Category Archives: Healthcare

And what do you do?

About three weeks ago I went to the dermatologist. The waiting room was an oasis of calm cleanliness. It’s not what I’m used to. I suspect living in London has taught me to accept a general state of shabbiness, especially in public places. I am at the dermatologist to get a growth on my nose removed. It’s something I’ve wanted to get rid of before, but in London I needed a referral from my doctor to get this little thing seen to. It might seem straightforward enough, but it was an exercise in exasperating bureaucracy – and I never got around to it.

I leave the doctor’s office feeling a bit like a tropical flower. I also now have a huge bandage on my nose.

Here, in the United States, getting the growth removed took less than an hour and only $200. I have no insurance, so I’m immensely glad not to be slapped with a huge bill. But I still feel uncomfortable every time I show up to a place where the receptionist asks patiently, ‘Do you have insurance?’ Saying no makes me feel irresponsible and, rather oddly, like a leech sucking the system dry. I don’t know why I should feel this way because I am paying for my treatment on this occasion.

My discomfort doesn’t end in the waiting room. I’m ushered into an inner office where I wait for the doctor to see me. He takes one look at my growth and says he’ll take it right off with a scalpel, but he’ll also do a biopsy to make sure it’s not cancer. As he prepares for this procedure, he says: ‘Wow, you have an interesting face. It’s unusual.’ His assistant adds: ‘Yes. I think it’s what you would call exotic.’

Exotic? I’m feeling a bit like a tropical flower that’s wandered in from the jungle. Is this how the Mona Lisa feels while tourists snap photographs from every conceivable angle? To make matters worse, this conversation is taking place while they both poke my nose.

‘You’re right, it is exotic,’ says the doctor, as he takes out a needle and injects it into my ‘wannabe mole’. I fake a laugh, trying not to betray my discomfort.

I have a follow-up appointment yesterday, and I’m inwardly cringing when my doctor and the same assistant walk into the sterile room I’ve been put in. ‘I remember you,’ the assistant says enthusiastically. I’m thinking, ‘Great, just what I wanted.’ They once again bring up my exotic looks, but then the conversation veers in another direction.

‘So, what do you do?’ says the doctor, trying to make conversation and put me at my ease. (He’s failing spectacularly.)

I really hate this question. It’s innocuous enough when you have a job and a purpose to your days, but when you spend most of your time trying to keep your children from destroying your mother’s house and each other, I feel like it’s loaded with potential misunderstanding.

‘I don’t have a job right now.’

‘So, what were you educated in?’ he persists, looking down at the book I have resting in my lap. It’s trashy, by the way, so I cover it with my hands.

‘Right now it seems I was educated to look after two kids,’ I reply with a straight face. This gets me a few laughs.

The doctor then launches into a lecture about how studying is important for meeting someone who is your equal. I suspect his children have been taught that anything less than a career in medicine, law or engineering is really not worth pursuing. I remember my dad, who is an engineer, once saying something similar when I told him that I was going to get a degree in communications. His look can only be described as crestfallen.

‘I don’t think you have to be educated to be intelligent or meet your equal,’ I say. He appraises me carefully, but I’m not sure what he is thinking.

‘Goodbye, Mom,’ he says, as he shakes my hand. I want to scream, I’m not your mother, but it’s useless to protest about this. I’ve encountered it many times before.

I leave the doctor’s office and replay the strange conversation in my head. Why should it matter to me what he thinks? Why should it matter to me that I don’t know what to answer when people ask me what I do, especially in professional spheres? It shouldn’t matter at all, but it leaves me feeling like I’ve tasted something bitter.

Next time someone asks me this I might tell them I am a hand model. I’ve always had good nails.



Filed under American life, Healthcare, motherhood

Don’t get a snakebite in the United States

Those of you who have read this blog from the beginning will know that one of my biggest worries before moving to the United States was finding affordable healthcare for my family who was coming from London, where it is socialized. I wrote several postings about my adventures in healthcare, which threatened to give me a nervous breakdown.

Well, I was right to worry so much about it. Today, on the local San Diego news, I heard about a 23-year-old Norwegian exchange student who was bitten by a baby rattlesnake on his way to his car in a parking lot.

He managed to limp his way to a hospital – he was luckily across the street from Scripps Mercy Hospital in La Jolla – and was treated at the medical facility overnight.

He says his care was top-notch. Good thing, too, because his bill came to … drum roll, please … $143,000. The anti-venom he was injected with twice came to a staggering $128,050. An itemized bill flashed on the television screen with bits highlighted for viewers.

I’m not sure who is setting these ridiculous prices, but there is something obscenely comical about it. How can an injection for a snakebite cost over $100,000?

