Monthly Archives: October 2011
This is a story with no ending, no neat resolutions – and it’s a topic that affects everyone. It’s about the state of healthcare in the United States. If this makes you yawn, I don’t blame you. It’s hardly a glamorous topic, but it’s one that has been on my mind since setting foot on American soil back in July. In fact, it was a recurring theme of my discussions with the English Husband. What would we do about healthcare if we decided to move back to the United States? Would we be able to afford it and how long could we possibly live without insurance?
A disclaimer before I launch in: I am not an expert on the healthcare industry and all of this is taken from personal experience. I don’t claim to have any answers, merely a lot of questions. Here’s the first big one: why does a country that is so advanced and civilized not provide even the most basic care for its citizens free of cost, without question? Some will argue that some of Obama’s reforms go some way towards making healthcare available to everyone, but people will inevitably slip through the cracks. I happen to be one of them. Being educated and middle class makes me even more of an exception.
In the UK there is universal healthcare for the entire population. When I went to live in London I never had to worry about how I would afford a doctor or what I would do if I was unfortunate enough to end up in the hospital. Despite the fact that for years I never had a stable job and that I was effectively an immigrant in a foreign country, I had as much right to healthcare in the UK as its citizens did.
The irony is that, once back in the country of my birth, I no longer have access to the healthcare I had in the UK and, to some degree, neither do my children. I came back here without a job and although I am doing my best to look for one, it could be months before something comes along. In the meantime I can’t afford to pay for some ridiculously expensive insurance plan for my family – it would cost thousands when we are trying to save money for the move. I feel like I’ve somehow been penalized for living out of the country. So what does someone like me do? You try to find subsidized care and this makes you feel like a pariah.
Healthy families is a huge headache
I hear about healthy families through my child’s school. It sounds good: affordable healthcare, heavily subsidized, for families who cannot afford to pay for it and who don’t have insurance. But trying to get this is like trying to find a cure for cancer. You will probably end up needing a doctor after the stress it causes. I happen to have a degree in English, but even I found it difficult to understand how you qualify. It starts straightforward enough – you need to fill out one of those exasperating government application forms. I get through this first hurdle and then get a letter – about a month later – with two official-looking insurance cards for my children. I think, great, this was easier than I thought. Wrong.
The letter unhelpfully explained nothing about how you get a doctor. I tried calling Kaiser to ask if they would accept these cards, and after some confusion and a stilted conversation, they tell me that they were closed to anyone with MediCal. I give up and decide to call healthy families for information. This is where I start losing the will to live. The only number you can call is constantly engaged. I spend an entire day trying to call and finally get through at 4.30pm. I am put on hold for an agonizing 40 minutes (they close at 5pm, by the way) and I am subjected to some horrific public-service announcements that replay over and over again; this is punctuated by even worse music. Eventually a human being comes onto the line and I ask about how I can use these cards. The person tells me that she doesn’t think I can use the cards because my case has not been resolved. But, I argue, your own letter says that the children will be insured while the case is pending.
‘Does it?’ she says.
‘Yes,’ I reply. ‘But I don’t know how to go about getting a doctor and I have a child who needs immunizations for school and another child who needs a health check before starting at a daycare. I’d like to see a doctor.’
‘Why don’t you look online?,’ she offers feebly.
‘But what am I looking for? I don’t know who accepts these cards. Don’t you have a list?’
‘Who is your doctor?’ I ask exasperated.
‘I use Kaiser.’
‘They told me that they don’t take these cards.’
‘Hmmm… not sure what to say. Why don’t you start calling around?’
Sensing I am getting nowhere, I hang up the phone and curse myself for wasting so much time. Then, two weeks later, I get another package from healthy families, this time with more forms – more complicated than the last – and requests for documents such as original birth certificates. I take too long to get this back to them and have to spend another day trying to get through to another human being to explain that some of these documents are in another country.
‘Okay, just send us what you have,’ she tells me.
‘It’s already late,’ I say.
‘Just send what you have.’
I get the feeling they have heard this all a million times before. I wonder about the many immigrants who come to this country hoping for a better life; many of them might not even speak English and have very little education. How are they supposed to make heads or tails of this overly complicated system that makes you feel like a dimwit and a drain on society?
