Growing up I grasped the logistics of healthcare and insurance only in the abstract. In my upper-middle-class childhood experience, things were simple. Whenever I needed medical care, I got it, and as far as I could tell it was good, without so much as a wasted day in a waiting room.
I had seizures as a child, which could have been a lot scarier than it was. But because my parents were able to get me to people who knew what they were doing (Children’s Hospital of Orange County, or “CHOC”), ultimately it seemed not that big of a deal (which, in the spectrum of seizure disorders, it wasn’t).
Otherwise, I wasn’t at the doctor’s much. Strep throat brought me there more than anything else. I broke a finger once, got mono, needed a few stitches a couple of times, was on antibiotics a few times when they were actually called for. And of course there were my annual check-ups.
For the first few years when I was first out on my own, I remained covered under my parents’ insurance plans, so nothing changed, except that I required medical care even less frequently. And so when I no longer covered, considering that I couldn’t afford it anyway, I fell into the pool of relative paupers at the mercy of fortune and whatever help you get when you need medical care but can’t pay for it. Lucky for me, I never found out.
Years went by without my becoming much more of an earner. Eventually my mother stepped in with some financial assistance, with the condition that I re-enter the world of the insured. Thus did I find myself a member of Blue Cross, which eventually became Anthem.
My good health luck held, and rarely did I avail myself of my Anthem/Blue Cross coverage, which didn’t include preventive care—ironically, maybe the one bit of healthcare that absolutely everyone on Earth should be getting. Every two or three years I’d come up with some concern so I could get the equivalent of a physical without spending several hundreds of dollars out of pocket, but doing it annually was still cost-prohibitive.
Then there were the jumps in premium, sometimes tied to age milestones, sometimes tied to market forces beyond my ken, often as high as 25% in a single step. And so early this year, with such a jump heading down the pike and the Affordable Care Act making things more favorable to my getting the government to pick up my healthcare tab, I kissed the world private insurers goodbye and entered the land of Medi-Cal, the California version of Medicaid.
Elsewhere I’ve documented my struggles to sign up with Covered California—although it only got worse from there. The short version is that, while I have no opposition even to true socialized medicine in principle, my personal experience with “Obamacare” comports with the general opinion that it was implemented with impressive incompetence. Finally, though, after about nine months of perseverance, my State of California Benefits Identification Card arrived in the mail, eventually followed by an informational packet welcoming me to my health plan (administered through a local managed-care provider). From there, a phone call cleared up some final details, such as the primary-care physician to whom I was assigned (I hadn’t chosen one, since the doctor I’d seen through Anthem wasn’t an option), and I was off. I phoned up and made an appointment to get the first physical I’d had in years.
“Are you fucking kidding me?” I said as I pulled into the dingy strip mall housing my primary-care physician’s (PCP, they call it in the trade) office. I felt like a cultural elitist as I said it, but this was the first time I was seeking medical care in a lot where a 7-Eleven would have been at home. For a few moments I considered blowing off the appointment entirely, but remembering what they say about how not to judge a book, I went inside.
I was right on time, although while making the appointment I got the distinct impression that appointments were not the norm, and rather that my wait would be determined wholly by the number of people who happened to be there when I arrived. (I had phoned a doctor located a bit closer to home to see whether it might be worth changing my primary-care physician before my initial visit, but when they told me they didn’t take appointments, I decided to stick with what I had.) Fortunately the waiting room wasn’t crowded, so it seemed this would be a non-issue. Through the receptionist window that seemed more like what I expected at a medpot dispensary than a physician’s office I was handed a standard batch of intake forms, including one inquiring about my personal and family medical history.
This brought to mind one of my initial concerns. When I had set up the appointment, there was no inquiry about acquiring my existing medical records from my prior doctor. And while I knew they didn’t document anything my new doctor needed to know, he couldn’t know that. And in any case, even when a patient is in perfect health, shouldn’t a doctor want to see, for example, the results of the patient’s most recent blood work so that any subtle trends might be revealed before they manifest as not-so-subtle problems?
Worse yet, the receptionist told me that I didn’t need to fill out anything on the forms, save the highlighted places calling for my signature or initials. “You don’t need me to fill out even the medical history?” I asked with incredulity. Nope. I resumed my seat and filled it out, anyway.
As a television in a high corner of the room pixilated the way TVs do nowadays when the digital signal is insufficient, offering abstract blocks of color and bursts of incomprehensible sound, I noticed on one of the forms I was being asked to sign a waiver “consent[ing] to the photographing, filming or videotaping of [my] treatment or procedure.” That’s weird, right?
Before long I was ushered into an examining room, where the chatty assistant taking my blood pressure embarked upon an unsolicited, friendly rant about how busy they had been since Covered California had shuffled off a percentage of their newly insured to Medi-Cal. “All day new customer,” she said with a harried smile. “So many don’t know how to fill out form. We have to spend hours just helping fill out form.”
I was left alone to take in the dingy walls, the standard-issue informational posters about immunization and HPV. Among them was an “IMPORTANT PRIVACY NOTICE[:] Our exam rooms have open ceiling walls. Please notify our staff if you wish to discuss private and confidential matters so that we can do so inside the doctor’s office or another private location.” As if on cue, I heard the doctor enter the exam room next to mine, where a woman told the doctor the story of her recent hospitalization for a psychotic episode.
Presently the doctor entered my room. Two problems. The first, while not his fault, was a deal-breaker: his English, while far better than my non-existent Vietnamese, was quite limited. If there’s one person with whom you don’t want a language gap, it’s your doctor.
But even if my native and only language tripped off his tongue like it does off Tom Stoppard’s, the second problem—which was very much his fault—would have driven me to a new PCP for good. While he seemed like a friendly fellow, he did not spend even five minutes with me. He asked me why I was there, listened to my heart and/or lungs, and then handed me an order for what I presume was a standard blood panel.
I’m no doctor, I don’t even play one on TV, but I’ve had enough physicals in my life to know that they involve more than a stethoscope to the thorax for ten seconds. I get that I’m apparently healthy and that perhaps anything wrong with me may be more likely to show up in lab results than in the examining room. But doc, don’t you even want to have a look?
Back at home, I found myself poring over the small list of PCPs in my area, about none of whom I knew the slightest thing. What to do? Then I had what seemed like kind of a stupid idea. Considering that the exterior of the office in which my last PCP had in fact been a perfect representation of what I found inside, why not have a look via Google Street View at the exteriors of the other potential PCPs?
Seeing an office that looked like, well, the sort of doctor’s office to which I’d become accustomed, I contacted my insurance plan and switched PCPs. The worst thing that could happen, I figured, was that I’d want to switch again—an annoying possibility, but not exactly life-and-death.
What I learned during that phone call was that switching PCPs is easy. The closest thing to a wrinkle is that you can only see one per calendar month, and so if I saw my new one and didn’t like him, either, I wouldn’t be able to see a new one until the month expired.
But as it turned out, the difference here was like that between the old and the new was night and day, although that wasn’t clear at first (even if the office was nicer), since this time I wasn’t even presented with a medical-history questionnaire. But it turned out that this doctor liked to ask the questions himself, filling out the information himself as he gave me a thorough interview prior to the thorough physical (after which he scheduled the standard blood panel, which was done quite proficiently in the same office complex). Plus, there was no language barrier.
The lesson here is simple: even on the public dole, don’t settle. In a perfect world the medical care to which you’re assigned would be top-notch. In the world we live in, it ain’t necessarily so. But that doesn’t mean you have to grin and bear it. There are good and bad doctors in every tax bracket. If you’re not happy with what you get, get something better. It’s your life.