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Kings Mountain, North Carolina, United States
"A mind lively and at ease" is a blog by a first-generation Russian-Ukrainian immigrant Maria K. (Maria Igorevna Kuroshchepova). An engineer by education, an analyst by trade, as well as a writer, photographer, artist and amateur model, Maria brings her talent for weaving an engaging narrative to stories of life, fashion and style advice, book and movie reviews, and common-sense and to-the-point essays on politics and economy.

Sunday, February 7, 2010

Up close and personal - why do I want a health care reform

With the exception of drugs, smoking and some particularly questionable sexual practices, I do my best not to speak negatively of things I have never experienced. By the same token, I do my best to share information or dispense advice either on the basis of thorough research or on the basis of personal experience (as opposed to something coming from a friend of a friend of a friend of a cousin of a wife of the original source). As with the subject of immigration, my reasons for supporting a health care reform - no matter how imperfect the first version of it might be - are based on experiences of my own and those of people close to me.

1) I want health care reform to focus on preventive medicine rather than on reactive medicine. Last year I had two miscarriages - one in April, one in October. These were my first two pregnancies, so I had no normal one to compare to. I was initially told that, while it was vitally important for me to get an extensive array of blood tests done, I could not get my insurance company to pay for them, until I've had three miscarriages in a row. Two wasn't enough.

Then my OB GYN put a reason other than the miscarriages on the paperwork and pushed the labwork through. It turned out I had a fairly rare genetic condition, which made it impossible for my body to metabolize folic acid. I lacked all the DNA boost advantages that most people build up by getting folic acid through the course of their lives. In my case, among other things, it meant that while I could get pregnant, the chances of my carrying a baby to term or having one without serious birth defects were very slim. Had this bloodwork been a part of a standard prenatal routine, available to women as soon as they decided to start trying for a baby, I would have still received the bad news about my condition, but at least I would have been spared the trauma of the two consecutive miscarriages.

The same range of tests can identify a number of other issues that might interfere with a healthy pregnancy and make it possible for a woman to start taking the necessary vitamins and hormones well before she becomes pregnant, to build up a healthy foundation for her baby. However, it is not available to women, unless they've had three miscarriages in a row.

2) I want our health care system to reward people for improving their health - not punish them. My mother-in-law has diabetes. Since her initial diagnosis, she made changes in her diet (although I still wish she would stop working so much - the 80-hour work weeks can't be helping matters) and was able to cut down her medication. Initially, she would pay the standard co-pay for her prescription but get the supplies for checking her blood sugar free. Now that she doesn't need to fill her prescription quite as frequently, she still needs the supplies, but they are no longer free - in fact, they add up to more than the cost of the prescription itself.

When my mother-in-law asked how she could get her supplies free again, she was told that she would have to go back to filling her prescription with the same frequency as before, even though she didn't need the medication. Not only was she being punished for doing better with her diabetes, but she was asked to buy medication she didn't need, while someone else may have taken advantage of the doses she was no longer using.

3) I want our health care to make sense. A few years ago my husband needed knee surgery. He already knew that his general care physician couldn't do much except give him pain killers to alleviate the pain in his knee, so when the time came to make a decision about the surgery, he went straight to his orthopede. The surgery went fine, although I, of course, couldn't miss the opportunity to make fun of how loopy he was while coming out of the anesthesia. The pain in his knee went away and after a period of physical therapy he went back to his normal level of activity. All was well, except one thing. The insurance company refused to pay for the surgery.

When my husband asked why, the answer was, "Because you went straight to the specialist instead of obtaining a referral from your general care physician first." He asked whether, had the general care physician made the decision and sent him to the orthopede, the insurance company would have approved of that decision. The answer was yes. And had that been the case, they would have paid for the surgery too. However, because my husband decided not to waste the time of his general care physician on telling him what he already knew anyway, his claim was declined.

4) I want doctors to make house calls. Between my husband and me, I am the sicklier one. I become ill easier and more frequently than he does. However, having been that way all my life, I am not impacted by illness as much. He, on the other hand, like most very healthy people, just doesn't know what to do about being sick. So, when something sneaks up on him, it's usually a big one.

