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The American Healthcare System - My Personal Story

Updated on July 4, 2014

For the past few decades, Healthcare has been a national issue. Every election year, politicians promise to fix the heathcare system to ensure that everyone has good and reliable health coverage. There can be no doubt that affordable healthcare is a great goal and should be on the national agenda, but what about those who now have healthcare coverage but are getting nothing for the thousands of dollars a year in premiums paid. Lost in the debate are those whose patient care has been undermined by the very HMOs that were supposed to provide them coverage and care. 

For proof, I detail my own experience with the American HMO system.

In early December, I began experiencing severe abdominal pain. More than the average tummy ache, this pain had me crying in pain. As it was five o'clock in the morning, my only option was to go to an emergency room.

I am an attorney. The firm I work for provides health coverage and I pay nearly $400 a month in premiums. I believed that my family and I were covered.

So while I lay crying in pain on my couch I decided to wait until my Doctor's office opened in the morning because I did not want to pay $150 co-pay for an emergency room visit.  I knew calling my doctor was out of the question because that office does not open until 9. Because of the current state of the HMO system, you can only get sick during business hours or have to shell out hundreds of dollars to see a doctor that has no idea who you are and is most likely tired, overworked and underpaid.

Doctors and Nurse deserve good salaries but dont' we deserve good service?
Doctors and Nurse deserve good salaries but dont' we deserve good service?

Our Choice: Live With The Pain

So I sat in pain until 9. Then I called my primary care physician. At first they said the next available appointment was over two weeks away. Its hard to schedule same day or even same week appointments as they are only open four days a week for a total of six hours a day.  They said if it hurt that much I should go to the emergency room. After over an hour of my persisting, I got an appointment for later in the afternoon.

So I showed up in pain at 3 p.m., paid the $30.00 co-pay and saw my Doctor. Actually, it wasn't my doctor; he left a few years back. So now I have a new doctor. She spends a total of five minutes with me and explains that it could be a myriad of different ailments and I need to see a specialist. She said it would take over a week to get a referral and have that referral approved by the insurance company but in the meantime she would have me get blood tests and Abdominal CTs. The blood tests were easy enough, but the CTs were booked until after Christmas. In the meantime, I should just rest and not eat much until they can figure it out.

One week and 7 phone messages later, my Doctor finally told me the referral went through. My next appointment is January 14. Blood tests show Crones disease, not that anyone has explained to me what this means.

So I have missed a bunch of work, paid out hundreds in co-pays and Rolaids and I am in no better position than I was. I guess the emergency room would have been a better option but I always thought the emergency room was for people suffering heart attacks, strokes and other near death incidents. Guess it is the only way to get efficient medical care these days.

Can this really be the way it is? I pay my premiums and hardly ever see a doctor. Yet, the one time I do I am in a constant state of waiting, with no one explaining to me what is going on. I could not imagine having cancer and being treated like this.

So how can we fix this system? Personally, I really have no idea. Perhaps the problem is medical care has become a big business and run like such. It seems to me the system has doctors seeing as many patients as possible without spending time with any. It seems that referrals and tests are delayed in the hopes that they will be forgotten. Because of the need to see patients, doctors do not follow up with the patients they just saw. No phone calls, no nothing. If you want to talk to a doctor, you have to go into the office so they can get the next co-pay. This is a direct result of the HMO system itself. I do not believe doctors can be happy existing in this world.

How can you take money out of medical care? Doctors and nurses deserve good salaries and the money has to come from somewhere. Hospitals need technology and good staff, so the money has to come from somewhere. I for one don't mind paying the premiums and co-pays as long as I am getting my moneys worth. But that is not happening. If I could, I would change doctors but apparently this takes over a month to do and needs massive paperwork to complete. I can't send it back like a bad meal. There are no return counters.

What can we do? All I know is the system needs to be fixed as the current system undermines patient care. The current system creates financial and timing barriers to actually seeing any doctor, never mind your own doctor. I also know I have no ideas on how to fix the problem.

Thanks for reading.

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    • bgpappa profile image
      Author

      bgpappa 6 years ago from Sacramento, California

      Sorry to hear that Hos. Hope all gets better soon.

    • profile image

      Hotsun 6 years ago

      Going through the EXACT same thing right now. I am done with traditional medicine.

    • bgpappa profile image
      Author

      bgpappa 8 years ago from Sacramento, California

      Thanks for reading.

    • HealthyHanna profile image

      HealthyHanna 8 years ago from Utah

      Thanks for the perspective. Something every American needs to read.

    • bgpappa profile image
      Author

      bgpappa 8 years ago from Sacramento, California

      Karen,

      Sorry to hear about your diagnosis. It is horrible that people with insurance can't get help, but imagine what it is like for the millions with no insurance whatsoever.

      But it can't remain the status quo. Is the new plan any better? I think so, but there are many doubters.

      Best wishes and thanks for reading

    • profile image

      Karen 8 years ago

      I can certainly relate to your story. I was diagnosed with cancer but there wasn't a specialist in my network that could see me before six months. I did not have HMO insurance and I worked in a hospital. I had to go out of my network and it cost me a fortune, but I couldn't afford to wait. I also paid several hundred a month for my insurance. Of course, with the new healthcare plan being considered, I probably wouldn't get treatment because I'm nearing Medicare. I'm too old to live.

    • bgpappa profile image
      Author

      bgpappa 9 years ago from Sacramento, California

      I am sorry to hear that. I have read a little bit about Lupus and it doesn't sound fun. But at least you have a good attittude about it.

      Chrones causes inflamation of the colon and intestines. Still learning exactly what is going on. Have a lot of pain. On a steroid cocktail now to try to put it into remission. But not disabling long term.

    • profile image

      Sciantel 9 years ago

      I am sorry you have crohn's disease. From what I know it is a inflamation of your intestinal tract. I suffer from a disease called Lupus. It is kind of like arthritis but I get inflamation in my tissue cells. It can attack my kidneys, lungs, and brain. I have been on SSI all my life and cannot work because of it. I get Medi-cal, and because I am disabled and have a diabled father now, I get Medicare too. I am really blessed and thank the Lord every day for this despite I suffer constant pains in my muscles, get headaches. Have severe low blood sugar. ( Fainting spells ) I also get real bad colon spasms. They are my worst pain. What's bad is if one hits me out in public, and it has happened a couple of times. I have to go into a bathroom stall and do a rocking exercise in order to deal with the pain until it subsides. I don't go out very often. I don't like to be far from my home.

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