Redline Doc

Jun 21, 2009 - 4 minute read - Medicine Universal HealthCare

Death by insurance

Yesterday I lost another, friend. Death by insurance read the certificate, or so it should have. Geno was a kind fellow, gentle soul, never made lots of money but found himself suddenly underemployed, a polite term for being older and getting paid for fewer than 20 hours a week, then finding there is no health insurance

Ok, you think. Let this guy pull himself up by the bootstraps. He did. He got a second job. Still no insurance. Then he got Diabetes. Oops. Its not quite like a third job because you pay them instead of getting paid. You work harder. The doc says you should have less stress. Ok. I’m working a job to pay the insurance and another to pay for food, now I have to pay rent because the diabetes job just doesn’t bring in enough.

Oops.

Now you can be on state sponsored insurance, some of the time. You feel really terrible. He did. He worked all his life and was always responsible. Now he’s a ward of the state and working.  He gets headaches. He’s not feeling well. One day he falls. He goes to a doctor but they can’t see him because his limited HMO insurance wants him to see a doctor 40 miles south. He bucks the system but there are not many alternatives.

Finally he gets an appointment with neurology.  He has a grade 4 astrocytoma; not a good prognosis. Although he has insurance for this and has coverage, because of his limitations (he has memory lapses and poor focus) after the tumor is primarily removed,  he often forgets to take his medications or takes them improperly. Insurance has no use for home visits.

He slips. He has difficulties. The secondary job is history. The primary job lays him off. He’s now totally on the HMO. They say he’s ok free living. He has slips and fall. He’s ok free living. He forgets his medications. He’s ok free living. He asks for assist but they say he’s not elegible on this cheaper chicken HMO insurance.

He died yesterday. Now the HMO is off the hook. No more insurance payments. No doctor visits. No Gene. Seems like a good system. Death by insurance.

Lest you think this is an isolated incident -

Two years ago a friend of mine, a retailer, sucessful in business but a small retailer, began to have urinary tract pain. He had no health insurance because at more than 1500$ a month it was more than he could afford. Additionally, that amount was for catastrophic insurance, you see, as a child he’d had bladder problems and every insurance company pro-rated him.  Finally he gets insurance. He’s had, what he thinks, is a bladder infection. Its been so severe that occasionally he sleeps in a bath tub with warm waters.  Small catch. There’s a 90 day waiting period.

He goes to his doctor who, as he’d suspected, sends him to urology. They want to examine his bladder and because of prior difficulties with anatomy need to do this in a hospital. There’s this 90 day thing. We wait. He’s more comfortable but of course not better.

The bell rings. Its a bladder tumor. They biopsy – perhaps benign, although most are not. It is benign it seems. But theres a second troubling spot next to it. Not benign. The tumor is resected, he starts chemo and radiation and everyone is hopeful. There are all sorts of limits to this insurance policy he has – so greater exploration, whole body films and the like, aren’t done.

Two months forward, he’s a bit dizzy and falls. There is an ominous cracking sound in his neck. There’s a baseball sized tumor there. Now we do more work up. Its a metatastasis. Alas it was a death knell. When removed and the neck repaired a shower of tumors widely spread show up.  After an enormous fight he choses to let go.

No more store. No more employees. No more friend. These tumors when seen early are frequently non-fatal. With time the outcomes are more dire.

Death by insurance.