Anger, Threats, Fear

It’s official. The health care bill is now law. Many people are angry. Some are making threats. Others fear this new law will take away their freedom instead of improving the quality of their lives. Anger, threats, fear…I understand those feelings and share them, but in a very different way.

I am angry when I think of my twenty-three year old friend who died from kidney failure because he didn’t have health insurance and was no longer covered on his parents’ policy once he’d graduated from college. Even now, almost two decades later, I remember visiting him in the hospital room. He’d already slipped into a coma by the time I’d arrived at County, the Los Angeles hospital known for handling low income and indigent cases. I crowded into the tiny room with his mother and another friend and we sat, watching his labored breathing, not knowing, but suspecting that in a few hours, he’d be gone.

When it was time to go, his mother walked me into the hallway and we talked briefly. I knew him, but not her. He was like so many of us in L.A. who are the far flung progeny that ended up moving away from our families and childhood homes, a young man who’d come to town, found a job, made friends, created a surrogate family when his own was so distant. I had never met his mother until that moment. Meeting under such circumstances was both awkward and freeing. After trying for a moment to exchange the usual greetings, she burst into tears. Strangers, we hug and held onto each other, sharing our mutual sadness over her son’s needless and imminent death. Her pain was so excruciating, so deep. It was only the second time I’d witnessed the pain of a mother who knew she would have to bury her own child. As my grandmother said when my own mother was dying, “Burying your own child is wrong, it’s unnatural, and it’s not how it was supposed to be.” I wasn’t a mother then, and until I had children of my own, I really had no sense of how much this woman and my grandmother had hurt. Now, just the thought of something little harming my own children, the flu, a broken bone, fills me with worry and sadness. Losing a child to an illness, particularly when the death might have been prevented if the person had medical insurance is a pain no parent should have to suffer. My friend’s mother and her husband had worked for the government their entire lives and were now retired. She had given a lifetime of service to her country, yet her country had failed her now by not providing her son with desperately needed medical care which might have saved his life.

I have had several relatives who have had long periods of hospitalization, one who was almost bankrupt by it. They had medical insurance, but the coverage had limits and once they’d reached the lifetime limits they were expected to pay out of pocket. In the case of my aunt, a retired teacher, her hospitalization cost over a hundred thousand dollars. Hit with huge bills, having to make the choice between eating, keeping a roof over your head, providing for your family, the hospital bills, the amount so overwhelming that owing that much almost seems surreal, they chose to ignore them. They stopped picking up the phone when first the hospital then the collection agencies started to call. Those are the real threats. When the cost of saving you threatens to destroy your life and everything you’ve built up over the years. In my own family, I’ve seen what was a very real threat under the old health care system – that we are all really one major medical emergency away from going bankrupt.

Years ago, while traveling alone abroad, I fell ill. I was staying at a small B&B in the French countryside, came down for breakfast and passed out before making it to the table. I awoke on the sofa to find the owner of the B&B, an elderly French lady with shocking white hair who wore a slim fitting black cotton dress everyday of my stay with her, putting a compress on my head. She didn’t speak English, and my French was passable for a tourist, but limited to questions about asking your name, finding the restroom and knowing how to greet you morning, noon and night. I did not have the vocabulary to discuss serious medical issues. When I was rested, she walked me to door and pointed in the direction of the town’s hospital. I had been sick, a small cold, I thought, but I was traveling and wasn’t going to let feeling a little under the weather interfere with my adventure. As I made my way down the cobblestone streets of this ancient town which couldn’t have had more than five or six hundred residents, I grew fearful, not of what was wrong with me, but of how I was going to deal with whatever illness it was while traveling abroad. I wasn’t at home with my doctor. I had health insurance, but surely a small hospital in France would be considered an out of network facility. I wondered if I would even be able to communicate with the doctors. Would my care be good or would the language gap cause a miscommunication which would cause something worse to happen to me? What if I couldn’t afford to pay what I assumed would be the astronomical costs of an emergency room visit in a foreign country? I imagined what a visit to the emergency room in L.A. would be like, waiting two to four hours just to be seen and if I was at a hospital that wasn’t covered under my insurance plan it would cost me hundreds, maybe thousands of dollars to pay for treatment. I prepared for this to be worse.

I turned the corner and was surprised to find a hospital building with a modern exterior jutting out from the town’s ancient stone walls. The nurse didn’t understand English, but took the time to speak to me slowly in French, as if talking to a young child, using words and phrases I could grasp. They quickly whisked me into an examination room. The nurse took my blood pressure, temperature, drew some blood. The doctor came in right away, listened to my chest, looked in my throat and ears. He explained to me, again very slowly and patiently in French, that I had an ear infection which caused me to lose my equilibrium. That coupled with a fever and being generally run down had caused me to collapse. The doctor wrote me three prescriptions and sent me back out to the nurse’s station. As relieved as I was that my illness had been minor, I was afraid that seeing the bill would make me sick all over again.

The nurse sat me down at her work station and put the bill on the table. In French, she explained the different charges and pointed out the final total. My mind was on overload, sick, trying to calculate dollars from francs, guessing at the exchange rate. When I figured it out, I was certain I was wrong. In disbelief, I asked the nurse in French, “The total is twenty-five dollars?” She nodded and added in French, “If you can afford to pay it.” The cost of my emergency room visit was nominal and I didn’t have to pay for it if I couldn’t afford to. I was being treated under their national healthcare plan which stated that everyone had the right to good care regardless of their ability to pay. I pulled a wad of fracs out of my fanny pack and handed her the money. I shook hands effusively with everyone from the doctor to the nurse to the janitor mopping up the floor on my way out the door.

I clutched my three prescriptions in my hand and again walked down the cobblestone streets towards the pharmacy, giddy about my good luck at the hospital, but certain that at the pharmacy, I wouldn’t be so fortunate. At home, three perceptions, even with my health insurance, could still cost me anywhere from thirty to fifty dollars. When I approached the counter, the pharmacist took my prescriptions and started to fill them. Since he didn’t speak English either, he called his son in from the back room and the boy translated. The kid couldn’t have been ten, but his English was perfect, as if he’d spent hours of classroom time honing his accent or watched way too much American t.v. His father handed him the bill to explain to me. Again, I took a moment to make the conversion from francs to dollars, but when I did, I was certain my calculations were wrong. The boy saw the confused look on my face and said, “Yes, it is seven dollars.” His father said some thing to him in French too quickly for me to understand and the boy added the same phrase I had just heard at the hospital, “If you can afford to pay for it.” Payment was optional? When was the last time you were in a pharmacy in the U.S. and someone said that to you? I happily paid my seven dollars for three prescriptions and returned to the B&B to take my medications and recover from my illness.

The owner of the B&B made soup for me and encouraged me to put my feet up on the sofa, bringing over an afghan that someone, maybe she, had lovingly crocheted, and put it over me. I was sick six thousand miles away from home. I was afraid that I wouldn’t be able to afford to take care of myself, that even if I could pay, the treatment would be poor and I’d get sicker or die as a result. But my fear was unwarranted because the country I was in had decided that the health of its people and even visitors like myself was a priority. I was cared for most certainly better than I would have been at home.

Now that has changed. The passage of the health care bill will ensure that everyone in the U.S. has a basic level of coverage and quality of treatment. I’m not saying the new law is perfect, but it is a start. There will be some difficulties and challenges at first, and the anger, threats and fear may continue for some time, but in the long run, it will help our our nation to have the assurance that the health care needs of the people most important to us – our aging parents, our families, our children - will be met.