Getting what you pay for?  

Before my near heart attack and subsequent quadruple bypass, I pretty much had one doctor, not counting my dentist— my Primary Care Physician. His name is Joel. I saw him regularly for check-ups and the occasional sinus infection. I went to him with the chest pains I thought were acid reflux, the chest pains that turned out to be a 90% blockage in three of the major arteries to my heart. Joel essentially saved my life when he set up the stress test that found the blockage just before it would’ve killed me.

Now, after my bypass, I’m under the care of two cardiologists: my main one and another one from the same practice who happened to be on duty in the ER the night I came in with an accelerated but shallow pulse. He diagnosed it as SVT (supraventricular tachycardia) so I check in with him every so often.

While my visits are tapering off, I still drop by my psychologist every six weeks.

I see a urologist because Joel discovered I have low testosterone.

I go to a podiatrist to get orthotics to correct the unusual arches in my feet.

I see an endocrinologist periodically because of the benign, but ever-growing, nodule on my thyroid.

Joel’s sent me to a pulmonologist because the endo found a cyst in my lung (I knew about the cyst; I’ve had it since I was a child).

I see an ophthalmologist now that I need trifocals and for that eye infection I can’t seem to shake.

I’ve been to physical therapists because of a rotator cuff and bulging disks in my back.

I get a colonoscopy every five years because they found a polyp two exams ago.

I’m taking, or rubbing on myself, six prescription drugs every day. That doesn’t count the low dose aspirin, fish oil, and other supplements various doctor have recommended.

Medical professionals use “for your age” a lot more now when we discuss my various ailments. Sometimes it’s sort of positive: “you’re doing well for your age.” But mostly it’s: “that kind of thing is expected for men your age.”

My quadruple bypass was my Big Event. Old people have those. My mother’s Big Event was an aneurism at fifty-seven that killed her instantly. My father’s was in his early 60s, his first stroke. He had his second stroke soon after and it was downhill from there. I was blindsided by my Big Event; it came out of nowhere. Now my life is divided into before my Big Event and after.

I’m lucky; I have really good insurance. When I’m checking in for one of my many appointments at the front desk, the receptionist’s posture straightens and her eyes light up when she sees my insurance card. I pay $5,100 every year for this privilege. (That’s for a family of 6) Even with that steep fee, there’s a “co-pay” on top of it, $20 that they ask for up front, before my visit to the doctor or specialist. There’s a co-pay for my prescriptions, too. That can be as little as $5 or as much as $30.

I never quite understood the co-pay. On top of the thousands I’m already shelling out, they need that little bit more. It’s like the ante in a poker game, I guess, or the cover charge at a nightclub.

The bill for my bypass: from admitting me on a Thursday evening, the angiogram the next day, waiting, watching cable TV Saturday and Sunday, the open heart surgery Monday, then recovery the next four days came to $158,000. They mailed us a copy. Because I’m insured, I only owed about 3% of it. Without insurance, I would’ve been on the hook for the whole thing.

In the States, we’ll never deny medical care for anyone who needs it. That’s true. It’s just a matter of how much debt you have when it’s over. Major medical events like mine bankrupt some families. It wipes out life savings, college funds. People lose their homes. It can devastate lives.

We didn’t have health insurance when I was a kid. My dad “didn’t believe” in health insurance, like it was the Easter Bunny or ghosts. He called it “a racket,” paying into a fund you never use. In his case that was pretty much true, it worked out for him. No one in my family really had any major medical problems. The two times I went to the hospital my dad whipped out his checkbook and paid in cash!

Of course, it was 1967 and hospitals didn’t charge sixty dollars for a Tylenol and I didn’t need surgery. Twelve days in the hospital cost just over $376 (I found the original bill). Okay, gas was a quarter a gallon back then, too, but still… They charged us twenty-one dollars for the room each day; an x-ray was five bucks…

The myth is: the more you pay, the better the care, like it’s a cut of beef. But there’s a point of diminishing returns. Our politicians talk about healthcare reform but the likelihood of anything ever getting reformed is slim when there’s so much money to be made. It’s a weird, broken system that really isn’t keeping anyone any healthier. It’s big business and I’ve become one of their best customers.