Getting immunizations without insurance – don’t try it without a stiff drink first
Eventually I need to get my oldest child immunized for school, and I’m still waiting on healthy families to make a decision about my case. I try a clinic that has a limited number of appointments on any given day. Well, you can just forget trying to get an appointment unless you drag your kid out of school and stand in a line at 7.30am. After trying here twice, I give up and opt to call another clinic, where I learn that I can make an appointment. This is vastly preferable. I still have to take my child out of school, but I figure I will be able to drop her off afterwards. How wrong I was.
The day dawns and I venture into the heart of darkness – deepest, depressing El Cajon, where a man with a Santa Claus hat pushes a trolley with all his possessions down the street. I feel a bit nervous about the area and I’m not reassured when I spot a security guard standing in front of the clinic. Why do they need a guard? He tells people not to eat inside and ushers me to the front, where I sign in. This is only the start. I have to fill out more paperwork than I imagine the average bank teller has in a day. I have to answer questions about insurance, income, etc etc. By the end of it I feel like a total loser.
I take my seat with the other unfortunate people and spot a very large flat-screen Sony television in the waiting room. This says it all about the United States. Here we are, in a clinic for people with little or no money, but we are reassured by the huge television in the waiting room. Couldn’t this money be better spent on something else? It is American wealth in all its useless glory. Unfortunately it doesn’t work, the security guard says. Typical.
Two hours later I emerge with the wailing Chatterbox, clutching her yellow immunization record like a prize. Once home, I discover that they gave her more vaccinations than she needed and they failed to stamp her for the one immunization she absolutely had to have for school, Hep B. Off I traipse again the next day, into a vast sea of people to get this stamp. Luckily, this visit only takes 5 minutes and they give me a stamp with no drama. I feel like I’ve won a battle, but I am weary and scarred.
The San Diego Union-Tribune, my local paper, printed selected facts from the 2012 Census Bureau this weekend. One of these stated that only five percent of American workers use public transportation. And people who use public transportation in San Diego can save up to $11,000 a year. I’m not at all surprised the figures are so low despite the financial incentive. Using what qualifies as public transportation in San Diego is almost guaranteed to shorten your life. Only one person I’ve met has even attempted to work out the complicated bus routes that take twice as long to get you anywhere. Meanwhile, the San Diego trolley seems like a good idea until you see some of the people who ride it.
All of this is the polar opposite extreme to London, where those who drive to work are very much the exception. Everyone else has to schlep around on the tube (the Underground system) and use the buses which go to every destination imaginable. To get to work, I had no choice but to take a 10-minute bus ride to my closest station, Finsbury Park, and then get on the tube and negotiate a ridiculous number of tunnels while dodging people holding briefcases and huge handbags. Hesitate for more than a second during rush hour and you will have someone either step on you by mistake or tut at you. It would take about 45-50 minutes on average to get to work. I’m not saying it was ideal – it could get very tiring – but I did get to read a lot of books. In the 15 years I lived in London I never once drove a car. Not once. And, honestly, I didn’t really need to.
So, it comes as no surprise that one of the biggest adjustments I’ve had to make since returning to the United States nearly three months ago is getting used to the car. When I was 16 years old, the car represented freedom from my parents, a chance to strike out on my own. Fast forward 22 years and I’ve come to regard the car as a necessary evil. While I recognize the convenience of the car, especially in southern California, I detest having to use it for absolutely everything. Gone are the days when I used to nip to the shop, five minutes from the flat, to buy a pint of milk, cheese and bread. Instead, I now have to strap myself into that hulking great piece of metal and drive to – I shudder to say it – my local Vons, a supermarket so cavernous and dark that even an experienced explorer from the South Pole could get lost in there without a compass and flashlight.
But the worst part of driving everywhere is the school pick-up and drop-off. The British call this, rather neatly, ‘the school run’. The race starts at about 7am, as I rub my eyes and try to rouse my five-year-old from the bed we now share together. (An aside: never in my wildest dreams did I think I would share a bed with my child and not my husband. At 16 I didn’t even think I’d have a child.) If it’s hard to wake her now, I’m trying to imagine what it might be like when she’s 13. Luckily, my imagination fails me.
