#HCR and you

President Barack Obama's signature on the heal...

President Barack Obama's signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

On the second anniversary of  the Affordable Care Act, I am reminded of a conversation I had with a reporter from The Daily Caller who likened the legislation to something from Nazi Germany (seriously).  He went on to say that no insurance company had ever dropped anyone for becoming ill.  He challenged me to find someone this happened to.

As luck would have it, I didn’t have to look very far because it happened to me.

In 2003, I left my job to go back to school.  For some reason I didn’t think I could get Georgetown University’s student plan for the summer session so I bought my own personal plan.  In the fall, I had planned to cancel the personal plan and just go with the student insurance but I forgot to cancel it and had both.  The effective enrollment date of this plan was June 1, 2003.  (It was a good thing that I kept both because a decent chunk of my care was received when I was not eligible for the student insurance.)

Prior to 2003, I had been pretty healthy.  I have always been a bit anemic but I used to donate blood and platelets on a regular basis.  My only real complaint was my knees, which suck and both have been operated on.

In November 2003, I started feeling really crappy.  I was taking organic chemistry and physics.  I was terrified of physics and orgo is just hellish (though it is the best class, in retrospect, that I have ever taken, it really improved the way I process information and every college student should have to take it).  My symptoms were stomach pain and nausea, things I could easily dismiss as being related to the course material and all the coffee I was drinking.  I am very good at ignoring things I do not want to deal with.

By mid-December, I could not ignore it anymore because I started throwing up blood.  A lot of it.  When I was seen at the GTown ER, they put in a naso-gastric (NG) tube to flush out my stomach to determine if there was any active bleeding but were pretty sure there would not be.  They were wrong. They found a bleeding ulcer which kept me there for the next week.

Over the next few months, the ulcer did not respond to treatment.  At least not in a good way.   It was growing and by late winter it was one of the biggest they had ever seen at Georgetown Hospital  (Go big or go home as I always say).  They recommended surgery to remove it.  So I had laproscopic surgery to remove just the ulcer.

A few days after I got home from that operation, I became really sick.  Had a high fever and was back in the ER.  An infection had developed and I needed a drain inserted.  (Side note: my insurance did not want to pay for the anesthesia used to insert said drain until I described, in as much gruesome detail as I could come up with, the procedure and then they did pay.)  Spent another week in the hospital.

Several weeks after that, a blockage formed and I couldn’t eat anything so back to the hospital I went.  My only option was an open partial gastrectomy.  This was much more invasive and serious a surgery than the first.  They removed the bottom (distal) third of my stomach.  This is called a Billroth II.

The next phase of my medical drama is at least partially my fault.  If you ever have major surgery, give yourself more than two weeks (once you are home) to go work on a national, political campaign.  You’ll thank me later.  I ended up in the cardiac care units of two different hospitals that summer.  That was because my healing stomach was still bleeding.

Meanwhile, back at the ranch, my personal health insurance had stopped paying.  By this time, the tab for my care for 2004 hovered around $450,000.  They were claiming this was a pre-existing condition and refusing to pay for any claims that had been submitted and any that were coming in.  My coverage had been pretty much suspended and I advised against going to the doctor until this was resolved.  In this area, I was lucky because I didn’t need to for a few months but things could have easily gone the other way.  It took several months but they finally agreed that this was not “pre-existing.”

Note:  It may be worthwhile to treat medical records like a credit score of sorts.  I had trouble getting Georgetown Hospital to send my records to the insurance company — there were hundreds, if not thousands, of pages of them.  When I went through them I found an injury I never had (one of the few!).  On on ER visit, subsequent to all of this, the nurse who triaged me asked me if a certain physician was my doctor.  When I told her I had no idea who that was, she replied “He delivered your twins.”  She really thought I was out of my mind until I told her I didn’t have any children.

In a sense, that reporter was right.  Insurance companies don’t come out and say, “We’re dropping you because you are sick.”  They do, decide to call something pre-existing, and it doesn’t have to be for them to call it that and get away with it — at least until now.

