Tick-Tock, Tick-Tock: Why Even the Insured Are Waiting Too Long for Care
Though a strong majority of all Americans support adopting a single-payer, Medicare for all model of healthcare policy, their political candidates and elected officials have failed to move confidently and clearly in that direction. Most of us know it is not rational to allow our healthcare system to be grounded in the same inhumane, cold-hearted and economically unsustainable way as it has been in the past many decades. The American public is funding ever increasing profits for the insurance giants, the pharmaceutical giants and the provider giants of the healthcare industry, and we are paying for those profits with our premium dollars, our co-pays/deductibles/out-of-pocket expenses, and with our own public tax dollars that pay huge amounts for the ACA subsidies to private insurance companies and that offer massive windfalls to insurance companies gaming the Medicare Advantage programs.
Some of those who oppose single-payer argue we’ll all wait too long for care like people in other single-payer countries do (most opponents like to find a Canadian or Brit to complain about and then globalize those anecdotal examples). Aside from scare tactics about not being able to choose your own doctors, the most often used fear tactic is about waiting for needed knee or hip replacements or other critical care. Most of these arguments are just plain wrong. Americans wait plenty long for healthcare access – with or without insurance. Perhaps the ultra-rich get access when they want care, but most of us are at the mercy of a system bursting with dysfunction.
"Perhaps the ultra-rich get access when they want care, but most of us are at the mercy of a system bursting with dysfunction."
Republicans continue to wail about repealing Obamacare, the Patient Protection and Affordable Care Act or the ACA as it is more commonly known. The Rs are so determined that they have voted 60 times in the U.S. House of Representatives to repeal the ACA. Democrats enjoy the support of 81 percent of their base for a single-payer model, yet advocates could not get clear single-payer language in the Party platform despite the attention Bernie Sanders’ campaign brought to single-payer throughout the primary campaign season. Democrats are afraid that acknowledging the need for single-payer reform somehow diminishes their work and eventual success in passing the ACA/Obamacare. Especially during an election year, no one is going to be stepping up now to demand better lest it show deficiency in what is in place.
As the premium rates for insurance sold on the ACA state exchanges soar for 2017, many Americans are growing extremely worried and angry -- even those who have been appreciative of some of the ACA’s provisions, like the end to pre-existing condition clauses and the ability to keep adult children up to the age of 26 on their parents’ policies. It is hard to be supportive of a program that raises our premiums beyond what many families can reasonably afford and that also makes it difficult to access care in a timely, affordable way.
Unfortunately, I can still use my own situation as a fairly representative example of what many millions of people are facing. I purchase my insurance coverage on the ACA state exchange. My monthly premium for my own individual coverage under a gold level, Kaiser Permanente plan is nearly $600/month. I receive a $12/month federal subsidy. Next year, my premium rates are going up at least 14 percent. If I keep the same policy, my co-pays will stay at $40 per visit for just about everything. It sometimes feels like I pay 40 bucks for the privilege of having one doctor refer me to another who charges me 40 bucks to send me to a test that has a $100-$250 co-pay, and I cannot get to finally having any kind of actual relief until I have had multiple doctor appointments spread out over weeks and tests that also take weeks to schedule and then weeks to get results. My costs might well exceed $500 out-of-pocket just to get one issue addressed.
In January of this year, I finally sought help for numbness, weakness and instability on my right thumb and wrist that threatened my ability to write, to drive safely, and to carry out basic personal care functions. For several months prior, I tried several remedies on my own – splints I bought at the store, OTC pain meds, ice, heat, etc. A doctor friend had me perform one little exercise and when it was nearly impossible for me to do due to pain, she said she believed I had De Quervains tenosynovitis. Once I got in to see a Kaiser doctor, he suggested a shot of steroids in the tendon and casting the thumb and wrist to help it rest and perhaps heal. After six weeks during which I could not completely rest that hand in spite of the cast, the cast came off. The wrist and thumb felt better but still not much better, so I sought some other way to proceed.
Next steps for me, now two months in to seeking help, was to see my primary care doctor again and see if she had other options. I had argued sufficiently through the hand and wrist specialist for some pain relief and even for a NSAID based topical cream another doctor suggested, so I wasn’t trying to be needy. My primary care doc and the specialist referred me to a hand and wrist surgeon. I called for an appointment. It was now April 2016. The surgeon saw me before the end of April, and they wanted me to have a consult with the neurology department for testing since he felt pretty certain that in addition to the De Quervains that I also had carpal tunnel syndrome. I called the neurology department and got an appointment for testing in late May. In the meantime, I was to go to occupational therapy to see if they might help with day-to-day functions. Are you adding the months and the co-pays now?
The tests showed definitively that I have both conditions. No surprise. So, everyone agreed that it was in my best interests to have surgery on this hand and wrist in order to improve function, lower the pain and preserve the nerves now being potentially damaged. I called to schedule the out-patient surgery for July – in-between the People’s Summit in Chicago and the DNC in Philadelphia. But because I have lingering issues surrounding my need for oxygen since the septic MRSA infection in 2015, the surgeon’s office said I had to be evaluated by the respiratory folks. I called for that testing. I paid the co-pays and did the testing in late July. In early August, I received an email saying I need to come in to discuss the results of the breathing study. I called for that appointment, and the next available appointment is in September. I took the first available appointment, and I will pay the co-pay to hear those results when I go.
We are now almost nine months in to my seeking help for my wrist. I have pain, numbness and loss of function even more severely now than I did, and both of the conditions carry the risk of permanent nerve damage when left untreated too long. After at least seven separate doctor visits, neurological and respiratory testing with co-pays exceeding $100 per test and additional office visit co-pays to hear results, I am not sure when or if my wrist and hand will ever actually get better – or if they will. So please don’t anyone tell me that achieving single-payer will mean Americans will wait for healthcare. We wait now. We hurt now. We pay huge amounts to get care and then still don’t feel better.
In my case, what incentive does Kaiser actually have to speed up this process for me? None. So long as they can collect multiple co-pays, the $600/month premium, and hold off care for as long as is humanly possible, the bottom line gets better and better. My only hope is that some doctor in the Kaiser midst decides to take pity on a patient or gets sick of me being upset. I am so frightened that my nerves in that hand are already permanently damaged, and our healthcare system just isn’t set up to put that issue front and center.
Under a single-payer, Medicare for all system, medical need drives access to care. Wouldn’t it be rather nice if our doctors and other providers could actually care for patients with a shared priority of restoring health? My husband, as a Medicare beneficiary with a supplemental plan, never waits for care like I do. Never. Anyone who doubts that the complexity and lengthy delays in the current healthcare system are intentional and part of a business model for profit is not facing reality. Under single-payer, Medicare for all, doctors and other providers would not have to do the delay and deflect dance they do now to avoid actually providing care.
Without the administrative waste and abuse for profit that is in the system right now, there is more than enough money to actually provide care to all. Single-payer, improved Medicare for all would allow for much more steady and reasonable premium costs without the co-pays and deductibles. Take out the enormous CEO and corporate profit margins, and we can control costs and ensure a more responsive, health-driven system. There is no need for us all to wait like this.