The poor kid did, thankfully, have insurance. His insurers – who claim they have never seen anything like it – are now in a dispute with Scripps over the billing, which was apparently ‘accurate and appropriate’.

You can read how a Norwegian website in English reported it here.

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The indignity of healthcare, part 2

Health clinic

The outside of the clinic - you can't see the bars on the windows from this angle

One of my first posts when I started this blog was about trying to find subsidized healthcare in the United States. Without a job I was very worried that I would become one of those Americans who has to pay for full healthcare out of their own pocket or who simply chance it and hope for the best. According to a 2002 census report, 15% of Americans had no health insurance for the whole of that year, a total of 43 million people. The proportion of uninsured children was 11 percent of all US children (8.5m people) in 2002. These numbers are likely to have risen in the ensuing years.

Before boarding the plane to start a new life here, and for weeks afterwards, I had visions of being in a car crash that would leave me bankrupt for the rest of my life. I couldn’t envision my injuries, but I could envision the medical bills piling up.

I was finally approved for a healthcare plan in late December – subsidized by the state of California – and the coverage started on January 1. Less than two weeks later, the Chatterbox gets a minor illness and I get to put my new plan to the test. Monday morning: the first thing I realize is that I don’t know what I’m covered for and I don’t have a clue who my doctor is. This is an uncomfortable feeling and one that makes me realize how precarious my existence is in the United States. I don’t know how the system works and I feel like I’m blindly groping for the light switch. I may have been born in this country, but I have never had to worry about my own healthcare because I was always covered by my parents’ insurance plan. Now that I am responsible for someone else, I am slightly panicked about how to get the best care I can afford. These are not problems I encountered with the NHS – and I was very thankful for that.

Getting an appointment

I call up one number listed on a form and then another. I’m eventually told that the Chatterbox has been registered with a clinic 20 miles away. Back in December I filled out some forms choosing a local doctor, but for some reason they did not honor this. Not that surprising, really. I call up the clinic and it takes ages to get through. Then I’m told the computer system has crashed and they can’t see what appointments they have that day. Then I’m told I’ll be put through to reception. Then the phone gets disconnected. Then I call again.

‘Come now,’ says a woman on the phone.

‘This minute?’ I ask.

‘Yes, now, before it gets too busy.’

I grab the kids, throw them into the car and head in what I believe is the right direction – and I am bad with directions. It takes me half an hour to find the place. It’s not a good first impression. What can I say? It’s a depressed area with a lot of squat dilapidated houses, surrounded by liquor stores and fast-food restaurants with neon signs. Beat-up cars rumble down a busy street. The only cheery thing around here is the sunshine. Outside the entrance there are cracked plastic seats – I can’t tell if they have been cracked by the sun or overuse. Things don’t get better inside. It’s dark and dingy, with seating arranged around a semicircle. There is a television with no sound in one corner, and a vending machine dispensing unhealthy snacks. I fill out yet more forms that make me feel like a non-person: questions about insurance, about liability, about social security numbers, driver’s license numbers, etc.

I sit outside on the plastic chairs that face a parking lot, because everyone inside is hacking. I imagine tentacles of illness in the air, germs smeared all over the old furniture. Nothing looks like it ever gets cleaned. An older man with a terrible cough walks outside and spits in the dust. I pray this won’t take long. It does, of course. We are finally ushered inside and the nurse tells us to take a seat while we wait for the doctor. We are in a tight hallway with one ancient green plastic chair. Not even the kids want to sit on it. Instead, I lean against the wall and wait.

And the bill is…

There is nothing seriously wrong with the Chatterbox, which is a relief. I was imagining an infection because of her nasty cough and the fever she has had for two days – but I’m told her chest is clear. I am prescribed an antibiotic as precaution (is this necessary?) and a nasal spray.

I still don’t know what, if anything, I will be charged for this visit; but when I go to the pharmacy to fill the prescription I am told that I don’t need to pay a thing for the medicine. I was imagining at least $20. My mother begins whispering in my ear about why this country is bankrupt. She is half joking, but I don’t listen. I want to pay my way; this is just a blip while I try to get on my feet. Should I feel guilty? I don’t know. I’m not going to seek welfare or go on food stamps, but if I got slapped with a huge medical bill, I know it would be a struggle to pay it. Yet I feel a stab of shame when I hand over my plastic insurance card, for people on low incomes, to the pharmacist.


Filed under Healthcare, transitions

The indignity of healthcare, part 1

immunization record

Getting this up to date has probably deducted five years from my life

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?’

‘No, sorry.’

‘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.

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Filed under Healthcare, transitions