I wrote this detailed account of my medical problems to show how rapidly things can go very wrong.  As I stated, I was healthy when I purchased the private insurance.   I was working out at least five times a week.

The United States stands alone in a number of areas.  Our approach to health care incentivizes costs, not care.  Moreover, while we pride ourselves of having the best system in the world, if we prevent access to it, what good is it?   Dr. Atul Gawande wrote an excellent piece for the New Yorker on the current status of our health care system.  You can read that here.  We are also exceptional in terms of how bankruptcies caused by medical bills.  That isn’t a problem in other countries but is huge here.  In economic times like these, far too many of us are one emergency away from bankruptcy.  That is unacceptable.

Personally, I think we need to do more with health care reform.  We need a single payer system.  I do not, however, think “Obamacare” is a vast overreach by the federal government.  I think it is a good start.

Go directly to the ER. Do not pass Go. Do not collect $200. (updated)

Original cast of the show (1994–1995)

Original cast of the show (1994–1995) (Photo credit: Wikipedia). I have spent way more time in ERs over the past eight years than I would like and I have never seen any of these people there. Bastards!

My new least favorite sentence in the English language is “You need to get to the emergency room as soon as possible.”

It had been, “If you leave here, you will die.”  That one is what a hematologist told me one time during a “get to know you” appointment before she had even talked to me but saw what my vitals were and concluded I had orthostatic hypotension, caused by decreased blood volume.  I ended up getting multiple units of blood and iron infusions and clearly survived.

Of course, while I am thinking of things medical professionals should not say, “Wow, that’s fucked up.” makes the list, too.  A doctor looked at my palms and saw they look like Rand McNally.  In his defense, when I was doing the Georgetown pre-med program, I was treated differently than other times.  I have noticed three levels of treatment since my medical odyssey began in 2004.  As a pre-med student, I was a potential future colleague.  Doctors would actually listen — the same physician spent nearly 45 minutes convincing me WHY I needed a certain procedure — to me. When I worked on the Kerry/Edwards campaign, I was a VIP.  When I am just me, well, that sucks.

In any case, today’s dreaded phrase changed because I started having really bad chest pain yesterday.  That was troublesome so I called my doctor and his office told me to go to the ER.  I didn’t like that answer so I called another one.  Shampoo, rinse, repeat.  I hate the ER so I then tried to convince myself to go by thinking about what some of my friends would do in this situation.  When I didn’t like what I thought they would tell me, I went where most people go for real, reliable medical advice: the Twitterverse.  Is there really a better place to go for a real evaluation of health issues than random strangers on Twitter?  Of course not!  I should have started there.

What actually got me to come is that in 2006-07, I had two near death experiences due to the aforementioned anemia.  My blood level got so low that my heart stopped and I had to be resuscitated with the paddles.  Something that really hurts afterwards.  The first time, I was walking home from dinner and woke up at the George Washington University Hospital where I asked, What did you do to me?  To which they responded, We saved your life.  Ok, then.

So, as we are on the eve of the baseball season and I got to thinking this afternoon that the third time might actually be my third strike and I have too many cool things going on right now to go and die and miss them.  That’s a cool development for me because in the past self-preservation has not always come so naturally to me.  Like the time when I was mugged and I chased the guy down and caught him. How stupid is that?  Incredibly stupid.  The guy hit me, I think with my own fucking bag, and knocked me unconscious. I woke up in the middle of the street.  There was no thought process there, it was instinct.  And my instincts clearly suck ass.  So having any self-preservation instinct kick in, ever, is a very good thing.  A very, very, very good thing.  Yay, me!

The second piece of good news came at the hospital where my EKG was totally normal.  The only bad news is that I have to CT and they need a much bigger IV in me than will be possible unless they go with a central line or something and they suck.

While Sibley Hospital still won’t give me frequent flyer points, the staff here are great and this is the best ER in Washington, DC.

Hopefully, I will go home tonight.  Thanks for listening.

Updated (as of 24 March 2012):  They did release me last night and I am ok enough to be back at work so all is good.