Saturday, March 27, 2010

On Health and Fear

This one thanks to the stimulating post by sweetsalty Kate.

Ask me what I think of the new health care reform bill? Hmmm, you know what? I don’t really know.

It is likely it might put me out of a job, or steady work, at least. It might shift a system terribly out of balance a little closer to midline. It might break it. That all stands to be seen. You know what I do know? What we are doing right now is not working. Not all the time, anyway.

I have worked in health care in some capacity since I was 19. I started as a volunteer at a rehab facility. Then I graduated and started working in the field of neuro rehab at 22 as a physical therapist. I have worked in the county system, which is the safety net that catches the millions of uninsured folks in this country. Well, catches them sometimes. People vilify the Los Angeles county hospital system, but I will tell you a secret. If you are really really messed up in a trauma, you should go there. I have seen their neurosurgeons save people missing half their head. And their ortho is great. But it is a huge mess most of the time, not always because of the care provided but because of the population they serve. The marginalized, the unseen and unsupported, the undocumented; these folks have very little to catch them when something bad happens to them.

County cannot keep up with the amount of people that need their services but they cannot deny care. They never have enough employees and never have enough budget. It is hard to attract new employees to the slightly heinous setting. When I was hired in early 2000 they hired me as a temporary traveling P.T. even though I was local. They had a special fund to pull monies from to pay for travel employees to fill the gap of the unbudgeted county positions. Confusing? It is. Basically, they hired temps to fill positions that were not really there but needed. The number of patients create the need; the County is obligated to provide that care. There were quite a few of these employees in my department, most out of state and some out of country. The real (non-local) travelers were provided housing along with salary. They lived in Marina del Rey in deluxe apartments. I shudder to think of exactly what the travel budget of the county looked like. But you also have to realize, no one wants to work there and the County has obligations to their patients. An expensive stop gap and one that I think they put an end to by building a much smaller hospital with fewer beds in order to reduce the number of people they could house. Brilliant solution, right?

I have worked in the private rehab setting too. The one where people go after terrible things happen. Terrible things like strokes or spinal cord injuries or IEDs in Iraq. The place where people go when they need to relearn roles in life. It was once a really great hospital, but the last decade has seen major change in the way people receive rehab in this country and it has not been kind to the facility. This hospital receives mostly insured, a mixed population of young and old, some with an immense need for therapy and equipment and support. Without this rehab facility, people would fall through cracks and end up receiving less skilled care in nursing home settings. Some get what they need, others do not. And sometimes even giving them everything they need is not enough because it does not give them back functioning legs or brain, it cannot replace the life they had before their incident.

I have worked in acute trauma hospitals, in the outpatient setting, worked in pediatrics and I have floated between 4 hospitals at once. Now, mostly due to Motherhood, I have landed in home health care. After 10 years in the field of health care I think I know some things. But the main thing I know is that the system works for some and not for others.

I know we keep people alive longer, with more complications and more medications and more health issues than ever before. I know some of these people want desperately to be kept alive so they can see their children or grandchildren grow, so they can help their spouse, return to work, have a chance to run/hike/live again. And some want to die and be left alone and yet, they are treated and treated and treated. Usually these are the ones with really good Medicare. I am not joking.

I have also been a patient in our health care system. The latest was my pregnancy with the twins. My husband was employed and had fair insurance and it covered us, but it excluded maternity. Yep. You heard me right. Excluded. But I work in medicine and I know a lot about a lot. I knew that California has a program specifically for pregnant women. You have to qualify, of course. I was not working at the time so we were a one income family. We qualified under their income guide lines and I received all of my maternity medical care under this program. It cost us 700 dollars total. I had private insurance, saw a specialist every few weeks, delivered in one of the top rated hospitals in our area and paid nothing for meds or hospitalization or complications post c-section. Not a cent other than the 700 hundred dollars. Yes, it is a state program. And a damn fine one too. If you live in California and have questions about it email me. Half my friends have used it since we had the boys. As an example of a ‘government run’ program, I have nothing but praise for its efficiency, efficacy and availability. And for the fact that it left us with two healthy children and no debt.

