Saturday, August 15, 2009

Health Care Reform?

The health care debate raging right now among both Democrats and Republicans ignores a growing component of health care: Christians sharing each other's burdens instead of insurance.

Keith has been self-employed for over 25 years, and obtaining health insurance when one is self-employed can be likened to climbing K-2. As a couple back in 1990, several plans wanted $800 per month for just the two of us. So you can compute how much insurance for self-employed costs now, almost 20 years later, plus adding our four children? Most health plans are way out of reach for the vast majority of the self-employed.

We had catastrophic coverage only for the first seven years of our marriage. Just as I was pregnant with our first child, the publishing company where I worked part-time offered us full coverage which we gladly accepted only a week before severe complications occurred in my pregnancy, necessitating several hospital stays and a C-section birth. I experienced further complications soon after Elizabeth's birth with the C-section itself. After months of painful cortisone shots that didn't help and months of being unable to stand up straight because of the pain of the scar, I finally begged my way to surgery to clear out the scar tissue. I was on the phone day after day, unable to work, tearfully begging paper-pushers to approve my surgery. It was humiliating, but it was the only way to move the system forward.

Once I was working at Point Loma Nazarene University, we had different coverage that was a slight improvement -- but once I quit to stay home with my kids and our COBRA option ran out, we were once again stuck with no health coverage we could afford except Kaiser, an HMO that proponents of government health care hold up as a model of what the government system will strive to be. Kaiser was great with pediatrics as the kids grew up and with my complicated pregnancies except for Benjamin's birth. Both of us were endangered by Kaiser's shortcuts of not doing an ultrasound before inducing labor, an oversight that almost cost Benjamin's life and necessitated an emergency C-section to remove him because of severe decelerations of Benjamin's heartbeat, down into the 50's (normal is around 150). During the C-section, they had crash carts ready, one for me with my erratic and uncontrolled heart rate and one for the baby. It was terrifying.

After I finished "birthin' babies" I was still having occasional problems with erratic heart rates and chronic pain, all of which were dismissed by my Kaiser nurse practitioners and the occasional doctor -- it was rare to see an actual doctor at Kaiser. After seeing an out-of-service chiropractor (paid for out-of-pocket) who sent me immediately to my medical doctor, I was finally diagnosed with fibromyalgia by a doctor who "specialized" in the chronic pain condition; a third of her patients were diagnosed with the condition. Within six months of my original diagnosis, I was wheelchair-bound and in so much pain that I was basically bedridden. The doctor tried prescription after prescription, but nothing helped. She referred me to pain specialists who dismissed my pain because I "smiled too much to really be in pain" so the pain must be "all in your head." After over a year of useless experimentation, my "specialist in fibromyalgia" finally referred me to the psychiatry department because she couldn't do anything to help me and "they have more meds." Now wheelchair bound everywhere but home, I wept, totally disabled by pain that no one understood, not even my doctors.
So I finally started to see an osteopath -- a full M.D. with additional training in "blended medicine." Again out-of-pocket. And the first words he said to me was that the pain was NOT "in your head at all -- it was REAL; it was physical, not psychological, and it could be treated." He advised our family to leave Kaiser "before they convince you that your pain is imaginary" and to join a Christian medical sharing plan called Samaritan Ministries. He had just shifted his own family over to this sharing plan in which we pay the bills of other Christians. Each month we receive a packet in the mail with a list of prayer requests and the newsletter listing one family whose name, address, and health need is given. We are to write a note of encouragement along with our check to this family, and we are to pray for them for the next month.

It wasn't until my osteopath stepped outside the bounds of my diagnosis and followed the diagnosis of rheumatoid arthritis given by my chiropractor, a diagnosis not supported by my medical tests, that I finally experienced some pain relief. Despite mostly negative tests, Dr. A. treated me according to the protocol for rheumatoid arthritis with prednisone and extremely strong narcotic meds (fentanyl patches, to be precise) that the pain finally began to be controlled. However, with my condition pre-existing and thus not covered by Samaritan, my patches cost us $950 per month, not including other medications and supplements. We quite often totalled medical bills of over $20,000 per year for several years in a row. Because of these medical bills, we've been on the brink of bankruptcy, but I am somewhat functional again now that my pain is mostly controlled. Dr. A. shifted my meds from the expensive fentanyl patches to inexpensive methadone a couple of years ago which work better and have fewer side effects.

But my doctor did what the HMO's would never do: he treated me according my symptoms rather than my test results, something that almost certainly would never be allowed by managed health care, much less government health care. We will almost certainly lose freedom when the government takes responsibility for America's health care because doctors will be bound even more than they are now by the HMO's. And that's a scary thought. If I hadn't left managed care behind, I would not be having quite the financial difficulties that we are currently experiencing, but I also wouldn't be walking, either.

Some people I read talk about how we will have more freedom with the addition of government health care -- how it will be just another option as it is in schools with private and home schools being options providing choice. However, according to sections of the health reform bill I have read, no new patients may join private practices by a certain year. So, governmental health care is not at all like school choice ... unless private and home schools are going to be prohibited from enrolling new students in a few years also.

(Kerataconus cornea)

I have seen many failures of the Kaiser Permanente system of managed care. In addition to our "scare" with Benjamin's birth, a frightening and life-threatening turn of events that would have been avoided by a simply ultrasound, my own grandmother's as well as Keith's mother's cancers were not caught early enough to ensure their survival despite complaints to their doctors of extremely suspicious symptoms for months if not years before their diagnoses. Kaiser also missed Elizabeth's diagnosis of kerataconus (an eye problem that prevents perfect vision) for five years despite seeing Kaiser's optomologists every six months during her childhood. One eye doctor thought there could be a problem and sent her to a specialist who found nothing, except that her eyes couldn't be corrected to 20/20. When we returned to our private eye doctor, she saw the problem, ran two diagnostic tests right there in her office, and had Elizabeth diagnosed and under treatment within 45 minutes, but much damage had already been done to her eyes by not having the condition caught at an early stage. She will most likely need a double corneal transplant when she's in her late twenties because of Kaiser's missed diagnosis.

If health reform is really to work, is really to help the uninsured, then provisions need to be made to help self-employed Americans obtain private health care premiums in an affordable range and to help small businesses provide health care for their employees -- perhaps both could be accomplished through tax breaks or some other means besides a complete takeover of the private health care system by our government.

Managed care itself doesn't work well. Doctors need the freedom to go outside of usual medical parameters at times so that patients can be treated like people and not like numbers. If these private companies cannot manage health care well, how can the government possibly do so? The $1,000 government toilet seats that made the news years ago could become $10,000 flu shots in a few years. Currently our government can't keep track of itself in the least. Do we really want to hand over our medical care system to them as well?

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