I've never had a blog before, or anything similar to this, so I was not sure what topic I wanted to start the semester off with. But the suggested topic "What do I want from healthcare?" does have some personal meaning to me and can serve as a pretty good intro into who I am.
I have always had a slightly different view of healthcare from anyone else I know. I was born with a congenital birth defect, tracheo-esophageal fistula (TEF). Basically, the upper end of my esophagus ended in a blind pouch, while the lower end connected the top of my stomach to my trachea. After two and a half years of surgeries, over a year of which I spent living in the hospital, my pediatric surgeons fixed the TEF by removing a part of my large intestine and using it to connecting the top of my stomach and the back of my throat. Because of how the surgery was done, and the fact that intestinal tissue can be destroyed by exposure to stomach acid, I have taken prescription antacids my entire life (and will have to continue doing so).
My personal definition of health has thus always been skewed; I do not get sick a lot, I have never broken a bone, and I have no other problems with my health. But am I really "healthy" when I need medication every day just to make it possible to eat and drink normally? I know that if I stopped taking antacids the stomach acid would eat away at my de-facto esophagus and I would have to be placed back on a feeding tube. (What time frame this would occur over I am not sure- I have never wanted to test the idea!)
One problem I have experienced in dealing with our healthcare system is getting insurance to cover the antacid medication I need. Many times growing up I watched my mom argue with insurance companies who did not understand why a young child needed "heartburn medicine," despite the fact that all my paperwork explained my unusual situation. After I turned 18 I began taking them on myself, and once again have been frustrated. Every six months or so I need to re-justify both why I need the medication and why my part-time income is insufficient to pay for it myself.
The worst time was when I changed insurance companies. My doctor currently prescribes Nexium, which is rather expensive. So the insurance company wanted documented information about me trying other, less expensive medications and some kind of proof that they did not work. To me, it just seemed insane and ignorant. First of all, my doctor explained the various mechanisms of action of a few different drugs and decided what was best. Why does some phone bank worker at an insurance company have the authority to question or overrule that when they cannot even pronounce the name of the medical condition I have? And second of all, the medication "not working" for me could result have huge negative consequences...all to save them a couple bucks. Forgive me if I'd rather be safe than sorry, and still be able to swallow my dinner.
I am sorry that kind of turned into a rant, but what I want most from healthcare is for it to take care of people's health without always first checking the dollar signs attached to it.
I completely understand your rant. My family is experiencing issues with our insurance companies since we just switched to a new company. Our old company would send my mom's asthma medication no problem,despite being one of the more expensive ones. Now, with our new insurance, they want her to test all the cheaper alternatives before they'll cover her medication we know works for her. What I don't understand is what you are supposed to do when the medication doesn't work. Should I follow my mom around the ER (where she works) and video tape her gasping for air as she runs to a trauma patient's room? No I don't think so. I agree with you 100%! Why should some desk worker (without a medical degree!) be able to turn down my mom's medication and dismiss her doctor's expertise?
ReplyDeleteSorry this comment turned into a small rant. Maybe this topic just does that to people
I agree 100% with you Joe. But what you and every other person living in the United States has to remember is that insurance companies are out to make money. Its sad the way they make their money, but they are an industry. At the end of the day the C.E.O. does not care how healthy you are, he cares about his profit. I don't know if universal health care would solve the problem completely, but it might be a start. Something has to be done soon, because it just keeps getting worse. And like you and Jess said, what gives the receptionist at the insurance company the right to tell you the best medicine to take. It should be finalized by the physician.
ReplyDeleteThis topic is certainly rant-worthy! I know where you are coming from Joe, even though I wasn't born with something as severe as you were. Anti-reflux meds can be crazy expensive, I was on Zegerid for about a year, and that was $25-$50 a month, which sucked. I also tried Nexium, but that didn't work for me... Protonix was about the best I found but that was still $25 for a month's worth. I actually just recently stopped taking the stuff because nothing helps completely, and I don't feel like wasting time talking to insurance companies! In addition to that, my doctors don't seem to be willing to figure out the root of the problem, which could possibly be a better idea than just sticking me on medication indefinitely.. Oh well. I guess we can just hope it will one day be easier!
ReplyDeleteI have to say that this is one of the few blogs that really kept me interested from start to finish. Your story is really touching about everything you had to deal with specifically in the health care world. I never really had that issue before, but hearing someone else deal with an issue with insurance companies to receive proper medications is obscure. I really do the best for you and hope everything gets straighten out.
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