — I’m making a very public (on my medical records) statement that I have a medical problem bad enough to seek medical help. In other words, I’m admitting I have a condition that, once admitted, becomes a “pre-existing” condition for future health care coverage.

Now, under the Affordable Care Act (ACA, AKA “Obamacare”), as it was passed by the government and enacted into law, pre-existing conditions didn’t matter. But things are different now.

Let me tell you another story about pre-existing conditions prior to the ACA.

Years ago, when I was very heavy, I was having digestive issues that included GERD, heartburn, acid reflux, and vomiting. To this day, I think it was a hiatal hernia but at the time I was unable to find a doctor to offer any advice beyond “take Pepcid AC.” Back in those days, I made the fatal error of mentioning “chest pain” as a symptom. As you might imagine, that triggered a flurry of heart tests, all of which came back negative. I did not have a heart problem, I had a digestive problem. I blogged about this in detail way back in 2010.

This profit-driven nonsense established me in medical records with a “pre-existing heart condition” that didn’t exist. All of the tests came back negative! So when my idiot wasband lost his job (again), made a late COBRA payment, and got our health insurance canceled, the insurance company refused to cover me when they started the insurance back up. I had a “pre-existing heart condition,” they said.

For six of the scariest months of my life, I had no health insurance because a couple of greedy doctors put me through a battery of unnecessary heart tests and an idiot couldn’t manage his money properly. It wasn’t scary because of my health. It was scary because if, during the time I was uninsured, I got some kind of real negative health diagnosis (think cancer) or had an accident at home (think falling down the stairs) that put me into the hospital or long term treatment, I could lose everything I owned. Medical bankruptcy is a real thing here in the United States and I was set up to become a victim.

I got limited insurance coverage back and later got my own damn insurance again so I didn’t have to worry about an idiot screwing things up for me. The ACA really helped things; it was as if those old medical issues simply didn’t exist. And, so far, I haven’t had insurance denied because of these things — although the rate has gone up dramatically since Trump took office. Next year, who knows?

So here I am in 2019. I have arthritis in my hands and want help to prevent it from getting worse quickly. But I’m afraid to make an appointment with a specialist because I’m afraid to get the condition on my medical records. So instead, I’ll keep waiting, letting the condition likely get worse. All because I don’t want to be denied insurance coverage in the future.

Is it right? Does it makes sense? No and no. But there isn’t a damn thing I can do about it other than emigrate to a country with decent health care for all. And believe me, I’ve been thinking about it.

So that’s my situation as I type this.

At least the CBD cream smells nice.

What’s Wrong with Being “Politically Correct”?

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I’m tired of being criticized for being civil — and you should be, too.

I was at an impromptu neighborhood gathering the other day.

Most of the people in the group were thinking people who understand the difference between right and wrong and the importance of having a civil society where we work together to make the country a better place for all of us. But one couple among us had many of the ideas espoused by Fox News and other right-wing media: that the country’s problems can be blamed on high taxes, handouts to poor people, and, of course, immigrants. Since they were hosting the gathering (in an offhand way that really doesn’t matter for this discussion) the rest of us were walking on eggshells, afraid to say anything that would “set them off.”

You can probably guess how each of us feel about Trump being president. And if you’re not a Trump supporter but are friends with or related to people who are, I’m sure you know exactly what I mean about “setting them off.” These days, it’s difficult to maintain a friendship with people in the opposite camp any time politics comes up. Simply said, those who don’t support Trump think Trump supporters are either stupid, gullible, racist, greedy, or crazy. Or a combination of some of those things. I suspect Trump supporters think Trump detractors are just plain dumb.

It’s unfortunate that we have to go through the exercise of a Trump presidency for history to report which group was correct.

Slurs from our Childhood

Brazil Nuts
Public domain image of Brazil nuts from Wikipedia.

