Let’s just say that throwing up between 1am and 5am the week you have to prepare for a scientific conference (ASM) is, well, suboptimal. Anyway, I’m fine (thanks for asking), but Tuesday I had plenty of time to think about this NY Times article about the increase in healthcare deductibles (the amount of money you have to pay out of pocket before your healthcare kicks in):
But Dr. King said patients were also being more thoughtful about their needs. Fewer are asking for an MRI as soon as they have a bad headache. “People are realizing that this is my money, even if I’m not writing a check,” he said.
For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn’t feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, “I can’t afford to use it.” Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. “The big question is whether it is going to stay weak or bounce back,” he said. “Nobody knows.”
Significant increases in how much people have to pay for their medical care may prevent a solid rebound. In recent years, many employers have sharply reduced benefits, while raising deductibles and co-payments so people have to reach deeper into their pockets.
In 2010, about 10 percent of people covered by their employer had a deductible of at least $2,000, according to the Kaiser Family Foundation, a nonprofit research group, compared with just 5 percent of covered workers in 2008.
Doctors, for one, say patients’ attitudes are changing. “Because it’s from Dollar 1 to Dollar 2,000, they are being really conscious of how they spend their money,” said Dr. James Applegate, a family physician in Grand Rapids, Mich. For example, patients question the need for annual blood work.
High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer.
While this no doubt encourages people to buy perfectly fine generics instead of brand names and skip unnecessary tests, it’s also forcing people to forgo medical attention they need.
Which brings us back to my vomit–don’t worry, I’m not going to get gross and tell you what color it was or anything like that.
Anyway, vomiting. It’s pretty clear that I had some kind of food poisoning, combined with a naturally peptic stomach I’ve had since I was a kid, along with a bad previous night of sleep, as well as not eating what I usually eat. Basically, everything that could break wrong, did break wrong (well, I suppose I could have been shot in the face or something). And for most of those four hours, the most disconcerting thing wasn’t the vomiting–and this is from a person who absolutely hates throwing up–it was the uncontrollable shivering. I don’t mean goose bumps and feeling cold, I mean the kind of bodywracking convulsions that hurt and make you feel sore (and I keep reasonably fit). Getting sentences out–the ‘subject-verb’ kind of sentences–and walking the eight feet to my bathroom was difficult. Fortunately, after the second time I got sick, the symptoms went away (I guess I got rid of everything–actually, not much guessing is involved…).
But I had decided that if the symptoms didn’t go away after a couple more hours, that I was going to the emergency room. For all I knew, it would have meant a very serious infection (or other problem), or it simply could have been infection-related dehydration (this has happened to me before), and I would leave the ER the same day. Either way, the last thing I needed to be thinking about was the fucking deductible. Suffice it to say, keeping my basic shit together was pretty taxing by itself–and if someone had been around (relative, etc.), I doubt he or she would have been making ‘objective’ medical decisions either–in fact, I very well might have been convinced to go to the ER sooner, rather than give it a few hours (I have no idea if I was being stupid by waiting a few more hours). And in my case, I’m fortunate that the Iron Law of Increasing Income applies: as your income increases, you’re less likely to get nickeled and dimed–or two thousand ‘dollared.’
I understand the need to cut down on unnecessary spending–and many plans’ ‘unnecessary’ ER deductibles are low, especially in the People’s Republic of Massachusetts–low for me, anyway*. But for some people, they can’t even afford a $100-$200 deductible. That is what poverty means. This ‘efficiency’ is going to get people killed.
*In Virginia, where I grew up, the ER deductibles are much higher, especially if the ER trip is deemed unnecessary.