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Health-Care Stories for America

A few weeks ago, Barack Obama's Organizing for America put out a call for health-care stories from its members. Thousands flooded in. Now they're online. This one, from Tristan, is particularly brutal:

I had health insurance through my employer after I graduated from college. I was having problems with my stomach, I vomited blood at least once a week. I went to a doctor to get checked out, but was told my insurance did not cover my treatment unless I had a primary care physician approve me for specialized stomach treatment. I tried to find a primary care physician, but the earliest available appointment for any PCP in my town was 8 months away. I never got the appointment, I never got the treatment (remember, I just wanted to be checked out).

I currently live in Japan and am eligible for the National Health Insurance plan here. It costs me approximately $100 a year. I went to get my stomach checked out, and learned that I have Barret's Esophagus. Though the doctors cannot be sure, there is a chance that if I had been consulted on things I could do myself (diet changes) or given some sort of acid-reducing medicine then my stomach problems could have been controlled before they caused Barret's Esophagus. Now, I have to live with the understanding that I have one of the leading symptoms for esophageal cancer (10% per patient-year or greater), one of the most deadly cancers known. I'm 27, and now my wife and I are questioning if we should have kids soon. I can't help but think, "am I going to live to see my kids grow..." I love my home country, but my anger towards what its health care system has done to me is sometimes beyond control.

Weird that such a thing could happen amid what Sen. Richard Shelby called "the best health-care system the world has ever known."

By Ezra Klein  |  June 29, 2009; 1:33 PM ET
Categories:  Health Reform  
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Comments

Where do you have to wait 8 months to see a primary care physician? If you say you want a routine physical then maybe you have to wait 8 months but I have never heard of anything remotely like this otherwise.

Posted by: spotatl | June 29, 2009 2:02 PM | Report abuse

Agreed.

This sounds too absurd. I'd hate to doubt that something so awful could happen to someone but this story is such an outlier that even if it's true it's hard to see how it's relevant.

Posted by: dugmartsch | June 29, 2009 2:14 PM | Report abuse

"I never got the appointment, I never got the treatment (remember, I just wanted to be checked out)."

Oh, so now he's at risk for "one of the most deadly cancers known" and it's the system's fault?

When I needed a consult with a specialist, I went and got the necessary referral. I'm not particularly moved by the story of someone who couldn't be bothered when it mattered most.

Posted by: whoisjohngaltcom | June 29, 2009 2:18 PM | Report abuse

Not to be unsympathetic or anything, but ... this guy was VOMITING BLOOD and yet he was apparently dissuaded from seeking treatment by a receptionist. Seriously?

Maybe lots of folks out there vomit blood on a regular basis, so it's well known that this vomiting blood thing is usually not a big deal. I, however, would be quite freaked out. So, for other people like me, I suggest that, if (1) you are VOMITING BLOOD on a regular basis, (2) you have a busy PCP who won't see you sooner than 8 months out (even when you tell the receptionist that you are currently vomiting blood regularly), and (3) you are (bizarrely) unwilling to go camp out in your PCP's office until there is a skipped appointment, then proceed to the emergency room immediately (preferably on the day you vomit blood). I note that while emergency rooms are unpleasant places where one has to wait too long, the wait is typically shorter than 8 months, and besides, YOU'RE VOMITING BLOOD.

Sarcasm aside, I feel bad for this guy. Looking at it from a policy standpoint, however, I'm not sure what this story actually demonstrates. After all this guy had insurance, yet was dissuaded from seeking care for a serious condition -- apparently for a significant time -- by a bureaucratic rule (gotta see the PCP first) and an apparent unwillingness to demand an emergency appointment at the PCP or otherwise seek emergency treatment. Will there be no bureaucratic requirements and zero wait times in the brave new world - or will folks still need to recognize for themselves the times when they need to speak up and seek emergency treatment?

Posted by: WmOckham | June 29, 2009 2:26 PM | Report abuse

I think you are always going to face a confirmation bias problem with healthcare stories. People will latch on to stories that make the other side look bad without stopping to do a reality check. Its going to happen on both sides since when you are talking about a large sample size there are always going to be plenty of outliers that sound perfectly reasonable to you if you have already decide that one side or the other is a terrible system.

