your body, your $

being in med school i get asked a lot about healthcare reform. i definitely believe in offering some form of universal healthcare, but strangely medical education doesn’t do a lot to teach future doctors about the realities of the world they will be working in.

but i was reading this article from the NYT about doctors rationing healthcare, and i think the point it makes is something i, and all doctors, and all my friends and family, and all patients everywhere should absolutely understand. your body and your dollar are inextricably, inevitably, and intimately linked, not 20 years from now, but now. here’s how. 

being sick is really, really expensive. and it’s expensive whether you have health insurance or not.

case in point. my friend is 28, and for unknown reasons has chronic sinusitis. he freelances, and a year ago he didn’t have health insurance. but the constant congestion and sore throats and rounds of antibiotics and his addiction to Halls were driving him crazy, so he went to see an ear nose and throat doc who he had to pay out of pocket. the visit itself cost $250. a CT scan of his nasal passages cost $600.  the MD read the CT and said, well, your nose is shaped just fine. and my friend said thanks, what a waste of a grand. (had the inside of his nose not looked so fine, whatever surgical procedure that doc would have prescribed would have been prohibitively expensive and could possibly have caused more damage than good, since digging around in people’s sinus cavities can be tricky…) that’s how being sick, even low-grade not really disabling sick, is expensive in terms of money.

now my friend has health insurance through his union, and it’s really good, if good is defined as no co-pays. nothing in the past year has improved my friend’s sinusitis, so armed with his insurance plan he made an appointment to see another ENT. my friend choose this ENT at random, out of the list of ENTs acceptable to his insurance company. there was no way for him to read reviews or know about the guy’s reputation. there is no national registry. despite the fact that the qualities blue cross/blue shield looks for in an ENT might be very different those he might like in an ENT, my friend had no way of telling one from another on his list. so he chose by office location. (anyone want to start a Yelp for docs?) the visit to this second ENT was free in terms of dollars, but cost him about 5 hours of waiting and travel time for a 3 minute visit in which the ENT offered him a CT, which he would have to schedule for another day, and no practical advice whatsoever. this is how being sick is expensive in terms of time, stress, redundancy and futility.

i’m starting this friend on a regimen of industrial grade probiotics and olive-leaf nasal spray from the vitamin barn, and we’ll see how he does. but being sick in this case, which is not something he could have prevented, has been crazy expensive, and he’s someone who has both financial and intellectual resources in life, and has at least found his way to a few doctors.

now factor in that we have a doctor shortage - we will be short 150,000 MDs in the next 15 years as the overall and elderly populations expand, and demand further outstrips supply. this means that now, and in the coming years, if you are poor, you are sort of screwed in terms of access to healthcare. here’s why. 

a bit of vocab helps explain: medicare and medicaid. medicare is for old people. medicaid is for poor people. medicare reimburses doctors 80% of the cost of their services. medicaid reimburses only 40%. private insurance pays 80% or better. the elderly vote a lot and have way more political sway, so they are better covered. as demand for medical care increases, many docs don’t and won’t have much incentive to take medicaid patients. if the healthcare bill goes through and we add a bunch of people to the medicaid and private insurance pools, the people who end up on private win, and the people who end up on medicaid lose.

essentially, at the moment in this country, if you are rich you can always get healthcare, though it will cost you a lot in private insurance and fees and possibly time. if you aren’t rich you face long waits, hard to come by primary care, and even if you have decent insurance, you may not necessarily find the medical help you get to to be of much help at all. 

what’s the takeaway for your wallet? don’t get sick. i know, this is completely impossible sometimes, like for my friend with sinusitis or my other friend born with cystic fibrosis who just had a lung transplant. often illness isn’t avoidable or fightable without modern medicine. nonetheless, if we’ve ever had incentive to stay as healthy as we can, and prevent illness as much as we can, we have it now. this comes down to the usual stuff you hear about all the time for a reason - healthy eating, frequent exercise, keeping your weight down, good sleep, and hand washing. 

i think we tend to have this notion in america that doctors and drugs are cure-alls and our health is in their hands. really the opposite is true - our health is first and forever in our own hands. rich or poor, at the end of the day your body is your dollar. you can save a lot of those dollars by taking care of yourself.