The Cost of Health Care
Along with a lot of other people, I assume, I watched the final debate between the Democratic and Republican candidates for president. I wasnít expecting much, if any, new information on which to base my vote in three weeks. And I wasnít expecting to be kept awake during the night mulling over my personal relationship to a current national issue.
I injured my right arm last December, swinging open the wooden gate across our driveway. It was a familiar gesture, a swinging and twisting motion, letting go at the last moment of the metal rod that digs into the ground to hold the gate in position. A sharp pain shot through my arm up to the elbow, and I doubled over, clutching the arm and gasping. The only previous experience Iíd had with that kind of pain was thirty years before when I sprained my ankle getting up off the living room floor after having been sitting on my foot for a while playing with my kids. Not realizing that my foot had gone to sleep, I tried to stand on it, instead standing on my ankle. I heard a sharp snap, and fell back to the floor, nearly fainting. The children were shocked and frightened.
This time, I made my way back into the house and nursed the arm for a while, testing it to make sure nothing was broken. I wrapped it in a heating pad, and after a while the pain eased, but it took several days before I could use my arm.
Then, a month later, I was taking the garbage can out to the curb one evening, and swung it by its handle up onto the snow at the side of the driveway. The same twisting and swinging motionóand the same sharp pain.
This time it didnít go away completely, and I visited my doctor. He diagnosed it as probably a carpel tunnel problem, and told me to wear a wrist brace at night. After a couple of weeks it wasnít better, so I phoned for an appointment at one of the local physical medicine clinics specializing in sports injuries. The Osteopath who examined me prescribed some x-rays, but admitted that my symptoms didnít match anything he knew about. The x-rays came back negative for bone breaks, so the doctor set me up with a series of physical therapy sessions. Those helped, particularly since I had by that time lost a lot of muscle tone due to lack of exercise.
But the pain kept coming back. I did some searching on the Internet, and found an orthopedic web site that had illustrated articles on such conditions as golferís elbow and tennis elbow, both of which seemed to fit my problem. On reporting my findings to my regular doctor, I got an offer of cortisone shots, but no real help. Since I had seen the other doctor without a referral from him, my doctor seemed uninterested in my arm.
Since then, I have tried to keep up the exercises taught me by the physical therapist, and my arm doesnít always hurt. I avoid lifting with it and especially avoid sudden motions. Iíve often thought of contacting a surgeon who several years ago had repaired my torn rotator cuff, with complete success.
Back to the presidential debate. The candidates spent a lot of time discussing (to use the word loosely) "the soaring cost of health care." Their focus was upon how the country is going to pay for the increased costs, especially with the growth of retirement-aged citizens who apparently need more health care. The subject of "health care rationing" was carefully avoided. But thatís what kept me awake that night.
Like most people, I suppose, I have mixed feelings about doctors, dentists and hospitals. I want them to be there when I need them, but I donít enjoy having to go there. I spent a day and night in the hospital last summer after an attack of amnesia. They tested me and admitted me overnight to make sure I hadnít suffered a stroke. It turned out that it was related to migraine headaches, and was not serious, nor was it likely to recur. My insurance, including Medicare, paid out over two thousand dollars. Several years ago, my rotator cuff surgery set the insurance companies back a lot more than that.
Both of those incidents were pretty clearly "medically necessary." I might have survived had I not had the surgery, but my arm would have been rather useless for a long time, perhaps for life. The amnesia attack would have gone away by itself without any professional help, but we didnít know that at the time.
While I think that my present situation is not life-threatening, it sure limits my activities. Since Iím no longer in the work force, itís not a matter of productivity. I can still feed and clothe myself, and even drive a car. Pain killers allow me to sleep when I need them. My Medicare and medigap insurance would no doubt pay for the surgery. If I lived in Canada, or some other country where the government supplies health care to everyone, I donít know whether theyíd say I needed surgery or not.
The big question: Given the growing problem of how to care for our countryís citizens without bankrupting us, do I have any responsibility, other than to vote in the elections? While the debates seemed to suggest that the President is the one to solve the problem, itís clear that no one person can do that. Itís very much like the breakdown of our environmentógovernment policies may have a lot of influence, but there has to be a cultural shift in how we all look at our natural resources. "Itís not my problem," is too easy when all Iím doing is running my lawn mower on a warm summer day. "Itís not my problem," when I throw tin cans in with my household trash. "Itís not my problem," when I drive somewhere that is easily accessible by public transportation. "I pay my taxes," may ease my conscience when I add to the overload in a public park. When I pay my health insurance premium, particularly to Medicare, what is the difference between what I want and what I need?
Social Security is cut and dried, in comparison. When I reached the magic age, I applied for and began receiving my pension, an amount calculated by the government based not on need but on amounts I paid into the plan from past income. Only if I had enough wealth to live independently of that pension would I have reason to consider whether or not to take it. I happen to have no choice. But Medicare is different. Some people are fortunate enough to need little of it, and others need a lot. If everybody needed a lot, the program would quickly collapse.
So how much do I need surgery on my poor arm? They asked me, when I took it in for physical therapy, "How much does it hurt?" They offered the idea of a scale, from one to ten, and asked me for a number to represent my pain. Ten is unbearable; one is but a twinge. It depends, of course, on when I am asked. Some days itís better than others.
And, of course, I donít know for certain whether surgery will return my arm to normal, as it did my shoulder. Suppose I spend ten thousand dollars of Medicare money, and I still canít lift a gallon of milk into the refrigerator. Is that ten thousand dollars the proverbial straw that does the camel in? Probably not. Does it mean that someone truly needy will be refused service? Itís conceivable.
The dilemma, difficult as it might be to resolve, is almost trivial compared with the really big medical decisions physicians have to makeóhow much to spend on someone who is riddled with cancer, for example? What is the patientís age? What are their chances of a "normal" life afterward? Let me put it baldly: Somewhere, someone at some point must decide: Is this person worth what it will cost to repair them? Iím glad I donít have to make such decisions. I donít want even to suggest a way for anyone else to make such decisions. I need only to decide whether to ask for my arm to be repaired. At my age, I have a relatively good chance of dying from any of a number of ailments in the next year.
Having gone through this process, having questioned and thought and felt the implications of this subject, I feel Iíve done my duty as a citizen, and will go to the polls in a couple of weeks armed with a bit more insight, if nothing else, about the issues involved in the election.
And for now, at least, Iíll keep exercising my arm. I can handle the physical inconvenience.
Donald Skiff, October 15, 2004