Missing the Health Care debate
SteveSome folks that know me, or follow me on Twitter or Facebook know by now that my Dad has been in the hospital for what is now going on 13 days.
It started, as many of these kind of cases do I have learned, with what seemed to be a cold, then a bad cold, then a fall at home, then a call to 911, and finally a diagnosis of pneumonia (along with some other assorted issues that have popped up).
As this process has unfolded, his condition has gone up and down, probably a bit more down, as additional issues and complications have arisen in the past few days. In the course of his care, the doctors (and there have been at least five, specialists for infectious diseases, neurology, endocrinology, cardiology, and psychiatry), and nurses have been very professional and have done their best to help both my Dad and us stay informed of what is going on in what has proven to be a complex, challenging case.
And as the number of doctors, nurses, clinicians, specialists, and other professionals has multiplied, so have the number and frequency of tests, procedures, and medications that have been involved in his care. There have been really too many to count among the MRIs, CT scans, X-rays, blood tests, and more in the last 13 days. In truth, my Dad's case has been extremely complex, and at times they have not been completely sure what is going on, and as such, several of the tests have been perhaps a bit speculative.
But as this process continues on, I can't help but wonder a few things:
One - had my Dad not had health insurance coverage in the form of some combination of Medicare and insurance from his former employer, just exactly how would all of this played out? Would any of the decisions and approaches to his treatment actually been any different? Does everyone in his situation get the same comprehensive, and I am sure incredibly expensive care?
Two - Is it entirely normal and expected that the actual costs of treatment are really never discussed with the patient and family? As each test, procedure, medication, etc. have been ordered, they have been discussed with us in detail. The goals, steps, process, potential complications are all carefully described. But not one time has the subject of cost ever been discussed. Should the cost of care, of each additional test or procedure be a part of the decision making process? I imagine that the Doctors or the hospital administrators take the costs into account, but to have what has amounted to zero discussion of cost between service provider and service recipient is certainly unusual (at least to me).
Three - These last two weeks, as the US health care reform debate, compromise, and vote has played out on the news, in the blogs, and in social networking, most of the (limited) information that I saw was primarily focused on the macro level. The many millions of uninsured people that would now get coverage, or depending on which cable news network you prefer, the billions of dollars that would be saved, or squandered as a result of these reforms. Big picture discussion on percentage of GDP and national obesity rates.
But to me, what is clear as a result of what my Dad and our family is going through, is that any talk of health care reform really starts and stops at the micro level. It is about what happens when Dad or Grandma gets sick and needs intensive, expensive care, (and rehab). It is about what happens if the new baby is born weeks and weeks early. It is about making a decision, as many people do, to stick it out in a dead-end and soul crushing job in order to cling on to a marginally decent benefits plan, because your spouse has been sick for a long time, the kind of sick that insurance types like to call a 'pre-existing condition'.
I have been really distracted the last two weeks, talking about ventilators, CT scans, catheters, spinal taps, and blood work. So perhaps I simply have not had the time or attention to think about the big picture, and what these reforms mean to the country, the economy, the workforce, and the next generation. For me, at least right now, these concepts are too vague, elusive, and certainly contentious to fully grasp.
Right now, for me, the only thing in 'reform' that I care about, is whether reform will affect my Dad's ability (and you can insert your own loved one's here), to get the needed treatment, and walk out of the hospital one day soon.
And I suppose any reform that makes that kind of positive outcome more likely for my Dad, and your Mom, Grandpa, daughter, husband, or friend, is the kind that we can all support.
Reader Comments (21)
I really hope your dad feels better soon! Thinking positive thoughts for your family!
Thank you for putting a name and a life out there for us to relate the healthcare situation to. First and foremost, I want to continue to wish the best for your dad, your brother, sister, you and your family. You know I'm pulling for this to have the best possible outcome- a healthy dad back with his loved ones.
I have to admit that in my younger years, before I had a family of my own or any real need for healthcare, I leaned more to the right on this issue. And while both political parties want us to choose sides, I have a much different view now. As a mom who has had times where I needed healthcare for my own kids, and less than two years ago I went through a major health scare myself where if not for the BEST care from the thoracic ICU I would not be alive, I know that what is important is that we focus on doing the right thing.
