My Experience In America's Health Care System

I’m sick. It’s some sort of respiratory deal. It started last Friday with a sore throat and cough, settled into my chest and took up residence. Tuesday (yesterday) I decided that the wheezing was getting to a point of concern, and thought a call to the doctor was in order.

I’ve been seeing this doctor for five years. In fact, my first meeting with this doctor was for a very similar issue, five years ago. So she knows me. She knows I have a background in nursing. So, I think, well, let me just call the office, see if she’ll write me a prescription for an albuterol inhaler. I’ve been using one, left over from the last respiratory deal, and it helps, but it’s almost empty. Of course, I know she’s a very cautious, very thorough doctor, and think she might want to see me before she writes a script. Well enough.

So Tuesday morning, the fourth day of illness severe enough to keep this family breadwinner away from work for two days, I call at 9:00 am. I speak with the office person, who does a lovely job taking the message that I don’t know if the doctor would wish to see me or not, but if she could I’d like a prescription for an inhaler, as I am wheezing.

I hear nothing back. I ask my husband to check the pharmacy on his way home from work; but nothing has been called in, and of course, the office is now closed.

So now it’s evening, and into the night. I cough hard enough to shake the walls and literally frighten the dog. Any trip to the bathroom makes me so short of breath I can’t string two words together. I consider going to the ER, but it’s too expensive, and mostly I’m ok, as long as I don’t move much. Or recline too far. Or have a coughing fit, which only happens hourly. Or so.

So I pass a fairly sleepless night and call the doctor again, asking why hadn’t I heard? They tell me a message was left to call the office for an appointment. I have been sitting in a chair next to the phone 24/7 since I’ve been sick and other than a few telemarketers it hasn’t rung. I check later; there’s no message on the machine. Oh well, whatever. I make an appointment for 10:45 am (approximately an hour away).

I mentioned some shortness of breath? I try to wash up a bit, brush the hair and teeth, put on some clothes. It takes about half an hour. I do a little, and then I sit and breathe and try to get my self together, do a little more. I keep thinking this would have been a lot easier if my husband had been able to pick up an inhaler yesterday…

I get in the car and drive to the office. It is lovely and close, except for the walking across the parking lot part. I get to the window to check in, and there are three people standing there. I grab the obligatory mask and sit; wait for them to move away, trying to catch my breath. I notice an older woman looking at me like she’s afraid I’m going to code any second. The people start to move away from the window, but before I can get up, a drug salesman hits the counter. I wait a little, but I know that if I don’t sign in, I won’t get called. So I go stand beside him. Luckily a coughing fit takes me about then, and he quickly moves aside.

So I fill out the new form that has taken the place of the simple signature sheet to prove to the insurance company that, yes, I really was there, it’s okay to pay. And I fork over the $20 co pay required, all the time breathing like a steam engine gone crazy. She finally says “Have a seat, we’ll be with you soon,” and I do.

It literally takes about ten minutes for my breathing to subside to something that makes the older woman’s shoulders relax, and I finally pick up the spindling I brought to pass the time, knowing that they were “fitting me in.” But there’s a problem; the woman at the desk calls me back to the window, saying that I owe $20 from my last visit. Are you kidding me? Just moving from the chair to the window brought the freight train breathing sounds back, so I fish in my bag for my card again and pay the twenty. I couldn’t have even begun a conversation to dispute the charge. I take my receipt and head for the chair again.

Another five minutes or so and I’m still wheezing pretty violently, and I begin to wonder if I should just walk out and head for the ER. Just then my name is called.

I follow the nurse to the exam room, where she takes my vitals (T99.1, hr 117, r 24, bp 120/80, pulse ox 98, and since when did pulse ox become a normal part of vital signs anyway? You know they charge 300 dollars for a simple pulse ox in the hospital?) She asks if it’s ok that a student examines me, and I nod yes. I remember being a student.

So, another wait. This time I’m so wheezing and straining my eyes are watering, and I can’t even attempt to continue my spindling; I just sit on the edge of my chair and gasp. The student enters, and she’s nice, and she tries to frame her questions so I can just nod or give one word answers, which I appreciate, but I can’t help thinking that someone, somewhere along the line might have thought it appropriate to take a quick listen to my lungs and pop me on an albuterol respiratory treatment before getting too in depth into the history. Finally, she finishes her H & P, and the doc pokes her head in the door. They leave to discuss her exam, and a nurse comes in to set up the treatment. I’m so happy I tear up!

Then the doc comes back and explains the treatment plan. An IM shot of steroids, oral antibiotics, albuterol inhaler, and steroid inhaler. Fine, I just want to breathe. She leaves, I finish the treatment, thank heaven I’m not gasping anymore. I’m still wheezing, but comfortable, at least. The student returns with my prescriptions, and I see trouble ahead; she’s written for the same steroid inhaler she wrote me five years ago. The CO-PAY was almost a hundred dollars. I ask the student if there’s anything else, more affordable. She leaves to ask the doc, and returns with a sample of a different med. She tells me to not get the other filled. Ok, that works. (Did not give me instructions on how to use the new med, which has a different dosage and administration method than the original, but luckily, I can read package inserts.)

I get my shot, pack up my stuff and make it out to the car. The treatment has helped so much that I only need to pause for about a minute of gasping before I can start the car. I head to the pharmacy.

I arrived at the office at 10:40. I left at 11:50. Must have gotten the treatment around 11:30 ish. An hour is a very long time to be that short of breath.

At the pharmacy, I’m in for another treat. I’m told that albuterol no longer has a generic form, so my co-pay is $40. The spacer the doc wants me to use is another $35. I opt out of the spacer, get the albuterol and antibiotics they’ve prescribed and head home. I realized while writing this that the reason the albuterol co pay went up was because the doctor wrote for a specific form, albuterol HFA, instead of the perfectly good regular medication that has always worked fine.

I have spent over a hundred dollars out of pocket that will not be reimbursed. At that; I got off cheap. If I had done all that the doctor wanted, it would be: $88 + 40 + 20 + 20 + 22 + 35 = $225. And I still don’t know what I’ll be charged for the shot and the respiratory treatment, which will be billed to my insurance, and the plans we have are so complex I can’t even begin to figure out what my responsibility will be.

I know that I’m lucky. I have decent insurance, which my employer pays 100% for not only me, but for my family as well. I am acutely aware that this is unheard of, and it is in fact, the only thing that is keeping me at a job that has become more than slightly unpleasant. I could take a cut in pay, but I can’t take a cut in my insurance.

I’m also lucky because this, comparatively speaking, is minor. I mean, it’s not fun not being able to breathe, but after all, it’s not cancer, or something permanent. In a week, I’ll be fine, back to my normal self. And while I live paycheck to paycheck, this hundred dollar expense won’t break me. I’ll manage.

It does seem like there should be a better way, though. What if I didn’t have a car to get to the doctor? What if that hundred bucks WOULD break me; the difference between eating or having rent and not? Is it really necessary to drag a person this sick out of his home, to infect every person he passes, to risk complete obstruction of the airways because of activity? Is it really necessary for the prescription to be written for the latest, trendiest, most expensive medications? What if I had the ability to choose my job based on what I like to do, rather than on medical benefits?

What if we had Medicare for all?