I don’t remember exactly how — I think it all started with rhymes we knew as kids that would not be acceptable in today’s society — but the topic of conversation turned to racial slurs. If you’re white and you’re old enough, you might remember certain phrases being quite common. It suddenly became a competition to list the common names for everyday things that would no longer be considered acceptable in polite society. (The one for Brazil nuts is a good example; Google it.) Then came company ad slogans and imagery. I admit that I hadn’t heard or seen many of them. I’m a bit younger than the others and maybe the fact that I had black friends and neighbors when I was a kid made it unwise for adults to mention such words and phrases in front of me. Growing up in the New York City Metro area probably had a bit to do with it, too.

(A side note here. I was born in 1961. Even in the late 60s and early 70s, my formative years, I had an idea of what a racial slur was. I clearly remember the day that one of my fourth grade classmates called one of my black friends a nigger in my presence. I nearly got into a fistfight with him and he didn’t do it again.)

Of course, a discussion like this is fuel for right wingers, who immediately start talking about how the country is “too politically correct now” and “people are afraid to say what they think.” And, of course, the husband of the Trump-supporting couple started going that way. He spoke up: “You can’t say those things now because it’s not politically correct.” He made sure to pronounce those last two words with as much scorn and ridicule as he could throw into their syllables.

I was already pretty much out of the conversation, not having anything to contribute and not wanting to contribute anything anyway. I honestly found the entire conversation disturbing and even rather shameful. But alarm bells were going off in my head. It was a nice afternoon and I was enjoying a glass of wine with people I mostly liked. (Yes, I even liked the Trump supporters when they didn’t talk about their political beliefs.) If the conversation went political, I’d have to make a quick exit and I really didn’t want to gulp the rest of my wine.

Fortunately, I wasn’t the only one hearing silent alarm bells. The group got quiet for a moment. Then someone else who had been in the conversation skillfully steered it in another direction. I breathed a sign of relief and joined the new conversation, eager to leave the old one behind.

Political Correctness Explained

I don’t remember when the phrase politically correct came into general use in this country. I’d Google it, but as I type this I’m sitting at a campground picnic table without any possibility of an Internet connection. I did use the dictionary built into my little MacBook Air to see what it would tell me. Surprisingly, it came up with a quote from Michael Dirda that says pretty much what I wanted to explain. I’ll let him say it for me:

The tediously overworked phrase politically correct can be used only with a smile, whether of irony or slightly embarrassed affection. Originally, the politically correct were those who ardently championed the rights of women, people of color, homosexuals, and other long-marginalized groups. But politically correct rapidly came to be associated with adherents who were overscrupulous in these observances, in short, zealots. Today most people recognize the fundamental justice of many, if not all, the legal and social advances linked to political correctness, but no one really cares to be called PC. The fight has largely been won, at least de jure if not always de facto, and so the term now sounds a bit old-fashioned, and usually carries an undertone of mild vexation or benign indulgence: Oh, Joan, she’s so politically correct!

I don’t know when Mr. Dirda wrote that, but in recent years, politically correct has taken another turn. It has been co-opted by the right to be slung as an insult to those on the left. These people don’t seem to recognize the justice of social advances linked to political correctness, as Mr. Dirda believes most people do. To them, political correctness is a farce — something to be laughed at.

And that’s a real shame.

Some Ideas are Incorrect

View from the Cheap Seats
Great book of essays that really make you think.

What got me thinking about this today, as I sit in a nearly deserted campground looking out at a secluded mountain lake in a smoky National Forest, is the very first essay in Neil Gaiman’s nonfiction compilation, The View from the Cheap Seats. That’s what I was reading just moments ago, while sitting in a folding chair facing out over the lake. Called “Credo,” it begins by talking about ideas. I don’t know where it goes from there — something on its very first page got me thinking about political correctness and I stopped reading while the idea to write this took control of me.

What triggered this overwhelming desire to write an essay about political correctness? This:

I believe that ideas do not have to be correct to exist.

