Just finished paying bills.  There are always too many, but now there are even more from our healthcare providers. Along with the usual sports physicals, school vaccine requirements, a couple of strep cultures and other routine things, we had a few more health care expenses this year.  Nothing serious, just stuff.  Nevertheless, in the short time since The Patient Protection and Affordable Care Act was signed into law, there are already signs “affordable care” may have hidden costs.

In the two years, since it’s passage, I’ve lost two gynecologists.  Both were Canadians who had come to The United States, because they wanted to practice medicine without the inevitable restrictions of socialized medicine. With our system due to be radically changed, both made the decision to return to Canada.  Once again, I would be looking for an ideal doctor within the confines of a healthcare plan.

In addition to the usual co-pays, our pediatric group started imposing a “surcharge” for office visits. Not long after, our famly’s pediatrician announced he would retire–early.  At least I still had my long-trusted primary care physician.

I had developed a minor skin irritation around my eyes. When it didn’t go away, I made an appointment with a dermatologist, I’d seen previously. When I arrived at the office, they apologetically informed me they had pulled out of our medical group. The doctor explained, they could no longer afford to absorb costs for services reimbursed, at a rate less than what they cost to provide. With new restrictions soon to be enacted, he decided it was no longer worth the trouble or the expense.  They were now going to focus their practice on services paid directly by consumers–elective procedures like tattoo removals and cosmetic surgeries.

So heartless, to deny care over money.  Many believe it’s about time, doctors stopped being allowed to make obscene profits, at our expense. I had tremendous respect for this doctor, but that day my respect for  him was increased.  By cutting ties to the medical group(s) and their overseers, this doctor had reclaimed his right to practice medicine his  way.  Medicine is a science, but the practice of medicine is an inexact science, fraught with risks.  It’s like life & death algebra, requiring its practitioners to solve for unknowns, with little room for errors.  Doctors can’t practice good medicine, if their decisions are controlled by people less knowledgeable.  Good doctors are as deserving of pay, as anyone else with specialized skills.

I would  have preferred that my insurer would pick up my tab, but I like this doctor, so I agreed to pay for the visit.  After the  examination, he explained there was something that would likely eliminate the problem, but it was costly and not covered by my insurance.  He prescribed an affordable alternative–a common steroid cream.  It helped, but the condition would return as soon as I stopped applying it. One tube of ointment later, I returned to my trusted family doctor.

Though the steroid cream alleviated the symptoms, it had done nothing to eliminate the underlying condition.  In fact, the problem had worsened and spread.  He suggested cold showers, no soap.  Cold showers?  Maybe he thought I said “sin” problems, instead of “skin” problems.  No tests, no prescription, no help.  This didn’t seem like the doctor I’d become accustomed to seeing.  Had the hassle of justifying treatment become too onerous for my previously proactive physician?

I left his office with skin that looked as awful as it felt, and a referral to a new dermatologist, who didn’t have an opening for more than three months.  By now, wearing makeup would have been about as effective as trying to spit-shine tree bark, so I threw out all my make-up.  It was going to be a long three months.

In the meantime, a family member who used to run a vitamin store suggested adding flax oil to my diet.  Another swore by the therapeutic benefits of Argan oil.  I bathed in oatmeal. I bathed in seaweed.  I soaked in oil.  I  used hydrocortisone cream and salycilic acid to control the itching.  I trekked to the beauty emporium, Sephora, searching for any kind of restorative moisturizer.  Nothing helped.  By now, the condition had spread and progressed to the point my eyelids were often cracked & bleeding.

Then came the stye.  For those who have never experienced this, it is a dreadful condition consisting of equal parts pain and ugly.  The first stye, was followed by a another about ten days later, the swelling of which caused me to resemble a prize fighter.  I returned to my primary care physician, who sent me home with instructions to try warm compresses. Though this the commonly recommended treatment for styes, it’s not a very good one, so when the third stye appeared, I pleaded with my doctor to dispense something more effective than old-world advice. At the onset of the stye number four, I no longer cared what my insurance would cover.  I made an appointment with an eye specialist. I was ready to pay whatever it cost to get relief.

I asked this doctor, if she thought there was any possibility the broken skin on my eyelids was making me prone to recurrent eye infections.  She laughed as if that were the most improbable and ridiculous thing she’d every heard.  Obviously, I was stupid for even throwing it out there.  Nevertheless, she began grilling me about what I’d tried on my skin.  I began listing all the things I’d tried.  She was clearly irritated as she reminded me I didn’t have the expertise to be treating myself–something I was well aware of.  She scolded me for using over-the-counter products, and told me I should leave the treatments to real doctors.  I tried in vain to explain my motivation was despair, not arrogance.  When I realized she had stopped listening to me, my frustration turned to tears.

She had examined me, but she clearly didn’t have any idea what she was seeing.  I on the other hand, recognized her condition immediately. It was easy to diagnose her as suffering from the vanity that afflicts some graduates of medical school.  She gave me a prescription for an antibiotic and told me to come back in a couple of weeks, but I won’t be going back.  I don’t have much confidence in a physician who doesn’t recognize the helplessness a patient feels when the medical system can’t or won’t help them.

I am still waiting for the appointment with the new dermatologist, giving me time to reflect on all of this.  Looking back, I realize what I spent on co-pays and out-of pocket doctor’s visits, would have been generous compensation for an office visit with a doctor of my choosing, and what I’ve spent on things that didn’t help would have surely have paid for something that would have.  I would have been better off, if I’d relied on the expertise of the first doctor and paid for the medicine he would have liked to prescribe.  My my time & money would have both been better spent, if I had chosen how to spend them.

Our medical system is in a troubled state. We are all affected by the rising cost of healthcare, but there isn’t any way to get around what should be obvious–somebody has to pay the bill.  Those who believe we can continue to get quality care without being charged for it, risk pain and suffering as they come to terms with the new reality.  We are yet to fully realize how the implementation of our our new healthcare system will impact us, but one thing is certain, the untold costs of affordable healthcare will be paid by us, not our government.  I hope we can afford affordable healthcare.

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