Health Insurance

Preface to this blog: This posting was written in 2008. In 2009 my partner Mark had an experience with the medical industrial complex, as we now refer to it, which more dramatically reveals that it is irreparably broken, with no hope of repair beyond revolution. Stay tuned for that story.

I was fifty-six when I first got health insurance. Two years later, I’m wondering if it was more of a burden than a benefit. Here’s the story.

I have arthritis: I’ve had it as long as I can remember and in as many places in my body as there are joints. Before Insurance, which I will refer to as BI, I did what I could with over the counter pain relief, an occasional shot of cortisone, slings for my arms to relieve tennis elbow, and hiking poles for the downhill stretches. When I tore my meniscus hiking the Grand Canyon (I probably already had a partial tear due to weak joints caused by disintegrated cartilage) and could barely walk down the stairs, much less squat in the garden, I shopped around for the most affordable orthopedic surgeon, who gave me a discount for cash, and under a county indigent fund got the hospitable bill paid off. The surgery was arthroscopic, and I was hiking the trails again within a few weeks.

So when I actually qualified for insurance, through a new state program that covers the under-employed and self-employed who can’t afford private insurance, I figured I was home free, at least with the stuff that Western doctors are supposed to be able to deal with. I finally had the ugly subcutaneous benign something or other removed from my upper arm, a colonoscopy (ugh!), and a few other check-ups that I was supposed to have before fifty.

My left thumb was already in trouble before I got the insurance, but the bone spur that developed at the base of the joint became increasingly painful. If I accidentally banged it against a wall I almost fainted. So I got a referral from my doctor at the rural public health clinic, which is the only place I’d ever gone to see a doctor (other than the guy who repaired my meniscus) and off I went to the hand specialist in Santa Fe (it wasn’t really “off I went” because it took almost two months to get an appointment). He sent me for specialized x-rays, and another month went by before I got his pronouncement: I had a deformed bone between my thumb and wrist and the treatment is called arthoplasty — as opposed to an arthroscopic — surgery to remove the bad bone and either replace it with a small piece of tendon from my arm, fuse the bones together, or implant an artificial “spacer” between the bones. I opted for the tendon, and he told me I’d have to wear a cast for a month, then go to a removable brace so I could start physical therapy, and be good as new (with maybe a little less strength than before) in three months.

I kept putting off the surgery because my life kept getting in the way (should I not go back east to visit our younger son who was obviously depressed as hell his first semester at the University of Pennsylvania, should I not be able to make pies for Thanksgiving and Christmas, or should I miss cross-country ski season?). But eventually I couldn’t stand the pain, and I had the surgery January 16.


It is now the end of June and these past six months have been some of the most miserable of my life. My hand has not only not healed but has triggered a chain nerve reaction in my arm, shooting pain from my hand up to a frozen shoulder and across my shoulders and even down my back. The surgeon was prepared to recast my hand—“it shouldn’t be hurting like this”— and sent me off for an MRI for my shoulder, where they shove you into this tube that is inches away from your face and tell you to be sure not to move because then you’ll have to start all over. They give you a panic button to push (and many people do panic, you can bet on that) and then the noise begins, the whirring and pounding and whining, despite the ear plugs. I closed my eyes and didn’t move, so it was over in 20 excruciating minutes. When the surgeon saw the MRI he said I had a small tear in my shoulder tendon and some abrasion, but that it really shouldn’t be causing me this much pain, so he sent me to his partner, the shoulder guy. The shoulder guy saw me for ten minutes, max, and said the same thing: these injuries shouldn’t be causing your shoulder to freeze up, which we need to unfreeze. He didn’t even want to look at my hand until I insisted: “That’s Dr. _______’s business.” But then he looked at my hand for a few minutes, asked me some questions, and said, “I’m going to go call Dr. _______. So he spoke with Dr. ________ on the phone, came back into the room and said, “I think you have Reflex Sympathetic Dystrophy.”

I, of course, had no idea what Reflex Sympathetic Dystrophy was, and he didn’t enlighten me, except to say that surgery seemed to have set off some nerve problems in my arm, that he wanted me to get a bone scan for diagnostic validation, and then he’d send me to the pain clinic on the floor below where they’d give me a shot in the neck. “What kind of a shot?” I asked. “A local anesthetic,” he said. “You may have to get it a couple of times but that should do it.” I got him to write down the name of this diagnosis before I left, and I went home.

Notice that he said “A shot in the neck.” What he didn’t tell me was that the treatment he was prescribing is a shot in the spine, that Reflex Sympathetic Dystrophy is one of those autoimmune classifications that doctors dump illnesses into when they can’t really figure out why you’re in so much pain, that there is no definitive diagnosis (not a bone scan or a blood test or anything else), and that there is no effective treatment. I learned all of this on the Internet the next morning, of course. As soon as I saw that RSD, or as it’s also called, Complex Regional Pain Syndrome, has a support group, like Sjogrens (which I already have) and fibromyalgia (which my younger sister has) and that I was consigned to a life of never ending pain and debilitation (as testimonials on the web site declared) I burst into tears.

After weeks of bitching and moaning and wishing that I’d never gotten the insurance and never had the operation, I decided to get a second opinion, which meant I had to be thankful that I could afford to do so—meaning that I had the insurance (fifty per cent of bankruptcies are triggered by medical bills). And I actually found someone who is trying to heal me. He’s a sweet Jewish doctor from New York, which immediately made me feel better, who had me in his office for two hours reading the medical records I’d brought with me from the other orthopods, listening to my story, asking me questions, looking at my whole body, recognizing me as a person with a medical history who might need some holistic treatment and gentle reassurance. He said, “Let’s not assume you have RSD, doctors don’t know everything,” and sent me back to the physical therapist, who is loosening up my arm. He also, without any request on my part, gave me a prescription for Valium, so I could sleep, and asked me if I wanted to try a new drug that might or might not work, to help relieve the pain.

So I took the drug, which does help, I’m loosening up my frozen shoulder with a physical therapist who also told me, “Let’s not go there.” I’m actually managing to fall asleep without the Valium, and the pain is diminished. So while I haven’t “gone there,” to the land of chronic pain and suffering, I still have a ways to go to the place where everyone experiences a little pain and suffering.

Solution: A complete revamping of the health care system, where everyone is covered by government, single pay, comprehensive insurance but also assigned a health care advocate who follows your course of treatment, informs herself about diagnoses and what treatments are necessary, possible side effects of treatments, what alternative treatments are available, etc. This person should be the doctor, but that probably ain’t going to happen, so let’s find someone else and pay them well to do it. The system would end up saving millions of dollars in uncalled for diagnostic tests, treatments, rehabilitations, etc. And patients might feel like human beings again.