I now work at a pediatric hospital and I can assure you, when you see the small, frail, sick children looking at you, your politics will no longer matter. All that matters is that you want to do all you can to make these children better. To give them the best possible care regardless of the insurance their family may or may not have. I applaud you for reminding us to think of the micro level. If each person would do that, somehow the right HUMAN decisions would be made. That would be a good thing.
Excellently written and gives us all a human side to healthcare rhetoric - Wishing your Dad improving health and you and your family comfort....
My heartfelt wishes that your dad has a speedy recovery.
I have good health care benefits and, as with your dad, no one ever discusses a procedure with me UNLESS they think it might not be covered. It's entirely different with my dogs, because the vets - particularly the specialists and emergency room - will do nothing until they have prepared an estimate and, in some cases, received a down payment (usually 50%). I'll bet that, if there was no health coverage, that would be the norm with people, too.
Isn't that sad? Can you imagine the decisions that are made to stay in a job because of the benefits? Or even if there are NO benefits but it is an income? I know that people sometimes don't treat their dogs when needed because they just can't afford it. Imagine if that was a child.
Amazing post and great thoughts on such a difficult subject.
I found myself thinking about something similar to this at this time last year. Our daughter wound up in the pediatric hospital for 5 days. Same situation, I just wanted her to get better. When we finally got the bill, I noticed that one, only one of her medications (actually the one that saved her life.) was billed to us at the cost of $12,500.00
The price of the med, actually caused me to think about how in the heck someone who's not covered by insurance or the state would be able to pay for treatment? It has taken me a very long time to reconcile the incident and the costs we incurred.
All my best to you and your family.
Thanks for bringing it back home Steve.
When my mom was in the hospital in 2000 there were no real conversations. No descriptions. No consultations. There were plenty of questions about insurance (which she did not have). If she did I am sure their would have been more smiles and a little different experience. But who knows.
When my wife went into the hospital 12 weeks early in her pregnant with our son there were plenty of smiles. She was in the hospital for 6 weeks. We had great insurance. I could not imagine what would have happened, with her and my sons health much less with the cost (which was the least of my worries at the time). When anyone goes through a traumatic event, the last thing you should have to worry about are hospital forms, insurance or the price of a test. All you want is for everything to be ok. Can't say if reform will change any of this.
My deepest prayers & wishes to you and your family!!!
Steve,
I send my continued thoughts to you and your family in the hopes of a speedy recovery.
I have first hand experience as someone who lives without health insurance. And it does need to be seen from a micro level.
Thank you for contributing your thoughts to this discussion while juggling all the things that you are.
Thanks for sharing what's been going on, Steve. My best wishes to your dad, you and your entire family.
Yes, it's odd - I can't think of anything else we purchase without knowing the cost. And the processes and procedures are so foreign to most of us the hospital may as well be on Mars. So glad that you've been able to be there and advocate for your dad - help with the decision-making and understand the specific benefits of a procedure or course of treatment. It's hard for people to do that for themselves when they're ill.
Keep going - you're doing a great job!
Great post, Steve. Sending you and your family all the good thoughts in my arsenal.
I had a similar experience when my mom was in the hospital about 7 years ago after she had a stroke. I knew she had insurance, but I had no idea what it covered so I was stressed out every time they ran a test or gave her new meds. Luckily, she was too out of it to be concerned. Her coverage turned out to be great, and fighting against the insurance company after she was released was pretty limited. I know this isn't the case for everyone.
I'm glad your Dad is getting great care and he's surrounded by people who love him. That's all any of us can ask.
Great post Steve and a great way to remind people that politics isn't about grand gestures and vested interests but about how decisions can and do effect each and every person in different ways.
In the UK we watch the debate, sometimes with shaking heads and often with incredulity, for however much we may complain about inefficiencies at our NHS, we know that we couldn't function as a society without it.
Sending my best wishes to you and your family...your dad sounds in good hands and has all the love and support he could hope for.
My prayers are with you, your family and your father.