Posted by: spotatl | June 29, 2009 2:46 PM | Report abuse

"Where do you have to wait 8 months to see a primary care physician?"

For a first appointment? In my relatively small city, the wait time for new patients is usually given as 3-4 months.

In the meantime, the usual Galtroid suspects are happy to say it was all because the guy "couldn't be bothered". Nice.

Posted by: pseudonymousinnc | June 29, 2009 2:51 PM | Report abuse

pseudonymousinnc:
"In my relatively small city, the wait time for new patients is usually given as 3-4 months."

Complete manure. If you're sick, you'll look harder. Put your money where your mouth is: Name your "relatively small city." I'll make some phone calls and post the *actual* wait times for a PCP in that city.

"In the meantime, the usual Galtroid suspects are happy to say it was all because the guy "couldn't be bothered". Nice."

Like he said, "I never got the appointment, I never got the treatment" Again: WHO never got the appointment??? What the heck, it's just a little bloody vomit, right?

Posted by: whoisjohngaltcom | June 29, 2009 3:06 PM | Report abuse

The point is that an insurance company imposed a bureaucratic rule on the guy that discouraged him from getting treatment. You would think that in a high dollar customer oriented health care system like the one we supposedly have, he could have gotten the service he needed right away without any hassle.

Posted by: fishermansblues | June 29, 2009 3:10 PM | Report abuse

This type of passivity is what Obama talks about when he says we all have the responsiblity to take care of ourselves. I agree with the other commenters that there would have been other options. ER of course, urgent care perhaps, or as one noted, just sitting in the waiting room until they take care of you. Ironically, Japan is one of the few places where a new treatment for esophageal cancer is being routinely used - it's sort of a lasso type thing that takes out small tumors before they spread. Barrett's is not necessarily a death sentence. There are medications and treatments, but they will require this person to be quite vigilant and assertive about his health. Keep getting checked and keep on top of it.

Posted by: LindaB1 | June 29, 2009 3:13 PM | Report abuse

Ezra -

In response to this, a helpful post might be to explain what various health care reform proposals might have done to help this guy. For example, I have to assume that he lived somewhere with few health care providers, such that there was de facto rationing. How would that change? And if it wouldn't, how do we fix that problem?

Posted by: JEinATL | June 29, 2009 3:22 PM | Report abuse

Agree with those above this is horse manure. A PCP might charge what, $80-100 to see in the initial visit. In any decent sized city there are about 20 Urgent Care offices that will see you in one day if you pay. This guy is either too stupid to call around or too cheap to pay his own money or too lazy to follow-up with his insurance to get someone quicker. Oh, how much you bet this guy spent on cable TV in the months he waited to see a doc? He could have seen half a dozen docs in this timeframe for the amount he spent on his cable.

Posted by: sgaliger | June 29, 2009 3:44 PM | Report abuse

A 3-4 month wait for a routine checkup when nothing is wrong I can understand. There is no chance in hell there was an 8 month wait to see a PCP when the patient was vomiting blood.

"Im vomiting blood but I need to see a Primary Care Doctor before I can go to a specialist- when can I get in?"

"Would you happen to be free on the morning of March 18th of next year? I'm sorry but every moment between now and then is booked up"

Seriously... you think thats how the conversation went? And I have a strong feeling that any single payer system is going to route people through some kind of primary care person before you can go to a specialist.

Posted by: spotatl | June 29, 2009 4:25 PM | Report abuse

I'm 100% behind you, Ezra, in your advocacy for improving health care access, but I recommend some serious fact-checking before pushing this story any further.

Because as Galtrian as it may sound, I agree with most of the posters above -- it just does not seem plausible that (i) someone vomiting blood would be told that it would take eight months to see a doctor, and (ii) someone vomiting blood would respond to such counsel by saying "Okay, never mind. I'll just deal."

Maybe this really did happen. But even if it did, the guy bears some serious responsibility.

