Total Drek

Or, the thoughts of several frustrated intellectuals on Sociology, Gaming, Science, Politics, Science Fiction, Religion, and whatever the hell else strikes their fancy. There is absolutely no reason why you should read this blog. None. Seriously. Go hit your back button. It's up in the upper left-hand corner of your browser... it says "Back." Don't say we didn't warn you.

Thursday, July 06, 2006

Adventures in universal healthcare

Every now and then we start the debate of universal healthcare and the desire to bring medical coverage to those that cannot afford it. I haven't had much experience with the systems in other countries, but the closest example in the US that I can think of is the military/veteran health care systems. Admittedly, these serve groups that are not perfect representatives of the general population. I would expect that military members are in better physical condition that the average American, though more prone to severe injury. Veterans in the VA systems tend to be older and retired, or had some sort of injury in service that needs continuing care. In most cases for the military system and in some cases for the VA system, spouses and immediate family are treated so they have to be capable of dealing with general health issues just like the civilian care systems. Keeping these caveats in mind, if these systems are representative of what we could expect from a government run system for the general population, I will definitely vote against it. This is based entirely on personal experience but you may find this little anecdote useful.

I was reasonably health while on active duty so I don't have much to complain about there. Some of the married folks, however, tell the horror stories of how long it would take their spouse and kids to see a doctor. I did have a sinus infection which congested me so bad that it made my face go numb. The emergency room told me it was not a big deal and to see my corpsman in the morning. Excuse me for freaking out a little bit. Let's imagine what would have happened to a real hospital ER that had done something like that. Other than the normal health monitoring and vaccinations, my first real dealing with the military system was following a helicopter accident. As you might expect, the military is very good at casualty evacuation and treatment in the aftermath. It's also decent at dealing with chronic conditions while it is determined if you are still fighting fit or preapproved for the VA. That is, assuming you can get past the first layer in the system. It took a month to determine that no, immobilizing a limb will not help a nerve injury. Once I was actually seen by a surgeon, things progressed rapidly. Nerve conduction tests, followed by surgery, followed by rehab, followed by exit from active duty. There were some lingering issues which makes me eligible for VA care. I never actually expected to use it though.

Through circumstances totally within my control, I found myself without medical coverage when I came down with some sort of aggressive arthritis thing. As hard headed as I am, I eventually broke down and called the VA to get an appointment. I was referred to a specialist. The appointment was three months away. By the time I went to see the specialist I was taking 2400 mgs/day of ibuprofen. Never mind the ulcer I was working on. It's an anticoagulant -- I didn't know that -- so one day I sneezed and blood came flowing after it. I freaked out a little bit after that. As with the military system, once I was past the first layer things got much better. A few zillion prescriptions and 2 surgeries later I was feeling much better. I could even walk again. Progress has been slow since those heady days. The battery of drugs I'm taking is mildly impressive. I don't know if I can even really be weaned off of them, but I definitely can't just stop taking them.

Twice it has happened now that I've been without meds. The first time was after a rewriting of a prescription and I was going to run out before the new one arrived. The pharmacy blamed the doctor for now entering it properly. It was fairly painless to solve as it's a drug I take everyday so I could see the shortage coming. I was only without it for a couple of days and it wasn't a really critical one. One of my meds I take once a week in one giant dose. Now, the prescriptions are filled in 30 day increments. Refills are done by calling a computer. Due to the shipping schedule, I take the last week's dose I have, order the next refill, and it arrives the day before I need it. This is how it's supposed to go. Unknown to me, I had used my last refill so my last refill request was quietly declined. I waited until the end of the week, thinking it was lost in the mail somewhere but nothing came. About halfway through the next week I called the computer again to check when it was sent. The computer informed me I wasn't getting jack. By now I was up against the Fourth of July weekend so I can't talk to anyone until the 5th. I called the clinic nearest me inform them of the situation. I expected a similar procedure as last time. Because most of my prescriptions are written by a specialist at another hospital -- two hours away -- I cannot have them filled at the pharmacy near me. It's a money thing and I knew it from the last time, but I still insist it makes no sense. I had missed two weeks' doses now. The nurse that I first talked to understood the problem that this was not a drug you can just stop taking. She went into high alert and sent a message to pretty much everyone in my medical record -- a long list. Someone should have called me and tell me what to do. No one did. It was getting close to quitting time so I called again. This time I got a nurse that was much less helpful. He informed me that my primary care physician would not rewrite the prescription so I could have it filled locally. I asked what am I to do without the drugs. He said that it would be renewed and sent from the specialist's hospital. It normally takes a week for that to arrive. That would be a total of three weeks without meds. I informed him of my concerns in this area. His response was "well I guess if you don't have them you can't take them." Again I ask, what would happen in a real hospital if a nurse gave that answer? I resigned myself to suffer kidney failure or whatever happens. The next morning I got a message to call the clinic. They told me that the specialist had renewed the prescription. I still couldn't fill it at the clinic, but I could get a partial refill while the rest was in the mail. She asked when I expected to come down there and I told her I was on my way. By some stroke of luck I was attended by the pharmacist that was familiar with the situation. She had planned to have my meds ready so I wouldn't have to wait too long. Just to show that no good deed goes unpunished, the nurse I talked to didn't give her the message so I had to wait anyway. At this point I was glad to have the problem solved so I didn't say anything else. It does show that even within itself the system has a severe failure to communicate.

In general, most people at the VA want to help. As with any organization though, there are the few bad apples that ruin the bunch. I feel that it is the system that keeps things from working better. As long as it can be planned and scheduled, everything goes smoothly enough. As soon as something unusual happens though, industrial mining equipment couldn't cut through the bureaucracy. If I had the ability I would go to private care. This does prove that you get what you pay for, so I guess I shouldn't complain.


Blogger Drek said...

This does prove that you get what you pay for...

Which is perhaps worth considering given that the U.S. tax rate is among the lowest in the industrialized world...

Sunday, July 09, 2006 9:47:00 PM  

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