How timely! This book was published in 2016, yet within the past month the war of ideas — both right and wrong — has been going strong. Charlottesville brought part of it front and center with a large gathering of Nazis, KKK members, and other white supremacists. This brought out protesters opposing their hate speech and resulted in violence when the two factions clashed, culminating in a senseless death and injuries of protesters when a white supremacist allegedly drove his car into them on purpose.

I think it’s an understatement to say that the ideas of Nazism and white supremacy are incorrect. Countless people around the world agree. These ideas are hateful and certainly un-American. America fought wars against these ideas and won. And, if need be, I’m sure we wouldn’t hesitate to fight them again.

The President of the United States should be, among other things, a moral leader who publicly, in no uncertain terms, condemns things that are widely accepted as un-American and downright wrong. Every president before him has done this after every American tragedy brought on by a difference in ideas — whether it’s Lincoln’s stand against slavery or Obama’s comments following the racially motivated shooting of elderly people at a church prayer meeting in Charleston.

Trump’s failure to condemn Nazis and white supremacists, in part, supports the view of his rabid followers that political correctness simply doesn’t matter. It also gives a boost to those who are pushing their morally wrong ideas, sending a message that their harmful, divisive views can be just as acceptable as those of the people who protest against them. It supports political incorrectness.

(And don’t try to tell me that morals should be left to religious leaders. Doing so reveals your own prejudices against those who don’t practice a religion — a growing percentage of the population throughout the world, including many of your neighbors, co-workers, and even friends and family members. Many of these people have higher moral standards than so many of the church leaders you look up to.)

The Importance of Political Correctness in Civil Society

Let me go back to our neighborhood gathering.

The racial slurs we talked about that weren’t necessarily recognized as such by white Americans in the 1950s and 1960s are still hurtful and wrong, especially today when we have a better grasp of how they affect the people they disparage. That’s what makes them politically incorrect. Is there anything wrong with that?

Are the people who mock those of us who try to be politically correct telling us that it’s okay be hurtful? That we can — or should — use language charged with racism or hate to inflict pain on our fellow men and women?

After all, isn’t that what political correctness is all about? Being sensitive to the feelings of other people?

And isn’t that a cornerstone of civilized society? Simply caring about our fellow man enough to have the courtesy not to insult or hurt him with words?

We don’t tolerate bullying in our school systems. Why should we tolerate it as adults in our everyday lives? Isn’t it the same? Using language or actions to spread hate and demean other people?

Isn’t being politically correct the same as being kind and civil?

What’s wrong with that?

Stop the Hate

There is an overabundance of hate and intolerance in today’s world. It has overwhelmed us, it permeates every fiber of our daily lives. It’s eating away at us from the inside, chewing away at our brains, making us blind to what’s good about other people and the world we live in. It’s stopping us from moving forward as a society; it’s preventing us from embracing our differences, learning from each other, and working together to make a better world.

We have the ability to stop it in its tracks. Being politically correct — not saying hurtful things to or about others — is a good way to start.

So yes, I’ll do my part. I’ll try to be politically correct — and be proud of it.

Getting Quality Health Care: Apparently Impossible

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The state of health care in the United States: ineffective and humiliating.

For the past two years, I’ve had a digestive problem. The symptoms, which are intermittent and vary in intensity based primarily on what and how much I eat, include:

  • Acid reflux, sometimes to the point of burning in the back of my throat.
  • Heartburn, sometimes quite severe.
  • Pain, soreness to touch, and hardness in the area between my lower ribs and naval.
  • Pinching feeling in my muscles just beneath my lower ribs when I lift something even moderately heavy.
  • Vomiting, usually at least six hours after the meal I’ve eaten.
  • Feeling hungry and full at the same time.

I don’t have all symptoms every day, but I can usually count on at least one of them to make me feel less healthy than I should.

caduceusTwo years ago, I went to a gastroenterologist. She came into the examining room, spoke to me briefly about my symptoms, made a few notes on an electronic clipboard device, and told me to take Pepcid AC, the over-the-counter version of Famotidine. Then she listened to my heart and took my blood pressure because she “had to.” (Her words.) That first waste of my time cost me $128 and half a day of work.

