An Uncomfortable Situation

TIME magazine’s cover story this week is entitled, ‘What I Learned From My $190,000 Open-Heart Surgery.’ It is a thought-provoking op-ed piece on how we might contain medical costs by having large medical centers run their own insurance networks, thus cutting out the commercial middlemen. U.S. healthcare reform is a thorny and complex topic that has eluded sweeping change for over half a century (Obamacare, regardless of what you think of it, is really only a few steps in that direction). Certainly, I cannot add much to the canon of what has already been composed on the topic; instead, I recently had a (fleetingly) uncomfortable experience of my own, one that I had not encountered before – but one with which many Americans have lived daily and seemingly permanently. That is why I feel the need now to put (cyber) pen to paper.

Like the author of the TIME article, I too have had an open-heart procedure in 2012, though mine ‘only’ cost $165,000 – an ungodly amount for all but the uber-wealthy or fully insured. I have been fortunate, however, that ever since I finished college and fell off my parents’ insurance, I’ve had good healthcare coverage of my own. I’ve never been without a job for more than a weekend (i.e., finishing one on a Friday and starting the next one the following Monday). COBRA (the federal law that mandates insurance access for eligible workers after leaving employment) is something with which I’ve never had to deal. Being without full-time benefits is utterly foreign to me… which is fortunate as I’ve suffered more than one ailment that needed expensive treatment in the past.

Recently, however, I left my position as Director of Mental Health Services for the Department of Public Safety, which I had held since 2006, and moved into another professional role. My last day as Director was in early December, and therefore my old health policy was paid through that month. The start date for my new position was at the end of December, leading me to believe that my insurance coverage would be seamless.

I arrived for orientation on 29 December, only to find that there was a waiting period of one pay-cycle (i.e., two weeks) before healthcare coverage under my new employer’s plan would become effective. And there wasn’t then enough time to get gap coverage through COBRA.

There I was – with a complicated personal medical history stretching back to the 1980s – soon to be without any health insurance at all!

At the stroke of midnight on 31 December/ 1 January, rather than toasting the upcoming New Year, my first thought was “I just lapsed.”

I didn’t mention this to my family, not wanting to concern them when nothing could be done. And I wasn’t able to hide inside the house under a blanket and wait for the calendar to set me free. But suddenly, I perceived risks everywhere. Traffic seemed increasingly chaotic, with individual drivers most reckless. That previously solid ladder that I use almost every weekend? It felt wobbly as I climbed. I’m not hypochondriacal, but my back started to hurt when I picked up boxes. I stumbled over curbs more than ever. Black ice abounded. Everyone was wheezing and coughing around me, spewing infectious agents from floor to ceiling. I watched the hours and days go by. I could see the finish line, and nothing bad had happened. Yet.

But for many, there has been no finish line, and each day/ week/ month/ year is greeted with the uncertainty of bankruptcy and financial ruin should medical fate so dictate.

I went to bed last night feeling as if I had dodged a bullet. I awoke at 0200 and rolled over, smiling because my insurance had again taken effect at one-minute after midnight as I slumbered.

I try to keep the Alienist apolitical. But as a physician and a dual US-Canadian citizen – yes, I hail from that awful socialized country to the north – I cannot help but express what seems self-evident, even though there are still many here who oppose what is otherwise obvious. The US cannot continue as a stable advanced nation in its current trajectory of gross societal inequalities, be they in terms of income, of life aspirations, of access to education… or of health maintenance. And it’s foolhardy to presume that every one of us is not already paying for the uninsured anyway, be it through increased prices for our own services, or through taxes to fund universal coverage.

I was lucky. I am lucky. But why can’t we all be honest and compassionate, and do what needs to be done, without the political drama and obfuscations?

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[Copyright 2013 @ The Alienist’s Compendium]

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