Last fall, he was down with the flu (don't ask me, which one - I quit keeping track of them), and I was taking care of him, having only just recovered from a bout of my own. I was on the phone with my parents, who live in Ukraine, and told them Gerry was sick. My step-mom asked, "Well, did you call a doctor?" "No," I said, "We are self-medicating." "But why?" "Because doctors here don't make house calls anymore."

It took me twenty minutes to explain, that when you are sick, you have to get on the phone and schedule an appointment first. If you are lucky to get one within a reasonable time (as opposed to two weeks out), you have to get into a car and drive to your doctor's office. Then you have to sit in a waiting room 45 minutes to an hour past your appointed time, quietly soaking up the germs from your fellow patients and spreading around a few of your own. All that - just to get five minutes with your harried doctor and a prescription for something you already knew you needed, but couldn't get because pharmacists here are not allowed to prescribe medications (as they are in Europe). After that, you have to drive some more to get the stuff from the pharmacy (spreading and picking up yet more germs along the way) and then drive yourself home where you can finally be sick in earnest.

You know you have a problem with your health care, when even the people living in the second-world Ukraine are shocked by some aspects of it. Now, I realize, that this is a big lumbering beast - the health care system of ours - and it cannot just be transformed overnight. And if a health care reform bill is passed, it is not going to be perfect from the start. It will have to undergo many changes, before things finally start making sense. But something has to happen - a baby step, a crawl, some kind of a movement, because I honestly cannot see how anyone in his or her right mind can be happy and satisfied with what we presently have: a system that waits us to get sick instead of encouraging us to be healthy, a system that disapproves of health-related decisions we make on our own because they were not signed off on by its own representatives, a system that suffocates doctors under fees and paperwork instead of letting them do their jobs. Am I the only one who is not ok with that?

3 comments:

The Jerseymooners said...

So sad about the babies, Maria.

This is a great, concise, clear statement. I completely agree with everything you said.

I will never understand why insurance companies refuse to look at the long-term picture when making decisions based on money. Wouldn't it make sense to test and treat rather than deny, wait, and then spend more in the long run?

So frustrating!

Maria K. said...

That, and the fact that we refuse to look at other countries because we are always hell-bent on reinventing the wheel. I realize that places like France and Canada don't have a perfect healthcare system, but they must be doing SOMETHING right, because otherwise where are all the dead Canadians and French? :-)

And how is it that almost all of the Scandinavian countries manage to give new moms AND dads up to a year of baby leave - with pay? AND additional 10 sick days for every child? And here we are - making women go back to work after six weeks! That's ridiculous.

Why not look around and see what works and how we can implement it?

Anonymous said...

I don't think anyone will have a problem with this, because it's all true. I am sorry about how long it took doctors to figure our your condition, how traumatizing.

I had a similar situation with my European friends, who wonder why I have to be deathly ill to go to the doctor, routinely ditch physicals, and only got enough time off with my children to establish a breastfeeding routine (only to have to pump every day and deliver to the caregiver).

The system is so broken and times are so hard employers are using that as excuse to drop benefits altogether, or require employees to pay for them

At the local college all full time teachers will be paying their own insurance next year--admin and support staff have better benes then the reason they are all there--the teachers--nevermind many of the students are simply uninsured--I know I was for eight very long years I was at the mercy of the student clinic and lucky we had very good med students and nurses to take care of us. But any major accidents or surgery--and I had a few, and I was paying it off for the rest of the year with what little money I had. That said, the profs have not been told if they can opt out, but if they can, I am sure they can find cheaper group insurance through the local teachers group--because insurance costs are ridiculous at the college for reasons I won't go into here. They are calling the insurance charge an access fee, but it is anything but. Nobody wants to take it, it is slow to pay and frequently wont.

Congress has a massive disconnect if they think this is ok. But then, they have the seamless health insurance the rest of us would love. Could they just give us that?