Steve, what a wonderful, timely and important post. Even as I've been sending my most ancient Hebrew prayers to you and your family, I've been working hard to ensure that everyone has the same quality of care that your Dad has received. Ron's chemo drugs were beyond costly, but he's wonderfully healthy today. Our terrific insurance (because of his work at NASA) covered most of the costs, and we are fortunate enough (because financial success is never just about your own hard work but also about the accidental gfts of your birth and the good luck not to have been hit by a truck) to have been able to pay our portion of those costs. And we know that, if he ever needs further treatment, there'll be new treatments at the ready and that we'll have the insurance and personal resources (aren't we lucky!) to pay for them. But we also know, because we paid the bill, that a close friend didn't have access to equally lifesaving chemo because her very limited but expensive privately purchased insurance wouldn't cover the costs of the chemo that she needed, and her disability income barely paid for room and board. It's that disparity on which I'm hoping this health insurance reform is a big step forward.
We can have very legitimate (hopefully a lot more civil than what the extremists have been doing) debates about the best way to ensure the availability, quality and cost of universal healthcare, but the principal of uiversal health care should never have been at issue. In a client meeting yesterday, I (a clearly overweight person working very hard to correct that) said to the room that, if we want to get serious about health care costs, about the long-term drain on our country of those costs, even as we open up health care to all, we'd outlaw being fat (or, at least, make it increasingly more expensive and more difficult to be fat), outlaw sloth when it comes to daily exercise, and outlaw a whole list of other unhealthy behaviors. But perhaps that's a good subject for another post.
What a nice post, thank you for sharing your situation with us. Our prayers are with you and your family. Take care. Chris
@Shauna - Thanks so much!
@Trish - Thanks for sharing some of your story with the health care saga. I am sure you are right, once you see these issues up close, it definitely impacts your thinking
@Robert - Thanks very much, I hope all is well with you.
@Joan - I know what you mean, it was exactly what I have been thinking all this time
@John - Wow, what a story. So glad your daughter is ok. Thanks for sharing with us.
@Benjamin - Thanks for sharing those two perspectives. I agree, it seems like two different experiences.
@Tammy - Thanks so much, and let's hope it all works out for those who are in need of care today, and all of us who will need care eventually.
@Marsha - Thanks very much for the kindness. I have to really say the rock in all this has been my sister, she has held everything together for my Dad.
@Teresa - Thanks for sharing your story. It is such a tough position to be in, to have to feel like you need to decide whether or not a given test or procedure is 'worth' it.
@Mervyn - Thanks for weighing in from the UK perspective. I imagine from there, all this talk seems a little absurd to you.
@Paul - Thanks again for all the support and well-wishes
@Naomi - Thanks so much for all your thoughts and prayers. Many thanks for sharing some of your experiences with the health care and insurance processes. I agree, the subjects of obesity, smoking, etc. do need to be looked at more closely.
@Chris - Thanks so much!
Again - Many, many thanks for all the well-wishes and messages, we truly appreciate them.
Thanks for a thoughtful post. Health care in America is a thorny issue all around, and no one has the complete answer. My hope, like yours, is that a system can be created to cause the most good possible. Best wishes and prayers for you and your dad.
Unfortunately healthcare costs will continue to rise, regardless of what transpired this week. Employers will continue to reduce coverage and folks will have to pay more out of pocket.
And until the majority feels the cost direct, the outcry to keep prices lower via insurance and the medical profession, the majority will fight tooth and nail for status quo. We may still be a generation or two away, but the current model can't be sustained.
I feel for you. My parents both have had major health issues for years and if they didn't have the legacy coverage from previous employers they'd (we'd) be bankrupt. And you don't want to have to worry about financial matters when the emotional cost is so high.
My wife and I are currently paying our own insurance with a second child on the way. We're planning a home birth, but if we have to go to the hospital, we're going to take a big hit even with major medical coverage.
My thoughts and prayers are with you and your family.
@Kevin - Thanks for sharing your thoughts and story here. I feel for you as well. Best of luck with the birth of your second child, it is truly a remarkable and wonderful thing.
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