On caregivers, faith, family, and writing…

I don’t know if we had health insurance when I was a child. When I had a sore throat that wouldn’t go away, I went to the doctor, and the rest of the time, I didn’t give any thought to healthcare. Now our entire way of life revolves around the subject.

Health insurance became a personal issue years later after I was married and wanted to start a family. Maternity coverage was excluded from many insurance plans, and if it was included at all, there were stringent limitations. My husband was considering changing jobs, and one of the normal coverage limitations was that maternity benefits didn’t kicked in for a year after the inception of a new policy. On the other hand, if I became pregnant before he left his current job, I’d be covered under that policy for the duration of my pregnancy. We made the deadline, getting a bun in the oven with a month to spare. My coverage was limited to $500, but since I had complications that led to a C-Section, my entire $1,500 bill was covered. Things have really changed. Now maternity expenses are covered like any other medical expense, and a round of blood tests for my CLL (here and here)  costs more than the birth of my son. Thankfully, the blood tests are covered by insurance.

When Christian was born, I was fortunate enough to choose a pediatrician that we both loved. He was patient with my new-mother questions and worries, and he seemed to genuinely care about my baby. He let Christian play with his stethoscope and the tongue depressors he always had in his pocket, and he left the yucky stuff like shots to the nurses so there wasn’t any fear in the relationship between child and doctor. It’s no wonder that, by the time he approached middle school, Christian thought he might like to become a pediatrician himself. By then he had a new, more grownup doctor, and they had more grownup interactions.

“I’m thinking about studying to become a pediatrician. What do you think?”

His doctor was very straight-forward and honest. “If I had to start now, I wouldn’t do it. I spend so much time on forms and paperwork and so much money on malpractice insurance that it’s not fun anymore.”

Being a patient has never been fun, but as the face of healthcare changes, it becomes even less so. When I had those childhood bouts of tonsillitis, Mom took me to the doctor. No appointment was necessary, and time spent in the waiting room was usually minimal. Now doctors spend so much time doing preventative medicine, doing check-ups and running tests that you can’t get in to see them when you’re actually sick. I had an eye infection and called the doctor’s office in June. The earliest appointment I could get with the doctor was in mid-July, so I saw a physician’s assistant. A few weeks later I developed a UTI and had to go to the night clinic because, once again, the doctor was too busy to see me.

When I had my C-section, my doctors made decisions based on their education and experience. Now insurance companies, instead of merely covering costs, are getting more involved in care plans. Unfortunately, in many cases, the resulting changes cost more, both to the consumer and to the insurance company. During my stint as a caregiver, I ran into the 21-day rehab rule once with Mom and once with Dad. In both cases, the patient had to stay in rehab longer than medically necessary in order for Medicare to cover the costs. In 2009 we got a letter from Dad’s cardiologist saying that proposed regulations would require tests currently being done in the doctor’s office to be done in the hospital on an out-patient basis, and the fees would be higher. And medications are not exempt from this kind of micromanagement. When I had Mom and Dad at home, I ordered Dad’s diabetes meds from a company that waived the co-pay, so the meds were free to him. I ordered their other medications by mail in 3-month quantities which lowered the co-pays. When they went into assisted living, government regulations mandated that medications be ordered by the facility in 1-month quantities which was more expensive for everyone.

Government participation in healthcare is also showing negative effects in some cases. While we were in Florida, Mom and Dad’s neurologist closed his private practice because of the cost of the government required computer system. The healthcare group he joined was already on the system, and the first time we visited him in his new office, the system went down while we were in the examining room. The four of us, two of whom had dementia and didn’t understand what was going on, sat and tried to make small talk for 30 minutes until the system came back up. My new primary care physician here in Texas has just gone on the system. His long-time nurse who was one of the stars of his practice retired rather than deal with the new system, and appointments take much longer as both nurses and doctors make notes on laptops rather than in paper files. The urologist I visited last month said he will have to cut his case load in half next month when he goes on the system.

This is my big brother. He has nothing to do with this post, but I like the picture.

The existence of this “big brother” database is a little disconcerting on a personal level. I take four prescription meds. In April I went to Wal-Mart for re-fills. I got two of the meds but was told that it was too early to refill the other two. Normally, that’s not all that unusual, but under the circumstances, it was pretty jarring. I had just turned 65 and signed up for Medicare. I had just visited a new doctor who wrote me new prescriptions. I was using new insurance and a new pharmacy, but they still knew all about me. In addition, the urologist I mentioned earlier is not affiliated with my PCP, but when I called for an appointment, they asked for my name and date of birth, and instantly they had access to all my personal information. I’m not generally a suspicious or paranoid person, but in this day of rampant identity theft, that is more than a little scary.

Healthcare used to be the last thing on my mind. Now it seems to be in the forefront of not only health concerns but also financial, political and privacy concerns, not to mention television commercials. Maybe it’s a sign of the age in which we live, or maybe it’s just a sign of my own “attained” age. Either way, it has become a bigger pain than the occasional sore throat.




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