When the symptoms didn’t go away, I went to a Wickenburg general practitioner who had been recommended to me, Dr. Diane Juilliard. When I described the heartburn symptom as a pain in my chest, she immediately hooked me up with a cardiologist who just happened to share office space with her one day a week. He put me through a battery of tests with the apparent goal of proving there was something wrong with my heart. Every time a test came back negative, I’d be told that it wasn’t conclusive and I’d be sent for another one. This went on for months, costing me thousands of dollars. After the final treadmill-jogging stress test, he was satisfied that there was nothing wrong with my heart.

While I’m very pleased to know that my heart is healthy, I wasn’t pleased to waste months of my time and thousands of dollars to obtain that information. Worse yet, when my husband paid his Cobra health insurance 5 days late and we were cut off, I could not get insurance because of my alleged “heart problem.” I was without health insurance for six very scary months. The only reason they let me back into Blue Cross Blue Shield is because I signed papers saying I wouldn’t put in a heart-related claim. (Why would I? There’s nothing wrong with my heart.)

I dumped Juilliard as a general practitioner when her office refused to give me the H1N1 vaccine last year, telling me over the phone that there was “a chance of severe neurological damage.” Yes, I’d managed to find a real MD who was a vaccine fear-mongerer. I suspect that she’s also a real supporter of the drug company salesmen, since she changed my two regular meds to new prescriptions for which no generics existed, pumping my prescription costs up from $15/month to $150/month.

I found a new general practitioner in Phoenix named Robert Rosenberg. He’s a little wacky — he has a weird sense of humor — but he knows his stuff. Unfortunately, I first got hooked up with him in the throes of my insurance problems, so I wasn’t able to attack the digestive problem immediately. We’re working on it now. To that end, he sent me to Dr. Stephen Winograd, who happens to have an office in the same building. Dr. Rosenberg suspected that I had a hiatal hernia and sent me to Dr. Winograd to get “scoped.”

I called Dr. Winograd’s office three weeks ago. The earliest appointment I could get was yesterday. I asked if I had to do anything special before the procedure. I was told that I wouldn’t be getting the procedure at my appointment. It was just a consultation.

Of course. The more visits, the more payments the doctor can collect.

The day before my appointment, the doctor’s office called and left a voicemail to confirm. The voicemail told me it was very important for me to call them back at a certain number and press #6. I didn’t see any reason to do that — after all, I had an appointment and hadn’t canceled it. They’d just confirmed it. Did I need to confirm it, too? I didn’t think so, so I didn’t call back.

I arrived promptly at 3:30 (as requested) for my 4:00 appointment. They took a photocopy of my insurance card and photo ID. They then gave me a stack of five forms to fill out. The first one asked for contact and insurance information — the same stuff they’d already gotten in their photocopy. The next three were for family medical history, personal medical history, and a summary of my symptoms. The last one was a form that said they could give my medical information to basically anyone who asked for it, as long as they seemed official enough. I was supposed to sign it but I didn’t.

I handed in the paperwork. No one checked it.

At 4:00, I was taken into an examining room where a nurse took my temperature, pulse, and blood pressure. I had to ask what my temperature and blood pressure were; she didn’t volunteer this information as she wrote them down. (I ask for this information because I like to collect data points taken by professionals. My temperature generally runs a bit lower than normal — usually around 97.8 — but I was 98.2 that day. Although I have a blood pressure cuff at home which I’ll occasionally use to check the effectiveness of my blood pressure meds, I think a nurse with an arm cuff and stethoscope is a much better way to get accurate data.)

The nurse consulted with the doctor and then came back and told me he was ready to see me. She escorted me across the hall into an office where a 50ish, overweight man sat in a chair behind a desk. He didn’t look like a doctor. He didn’t look healthy. He looked like someone who needs to get out in the sun once in a while, perhaps while trying to get some exercise.