Because I am one of those unfortunate souls who doesn’t own a car in SoCal, I have to share my mother’s. This means dropping her off at work before dropping the Chatterbox at school. The whole journey takes an average of 45 minutes, the amount of time it took me to get to work in London. In the afternoons, the whole thing is considerably more harried, because it’s impossible to drive into the school without negotiating an obstacle course of cars, cones and frustrated parents. I prefer to park on one of the surrounding streets and then walk, passing kids holding stop signs and well-meaning parents wielding whistles.
In London, I used to walk across the street to my child’s school. Journey time: 5 minutes on foot. I realize how lucky that is, and I know what I prefer. I’m not trying to say that a car wouldn’t have been nice in London sometimes. Try negotiating a stroller up a hill in driving rain with about 10 pounds of groceries hanging off the handles. But I’d rather have the choice to do one or the other: take a car or go on foot. It’s a shame that more Californians don’t have a choice but to use the car.
When I was a little girl I had lots of diaries with colorful covers and, most importantly, locks. I never filled any of these diaries; I’d usually lose interest after about a week. I got to college and my entries got longer, but no more consistent. Finally, a few years ago, I bought yet another diary and managed to fill about half of it.
This blog, of course, is the 21st-century equivalent of all those scribblings. Although my track record isn’t great, I’m hoping that there will be some advantages to writing a diary in the digital age. The main one seems to be that I won’t get a cramp in my fingers after 15 minutes of furious writing. And I get to go back and change the entries I don’t like. I know that’s cheating.
First, some ground rules. I wanted this blog to be up to the minute. As it turns out, I come to most things late (except marriage and children – more on that in subsequent posts) but my posts are hardly going to be breaking news. I’ll write about things when they strike me.
Second, I’m crap with pictures. I’ve tried to embrace the digital age and get into all the gadgets that people use, like digital cameras. But I just can’t seem to get excited about small, shiny, metallic objects. Maybe this explains why I sent my first text at the age of 33 and didn’t buy a mobile phone until I had my first child in 2006. When the child came along, so, too, did the realization that I would have to be a Responsible Adult who is contactable in an emergency. In short, I’m going to do my best to make sure this blog has as many images as I can be bothered to cram into it, but don’t expect works of art. Miracles won’t be happening overnight.
Thirdly, when I refer to ‘we’, ‘us’, ‘our’, I am talking about my immediate family. This includes one English husband, who I met working in a cafe in Charing Cross, London, in 1996; two children, five and two years old, who will subsequently be referred to as Chatterbox and Raging Bull respectively; and a neurotic cat, Robbie, who smells and sheds hair on every single surface he comes into contact with. There is also a mother, a father (currently in Maryland because he weirdly wants to keep working until he decomposes), and a brother, who is more directionless than I am and still living in the family home at the age of 36.
Some of you might ask yourself, why ‘The Coffee Table Years?’ I thought I should get that question out of the way as soon as possible and leave everyone else who dips into this blog months from now totally in the dark. I feel like most of the progress in my life, or lack of it, has been defined by the coffee table. Having lived for 15 years in one of the most expensive cities in the world (London) I’ve not had the privilege of a dining room and a full-sized closet. Plumbing has been largely hit and miss. In fact, at the age of 38, I can safely say that most of our dinners/dinner parties/drinks/game nights/Christmases/etc have happened around our very modest coffee table in the front room of our modest flat.
I’ve recently graduated to a full-size table but it’s located in my parents’ house in San Diego, California, my hometown, and the place I fled to when I hastily left London in July. As much as I like this dining table – around which I’ve had thousands of family dinners as a child, teenager and adult – it doesn’t actually count, because it’s not mine and I didn’t pay for it.
Why return to San Diego, a place I’ve not lived in since 1994? This is all you need to know: Three months ago I was languishing in a job I’d lost interest in and we’d also lost our home in London, which we’d been renting for two years. It felt like a sign to try something new, in a new city, with new possibilities. The main obstacle, of course, was finding jobs to enable this great new life in a country I haven’t lived in since I was 22.
For now, I’m living in my brother’s old room, surrounded by his teenage stuff and sharing a bed with my firstborn, while Raging Bull spends her third consecutive month caged in a Pack and Play in my childhood room, now converted into my dad’s dream study. I truly hope she doesn’t remember this phase because she probably wouldn’t be very impressed. This ain’t the stuff of Pottery Barn catalogs. To say the transition is a bit of a shock is something of an understatement.
This journey back ‘home’, in all its infinite possibilities and frustrations, is what I intend to document here.