Our Expensive Third-World-Quality Health Care System

In San Francisco for the BlogHer Conference last weekend, I met a young woman who had just arrived from Canada to study medicine at Stanford. Her mother is a physician in Canada and her mother’s associates had encouraged her to study in the US because, "You’ll see a lot of crazy things there.” I thought she meant culturally, but no. Apparently, doctors see many diseases in far more advanced stages here than in Canada where public medicine means lots of preventive care and diseases are often caught early. The US health system provides a clinical laboratory where disease is allowed to wreak its damage on humans unchecked and untreated. People are more afraid of the economic consequences of disease than the physical ones, and so they wait to go to the doctor until they cannot bear it any more.

I remember reading stories from my childhood and teens of American doctors going around to third world countries to help the sick. They described with great pity the advanced stages of diseases they would find in those places. I was shocked that people should suffer long and lingering deaths from diseases we had cured or could cure if caught soon enough. When I traveled in my college days, I was warned off with horror stories from going to doctors or dentists in Europe. The evidence of my friends' actual experiences confirmed that the United States had the best medical treatment in the world and I was grateful for it.

That idea may be fixed in my brain but it is simply no longer true. We rank 37th in the world, right after Costa Rica and just ahead of Slovenia when it comes to the quality of oour health care. When I look at my life and how I use the health care system, I understand. I have health insurance that only covers one checkup a year and then doesn’t kick in again until after I have spent $5000 each benefit year. This is the level of care that I can afford. Chronic or serious illness would not only limit my ability to work and thus reduce my income, my deductible amount would mean that the first $5000 I earned every year would go for doctor bills. I cannot afford to get sick.

Earlier this year I went to a doctor for palpitations. When I asked the cardiologist to discuss how to investigate the problem with an eye to cost because I had such a high deductible, he dismissed my request, saying, “That was your choice.” To him, my lower coverage was a choice to be like the grasshopper and not the ant in the Aesop fable. He must have figured I had fiddled instead of saving, coming as he does from an income bracket with excess income where saving is an option.

It turned out that my problem was no health risk and I would just have to live with thepalpitations. I was upset at having to spend so much money on doctors and tests to find out it was nothing. Yes, I know it is important to know for sure, which is why I went. But now I sit here trying to decide on whether I should have other preventive tests that doctors recommend for women my age: mammogram and colonoscopy. I’m not sure I can afford them. What would be the harm if I waited another year? Or two.

You might ask why taxes should pay for these tests if I am not willing to do it on my own. I am willing to pay several hundred dollars a month for health insurance so that if I find I have a serious problem, I will not find myself in the pitiable place of those childhood third-world ghosts I carry around in my mind. If and when that happens, the insurance will have to pay much, much more if it is discovered later rather than sooner, but the financial calculus for me does not encourage me to discover it earlier. Once I have a serious health problem, I am looking at financial ruin on top of ruined health. So I delay. I tell myself I should go but never get around to scheduling the tests. Time passes.

Yes I have my head in the sand. The cardiologist was wrong. I am not a grasshopper. I am an ostrich. I am an American.