Posted by: steveh4 | June 29, 2009 4:37 PM | Report abuse

The thing many of the comments are missing is that for many people, especially young people and even more especially young men, seeking health care is related only to acute and ongoing problems. If the symptoms go away while hassling with the system, the patient often decides they are safe to ignore.

This is a symptom of one of the biggest problems in US health care. The bias in this country is toward aggressive intervention in acute crises. This is partly due to the payment system, which penalizes more trivial use financially, and partly due to culture, a culture that extends to providers.

Granted, the patient story shows a poor understanding of how to deal with a significant health problem. Granted, there are ways the guy could have done a “work-around” to deal with the problem. But the biases in the system push many patients in the direction he chose. There are hundreds of thousands, if not millions, of people out there who have ignored chest pain, have not paid attention to transient neurological problems, have not paid attention to this or that, especially if their contacts with the health system pushed them in that direction. Most doctors have experience with many patients who have waited and waited and then ended up in the ER at three AM, or the ICU after having collapsed at work or at home.

In a system where the financial system actively discourages seeking help for all sorts of problems unless they beat the patient over the head on a repeated and sustained basis, this type of story is all too common.

This is one of the big reasons why our system is consistently outperformed by other countries. They actively encourage early and frequent doctor visits, having found that having more frequent outpatient visits prevents more serious problems, leads to better results, and is actually cheaper than reliance on high tech home run medical care.

Posted by: PatS2 | June 29, 2009 4:43 PM | Report abuse

A few years ago, I was waiting for my appointment at a PCP's office, and the receptionist was on the phone with someone who was a new patient, and who wanted a physical exam. She said that the earliest slot for that would be in several weeks. The guy had a very loud cough, so loud I could hear it from where I was sitting, and she told him that if he was sick and wanted to come in for the cough, she could get him in within 2 days.

I've lived in Dallas, and San Jose, CA, and I've never had to wait more than 1 day for an urgent appointment, even with a doctor I had not seen before. The time I called a urologist about a kidney stone, they said it would have to wait until the next day. I said I was in terrible pain and I thought was getting an infection, and they told me to come by that afternoon - there were no slots available but they would work it out.

I've heard enough stories about people who have to wait a long time to see a doctor to think there must be something to it, but I'm not sure why my own experiences are different.

Posted by: apsalar | June 29, 2009 5:02 PM | Report abuse

"If the symptoms go away while hassling with the system, the patient often decides they are safe to ignore."

You mean unlike those folks in Canada who decide to come to the US because their symptoms won't go away? Is that what changes under universal health care -- the symptoms stop going away??? Or do people just come to understand that time is more critical when the lines are always very long? Maybe when we have more horror stories here about long lines people like this guy will seek care with more determination.

I have news for you. This character -- Tristan -- if that guy had walked into a DMV-like waiting room for the same symptoms he might very well have reached the same conclusion. And I don't want to hear any bogus extrapolations of current demand being used to prove that unlimited demand for "free" care will not swamp waiting rooms. It's a dynamic problem, and static projections of demand are pure fiction.

You yourself have just implied that the problem is people not sufficiently concerned to do what's in their own best interests -- as it almost always is. Again: how is that your problem (or mine, for that matter), and not THEIRS???

The fact is that if this guy knew that vomiting blood means you have to see a doctor ASAP he would have done so. That doesn't take a new program, another trillion dollars or two, or an act of Congress. It just takes someone who thinks throwing up blood is more serious than all the other things he went on to do before he was finally diagnosed however months later.

Posted by: whoisjohngaltcom | June 29, 2009 5:10 PM | Report abuse

"If you're sick, you'll look harder."

Here we see the Calvinist definition of the elect and damned at work.

"You mean unlike those folks in Canada who decide to come to the US because their symptoms won't go away?"

And if you weren't sure that the silly Galtroid was just a slogan-chanter, there you go.

Posted by: pseudonymousinnc | June 29, 2009 7:23 PM | Report abuse

“You mean unlike those folks in Canada who decide to come to the US because their symptoms won't go away?”