He didn’t get up or offer a hand. I sat in one of the two chairs on the other side of his desk.

He glanced at some paperwork in front of him. I don’t know if it was the forms I’d filled out. If it was, he obviously didn’t read them. He asked me for my three worst symptoms. This annoyed me. I didn’t realize I was only allowed to have three symptoms. (Maybe I watch House too often.)

I chose vomiting (never fun), acid reflux, and the pain in my gut. He asked if I were taking any medication for the acid reflux. I told him that I didn’t think taking medication was a good idea until I knew what was causing the symptoms.

He said it was either medication or surgery. (Yes, he really did say surgery at that point.) He said most people chose medication. I told him that I didn’t see how surgery could be possible without a diagnosis.

That put him off a bit. Of course he had to come up with a diagnosis. But as far as he was concerned, he already had. It appeared on my paperwork later: GERD.

I told him that Dr. Rosenberg thought I had a hiatal hernia and had sent me to be scoped. He asked me if I wanted to be scoped. I told him that’s what I’d come for. He asked me if I’d ever been scoped. I told him I hadn’t.

I told him about the pinching pain. He said that didn’t sound like it had anything to do with my digestive system. I pointed out that it started the same time as my other symptoms and had been going on for two years. He insisted it had nothing to do with anything he could help me with. He suggested that I Google it as a symptom and see that it had nothing to do with GERD. (Yes, he really suggested, during a “consultation,” that I get medical information via Google.) Then he took a step back and said that anything was possible.

I asked him how I could be vomiting food I’d eaten at least 6 hours before. Didn’t it all get through the stomach in that time? He told me I was probably not vomiting food. He said it was probably just the acid. I assured him it was food. Lots of it. Like a whole meal. With bits and pieces I could taste again on the way out. He didn’t seem to believe me.

He did not offer any explanation of what could be causing my problems. He did not use any visuals — diagrams, charts, drug company pamphlets — to show me how it all worked. Instead, he made a big show of agreeing to send me for a upper gastrointestinal endoscopy and a upper gastrointestinal series. He then made a big show of rising from his chair to “escort” me back to the examining room. There were no goodbyes. I’d obviously rocked his little world.

Back in the examining room, the nurse came back in with a much photocopied pamphlet with information about the endoscopy. She then escorted me into another office where two women sat at computers facing a wall. Behind them, on the opposite wall, were three chairs. I sat in one of these chairs while one of them women, her back to me most of the time, scheduled the test for me three weeks in the future. She handed me more paper and told me to “check out.” Like at a supermarket.

I found the front desk and handed over the paper. They took my $50 co-pay — I’m sure I’ll see a bill later, considering my deductible is $10,000/year — and handed me a sheet of paper with information about calling to schedule the other test. Evidently, it wasn’t possible for them to do it for me.

I left feeling angry and stupid.

This morning, I woke wondering whether I should go ahead with the tests. Dr. Winograd had already made his decision on what was wrong with me based on looking at me across his desk and hearing a few choice symptoms. Would he even look at the test results? Was I just going through the motions, throwing more money at an annoying health problem that no one seemed to think was serious to warrant real attention?

Was I wasting my time? Should I ignore the symptoms and simply mask them with drugs?

I recall the surgery I had back in 2006 when a lump in my abdomen had grown to the size of a 6-month fetus. I’d had the lump for years and had asked various doctors about it. They didn’t seem concerned. It was only when a routine visit to a gynecologist got another doctor’s attention. Visiting a gynecologic oncologist, seeing all the cancer patients in his waiting room visit after visit, wondering if you’ll soon be as bald and near death as they are, is a truly terrifying experience. The surgery and what came afterward wasn’t fun either. Thankfully, no cancer, but I have a scar big enough to be the mother of caesarian-born twins.

An experience like that sticks with you forever. In the back of my mind is this nagging thought: what if this is something serious? How bad does it have to get before I get proper medical attention?

Or is it “just GERD” that I can “cure” with Pepcid AC and a switch to decaf?