I also know how to be my own health care advocate, and lobby for better care for myself, my family and my patients by using my medical knowledge. I use my knowledge when I need to, try not to abuse it and try to inform my patients how to better be their own advocates. Another secret? Insurances can be pretty damn accommodating when you are a squeaky wheel and know medical jargon. What sucks is that if you do not know how to squeak, you will not get any oil. When my Mama was in the hospital last week every single provider knew I was a therapist. They were respectful and so was I. But when they wanted to discharge her two days after her knee replacement and she called me crying and unsure, you better believe I told her exactly what to say. And of course, they let her stay. They are not monsters, just opportunists.

Right now, in my position, I make a more than a reasonable amount of money. Yes, I went to college. Yes, I work hard and feel that I provide excellent care to the people that I follow. And I chose to work for a non-profit home care so the bottom line is really not the focus at our company. I am pretty sure my salary is on the on the lower end of the spectrum of home care therapists. Which boggles my mind because I think that they pay me quite well, thank you. What I love about our company is that they provide uncompensated care when they can, they truly provide support to the community and most nurses and therapists care almost fanatically about our patients. The environment itself supports ethical use of our patient’s resources, whether they have Medicare or some other insurance. I try to approach my patients with the idea that this could be my mother/father/sister/brother/child and what would I want for them. I try to go to bat for my patients who have insurance that metes out therapy in single session increments. I try to provide respectful and needed care and I leave when there is no reason to be there. I try to do my job well. And I do think that what I do makes a difference and helps people stay in their homes and out of the hospital.

Having said that, I think there are so many things that have to change. We need better personal responsibility for our own health. We need better knowledge of how to speak with agents in insurance to represent ourselves and our health needs and demand better service. We need better accountability of our medical staff, better use of our skills with less use of our services so that the bill does not add up to such staggering numbers. We need to stop thinking of health care as a way to make money. I think the crux of the problem is that we treat people as a commodity in this country and it is starting to break down. Making money off sick people is sick. And it is not working.

Is this bill going to change all of the above? Probably not. But it is going to help affect change. It is helping us discuss and acknowledge the drawbacks in our system, the lack of a system, the lack of accountability. It is starting the change.

And just so you know, after all of my years working and seeing how it goes, I totally support social medicine. All the best health care workers I have ever met worked in the settings where government was providing the care. They were not there for the money, they were there because of their calling to their field. And aren’t those the people you want caring for your mother/father/husband/child/sister/brother/friend?

Kate asked what I fear? To be honest, not very much. I do not listen to the reports of doom and the insane rhetoric flying around in the air of this country right now. I live my daily life, perform to the best of my abilities in my job and remember that I may have to remain very flexible in order to stay in my field. Fear can suck it. That's what I say to that big ol' fear boner, Kate.

And that's all I have to say about that.


Dawn Johnson Warren said...

Thank you. For being you and for being willing to share your experiences. I don't have a lot of experience, only instinct and I agree with you that I don't know and that I'm glad the conversation is being had. That's how things change, when people get emotional about it and when their individual stories become the stories shared among others.

LauraC said...

Love This Post!

Bea said...

loved this post! i've been following the health care thing pretty closely, and it's always so interesting to get the point of view from someone who's in the trenches. i'm just really glad robby can't be denied coverage when he gets older because of his asthma. i've heard the same thing about socialized medicine from friends who live in turkey, and my sister who lived in costa rica, that while the technology isn't as advanced as ours, the level of care is very good.

Sarah-potterknitter said...

When I got pregnant the first time I did the math. Maternity coverage would have cost three times as much as paying out of pocket!
Luckily NC has a state program also called BabyLove. It's pretty amazing to be having an ultrasound every two weeks and never think of the cost!

Sadia said...

Amiee, thanks so much for taking the time to share your experiences. I think you underscore what we all know, but many choose to ignore. The system is complicated because the needs are complicated. I am delighted to see that the Powers That Be are tackling the issue.