You always know you have fallen down the rabbit hole when people start talking about Canadians coming to the US. Canadians do not wait in DMV style waiting rooms. Canada has private practice just like the US. Although they aren’t perfect – doctors in the US aren’t either – Canadians do not wait for acute or emergency care. They do wait longer for some elective and semi-elective procedures than in the US, and some people “queue jump” by going to the US, but that is actually quite uncommon. I worked as a doctor in a large health system that dominated a US city that was the closest in the US to a larger Canadian city, and seeing Canadian patients was very rare.

Systems with little or no charge to the patient encourage more frequent visits to doctors. That statistic is easily available. As a result, people are less likely to decide they should defer visits.

Saying that that causes better results is a speculation, but the fact is that the medical systems in most developed countries get better results than we do in terms of medical care, both overall and in results measured in outcomes of specific illnesses once the patient has been diagnosed and brought into the system. Canada is just one of those countries.

Posted by: PatS2 | June 29, 2009 7:47 PM | Report abuse

PatS2:
"Canadians do not wait in DMV style waiting rooms."

That's true. Nobody would wait 8 weeks for an MRI in a waiting room. People prefer to die at home.

Posted by: whoisjohngaltcom | June 29, 2009 10:10 PM | Report abuse

Galtroid's just waiting to wave Natasha Richardson's bloody shroud. What a tedious maroon.

Posted by: pseudonymousinnc | June 29, 2009 10:30 PM | Report abuse

PatS2, you expressed my concerns exactly with the comments above saying, "he could have done this or that." I do agree that he probably could have been smarter about handling the situation, but when you look at the context in which he made his decision, it's understandable that he chose as he did. In addition, the biggest factor I think is the uncertainty involved. Of course if he had known that getting care immediately could prevent a more serious problem later on, he would have done everything in his power to get care, as would most people in that situation. But that's usually not the situation we're given. If his symptoms went away, it's not that unreasonable that he'd assume everything was okay, especially for someone young and not used to thinking about issues of mortality.

Posted by: bupkiss | June 29, 2009 10:44 PM | Report abuse

LOL!

""Any wait time was an enormous frustration for me and also pain. I just couldn't live my life the way I wanted to," says Canadian patient Christine Crossman, who was told she could wait up to a year for an MRI after injuring her hip during an exercise class. Warned she would have to wait for the scan, and then wait even longer for surgery, Crossman opted for a private clinic."

http://www.foxnews.com/politics/2009/06/30/canada-sees-boom-private-health-care-business

Posted by: whoisjohngaltcom | June 30, 2009 4:08 PM | Report abuse

Individual experience means nothing, since it is ideosynchratic. You can find plenty of stories about people who died in hospital waiting rooms in the US, and there are millions of lawsuits each year alleging that US doctors and hospitals mismanaged their patients.

In point of fact, as a doctor (a radiologist at that) I can tell you that an MRI is rarely indicated in hip injuries. There are rare exceptions, and they make good stories both here and in Canada. Very few US doctors would order an MRI for hip injury without waiting quite a while to see what happened.

What really counts is overall data showing how a health system works for everyone. Unfortunately for Americans, the Canadian system has better results overall. This information, as well as similar results for other systems, is widely available. Look it up.

He who laughs last, laughs best.

Posted by: PatS2 | June 30, 2009 5:12 PM | Report abuse

I call BS on anybody in any part of the United States having to wait 8 months to see a doctor for ANY REASON other than lack of health insurance, in which case the ER is your best option.

Just to prove my point, I'm posting a challenge on this thread. Give me any zip code/town in the United States, and I'll find a clinic within 50 miles that has an open appointment slot within 2 weeks. Any zip code in the nation.

Posted by: platon201 | June 30, 2009 6:42 PM | Report abuse

"Very few US doctors would order an MRI for hip injury without waiting quite a while to see what happened."

Yes, but once you ordered it, you shouldn't have to wait 8 weeks, right?

"What really counts is overall data showing how a health system works for everyone."

Disagreed. What really counts is how the system works for those who are funding it. I suspect your comparison factors the fate of free riders pretty heavily.

Posted by: whoisjohngaltcom | July 1, 2009 5:02 PM | Report abuse

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