Held to answer

How sacred is your life? How much should be spent to insure your health?

With the continuing debate over President Obama’s health care reform, the questions are worth considering.

Personally, my life isn’t as sacred as it used to be.

A few months after Obama’s health care reform passed, my insurance carrier dropped me because of a pre-existing condition. For the first time in my life, I didn’t have health insurance. I still don’t. (If Congress had my insurance plan, U.S. Sen. Ron Wyden might still be walking around with prostate cancer and not know it.)

I’ve always thought not having health insurance would be frightening. Instead, when a friend asked me what I was doing about insurance coverage, I told him, “My primary care physician is Dr. Strangelove. I am learning to stop worrying and love the uncertainty.”

I remind myself that having insurance is no guarantee of receiving good medical care. Paying for insurance is no guarantee of actually having insurance. And certain health plans carry a whiff of inferiority. For example, an employer-provided group plan carries more privilege than an individual plan, even though the latter may cost a lot more.

After being laid off from my newspaper job in Spokane, Wash., I paid about $12,600 in medical insurance premiums for two years, first through my employer’s COBRA and then to a private insurance carrier called LifeWise, which promotes its coverage for Washington, Oregon and Alaska.

I later moved to Oregon. When I sent an address change to LifeWise, I was told that because I had an individual plan I would have to reapply for insurance coverage through LifeWise in Oregon. (Had it been a group plan, there would have been no need to reapply.)

My change of address provided LifeWise a chance to dump someone who had needed to use her insurance.

A year earlier I had been diagnosed with pericarditis, an inflammation of the heart lining, which may or may not be serious, depending on the cause.

My physician at the time sent me to the hospital after she misread the results of a CT scan.

I was volunteering at a 24-hour crisis hotline for a mental health agency when my doctor called there in a panic looking for me.

“You have 300 cc’s of fluid around your heart!” she screamed.

She had reserved a bed for me in the cardiac unit of Sacred Heart Medical Center and said I needed to leave immediately. I needed to be monitored.

When I hesitated – I felt fine, the only problem I had was chest pains when I lay down – my doctor shrieked, “You could collapse and die!” (This doctor was from Ukraine, so her prognosis was delivered with a Russian accent.)

Two hours later I was in a hospital bed. Drs. No. 1, 2 and 3 – all residents – took turns looking at me and my CT scan. None of them seemed too concerned.

“We all have fluid around our hearts, some more than others,” said Dr. No. 2. “This doesn’t look like that much.”

I glanced around the room, at the doctors, the screen showing my CT scan. How much is all this costing, I asked. None of the doctors knew. Neither did a nurse.

The doctors decided I had pericarditis. A nurse gave me 500 mg of Naproxen and a Pepcid, and the chest pains went away.

“You can probably go home tomorrow,” said Dr. No. 3.

The next day, Drs. No. 4 (another resident) and 5 (a hospitalist) told me my blood work showed my body was fighting an infection. If an echocardiogram confirmed my heart was OK, I could leave. Because it was a Saturday, though, I might have to wait until Monday for an echocardiogram.

Again I asked, how much is this costing? Again, nobody knew.

A woman wheeled in an IV unit and told me, “We’re going to give you something to help you relax.”

I declined. “No thanks. I’m not interested in relaxing.”

I called a friend who advised me to buzz the nurse and demand to speak to a social worker and tell her I was concerned about the costs, of having an expensive wait for an echocardiogram that I could get at an out-patient clinic.

Within an hour of ringing the nurse, I got the echocardiogram and was released. The discharge papers told me to take Aleve. In 19 hours I went from supposedly near-death to business as usual.

Normally in these situations, a patient is so thankful to be alive that it seems ungrateful to raise questions. Perhaps that’s one reason hospitals get away with demanding blank checks when they admit patients who have insurance.

I hung on to my questions while $6,000 in bills arrived from the hospital, and my insurance paid roughly $4,000.  It took more than six letters from me to the hospital before I could obtain even a partial breakdown on what everything cost. At one point, they sent me a form letter saying the charges were “usual and customary,” so I wrote back and said in that case, why can’t you give me a list of the most common ones? Why can’t you post them in the hospital? Why can’t you make that information readily available to the staff and any patient who asks?

The hospital warned me that if I asked for an audit, the bill could go up.

The cost of that single 500 mg Naproxen: $6.30.  The cost of a single 20 mg Pepcid tablet: $5.92. The cost of the echocardiogram: $1,110. (I later had one in an out-patient clinic that was more thorough and cost $500 less.)

What if I hadn’t put up a fuss when they said they might have to keep me until Monday? The entire price tag would have been worse. They could have kept me in a hospital room with the meter running. A meter that only the billing department is allowed to see.

It wasn’t much better with the related medical services that followed. My physician sent me to the lab four times for blood work trying to find the cause of my pericarditis. On one visit, they drew nine vials. On another, they drew eight. Not once could anyone at the lab tell me how much these tests cost.

On what turned out to be my last visit to the lab, there was considerable back-and-forth conversation among the staff about my tests. Finally, a woman with a Russian accent called me into an office adjacent to the waiting area and said, “We don’t know what some of these tests are, but we found them on the Internet.”

She called my doctor on the phone and, speaking in Russian, they discussed my case.

Although the Aleve was working, and I had no chest pains, the doctor wanted me to take steroids while they tried to find what caused my pericarditis. I declined.

Later as I left the parking lot at the physicians’ clinic, I mentioned to the parking attendant – a white-haired gentleman – that I thought my doctor was making me sick.

“I know what you mean,” he said. “That’s why I haven’t been to one since 1984.”

I never went back to that doctor. I turned to DIY medicine. I sought the advice of a cardio nurse, a pharmacist and a physician who was a friend of a friend. They all said the same thing: Stick with the Aleve; get rid of the doctor; the cause of pericarditis is often unknown; continue practicing healthy habits. (I’ve never smoked, take no prescription medication, get plenty of exercise and eat good food).

My healthy lifestyle didn’t matter when I had to find another insurance carrier. That bout of pericarditis scared all of them.

LifeWise told me it would consider a new application from me in 2014 – the same year that Obama’s reforms will prohibit insurance companies from denying coverage because of a pre-existing condition. Until then, I’m supposed to use the “affordable” option offered me through the Oregon Medical Insurance Pool, which costs $500-plus a month. That’s $200 more than LifeWise and more than my budget allows.

Oregon’s Gov. John Kitzhaber this month signed legislation that he thinks is going to be a model for the rest of the nation. It may be a model for drug addicts and the homeless, but I don’t see how it’s going to lower hospital costs for non-ER patients, or encourage people to make healthier lifestyle choices or reduce mistakes by medical staff – all things that contribute to high health care costs.

The latter – medical mistakes – is especially touchy. Kitzhaber had hoped to tackle reforms that would set malpractice limits. If we had fewer medical mistakes, we wouldn’t need malpractice reform.

A few months after my little hospital adventure I was once again working the 24-hour crisis hotline, and I took a call from a woman having an anxiety attack. She had a doctor’s appointment she was dreading.

“I’ve been afraid of doctors since 2003,” she said.

What happened in 2003? Her doctor had given her the wrong prescription and when she went to fill it, her pharmacist caught the error. He told her that with her medical history, the drug could have made her seriously ill, maybe even killed her. He suggested she find another doctor.

The woman wrote her doctor a letter telling her she didn’t want to see her anymore and why. A couple of days later, the doctor called the woman and screamed: “You can’t fire me! I’m firing you!”

The physician’s histrionics sounded familiar so I asked the woman for the name of this doctor.

It was my former physician.

– Pamela Fitzsimmons