Universal Health Scare

Millions of people, including some kids I know are without health insurance in the US.  Many of the lucky ones who have coverage pay up to 50% of their monthly income on premiums (like my mother, for example).  Many others don't actually receive the benefits they are promised.  Most of us have seen Michael Moore's Sicko (or at least The Incredibles), and know the common arguments.  We know the evils of HMO's.  We know how they make a killing denying benefits and cutting people off from their replacement organs.  Very few people would argue that the United States has a brilliant health care system that serves all its citizens fairly - and those who would make such an argument probably aren't poor, middle class or in need of pre-approval for life saving surgery. 

There are some very strong arguments out there to universalize the health care system and put it in federal/state government's hands.  Let it be said that I believe that this is possible, and that it is a good idea, depending on how it is realized.  The system is thoroughly broken, and needs something needs to happen soon to fix it.  I was a huge fan of Bill and Hillary's efforts to overhaul health care in 1992.  I am a supporter of Barak Obama's current proposals.   A good start would certainly be cutting administrative costs and protecting children.  I agree that we're not yet ready for a completely federally run healthcare system and that, like it or not, we are going to see private insurance and providers carry us through at least the next generation or two of Americans. 

I live in a country (Costa Rica) that has universal health coverage for every citizen, administered and paid for by the federal government.  I live in a country that has four million citizens, so this is in fact possible.  The health care here pretty much is broken, but in a different way than America's... While the system up there is corrupt, held together like shattered safety glass, ours could be more described as moth eaten and full of holes.   

For the first two years I was here, i found no occasion to see a doctor or a dentist.  My health was fine, and I just happily buzzed along, assured by the fact that I had a card that entitled me to services whenever I needed them.  Most of my local friends from the US who needed serious medical care chose to go to private medical clinics, as the word on the street is that the best practicioners end up there.  Most of my students and Tico friends went to the public clinic.  Since we got the positive results about the baby, we have done one ultrasound through a private clinic (better quality video and pics) that cost us around $50.  Not bad for a check up and full baby monty (okay, not the FULL monty - we still don't know the gender).   Since then, we've been taking advantage of the free public services.  I must say, that while it is nice to not have co-pays, premiums, pre-existing conditions, etc. to contend with, the sustem here has been rather maddening. 
Sandra went for her first check-up and was immediately labeled "high-risk" for "obesity" and advanced age.  She is a little big for four months, but to call her Obese?  And she is 36 years old... Anyway, the local doctor told her she couldn't receive any more services until she went down to Puntarenas hospital for a battery of tests. 
Puntarenas hospital is one of the scariest, most unhealthy places on planet Earth, right up there with Abu Ghraib.  There are always people bleeding in the waiting room, patients get lined up in beds in halls and people with broken bones leave equipped with paper mache casts that barely hold their limbs in place, often at funny angles.   the next stop after Puntarenas is always a private clinic... (Not all the hospitals are that bad, but it is the closest to us...)
Sandra took the three hours public bus trip down to the hospital on a tuesday morning.  The bus arrived at 8:30 AM, and she headed into the maternity unit.  She was promptly greeted and told to come back the following Friday, as there was no one who could attend to her that day.  The bus back to Monteverde didn't leave until 2:30, so she spent a total of 11 hours waiting in the sun and traveling on rocky roads to get an appointment.  There is no phone reservation system.  Talk about high risk...
    the following Friday, I took off from school and went down with her for the second attempt.  We arrived again at 8:30 in plenty of time for our 9:00 appt.  We were called into the specialist's office at nearly 11:00, and the appointment lasted all of six minutes.   The doctor listened to the baby's heart, felt Sandra's belly and told us that she is fine and there was absolutely no reason for her to have come down, risking a miscarriage on the bus.  He was furious at the clinic doctors in Monteverde. 
So now we're cleared to get tests done in Monteverde.  To do so, one has to be at the clinic before 6:30 am to get in line (otherwise all the day's appointments get filled).  Twice now she has gone to turn in fluid samples and been turned away.  We did manage to  get in one day and were told she has a UTI and given antibiotics. 
But wait, there's more!  I decided that since we were having such luck with our pre-natal care, I'd pay a visit to the clinic dentist.  Sandra got an appointment for last Thursday at 7:00 and we all went together.  I waited in line and was selected for a 10:00 appointment.  Everyone around was red with envy.  We got Bismark a vaccination  that he needed and Sandra's check up wound up being on time and easy. 
At 9:00 or so, the dentist came out of the office and called a name.  No one answered.  She called the next name and that too was met with silence.  I sauntered over and asked how many people were ahead of me, and she said "Aw, just come on in."  So far so good.  I sat down in the well used chair and stared into the familiar mouth illuminating light.  My first check up in three years.  A simple cleaning, right?  Wrong!   
I opened up and she peeked in, immediately counting "1,2,3,4,5,6,7,8,9... nine cavities" she pronounced to her assistant.  I thought to myself, "what is she doing?  She hasn't even touched any teeth.... and she's... Were's the little mirror?  Where's the little metal tooth scraper thingy?  When is she going to ask what flavor of tooth polish I'd like?  I sure hope they have cherry!"  It was around that point in my inner monologue that I felt the first wave of pain and realized that she was drilling.  No warning, no anesthetic, just a piercing shrill electric drill.  I ran my tongue over my teeth quickly the moment she took a break, and two back molars were already hollowed out.  The assistant came over and filled them from a squeeze tube of liquid metal.  When they were filled, I asked her to stop and said I'd like to get a second opinion about the other seven cavities.  She said she was done anyway, because the rules prohibit her from filling more that two at a time.  She handed me another appointment for next Tuesday, ominoustly labeled "cleaning and care" and called in the next patient, who sat down before I was out the door.  I considered rescuing them, as she fired up the drill again, but this one seemed to expect what was coming. 
Needless to say, I made an appointment with a private dentist.  It will be worth the chunk of paycheck for peace of mind. 

Last night I couldn't sleep for the pain in my jaw.  They put too much metal in, and I'm pretty sure the handiwork will have to be filed down soon.  When I did finally sleep, I dreamed I was on an assembly line and anonymous people in medical masks kept cutting pieces of me off and replacing them with things like old tennis shoes, a blender, and bicycle parts.   

The moral of the story is that our signs need more that just calls for Universal health care, because quality should probably be part of the equation as well...

Comments

[moose]

I recently paid almost $1000 to a dentist for cleaning, x-rays, and filling 3 cavities. Nonetheless, I'm making an appointment for you!

[eric:p]

Good grief! What an ordeal. An important post. Thanks, J, and I hope everything goes more smoothly with the baby from here on out..

[Ryan]

Mothereffer, man. I would be embarrassed to be a doctor or health care worker who treated anyone that way, much less a pregnant mother. Christ.