Monday, August 31, 2009

Join Me In A Conversation: Tell your healthcare storey.

? Why do we need healthcare reform?
As our leaders in Washington debate healthcare reform and the media
pundits pontificate it becomes easy to forget that what they
are talking about is us.
This is my healthcare story. I am telling you my story because I believe that true change cannot happen without understanding.
Understanding comes through dialogue. As the internet has taught us, a committed group of thoughtful people can change the world.

If you like, you can continue the conversation by telling your story and
placing it in your FB notes or on your blog. Tag your friends. Ask them to tell their
stories, and don't forget to tag me back.
This isn't about black and white regulations or profit or taxes, it is
about people like me. It is also about people like you...

I was born in a small mountain town called Durango Colorado. Durango is
located in the Southwest part of Colorado. Soon After my birth the
doctors discovered than I had an eye disease called Glaucoma. In the
first 24 months of my life I had 21 eye surgeries. Ultimately, Glaucoma
ravaged my eyes. I now wear bilateral prosthetics. Translated this
means that I have two fake eyes.
My family had to absorb the costs of my medical care because my father
made too much money to qualify as poor. Nor did my family qualify as
rich. My medical expenses included airplane trips to both Denver and
San Francisco. My surgeries were performed in Denver and San Francisco
as the town where I lived didn't have pediatric glaucoma specialists.

There was no public option to provide medical care, rather my family had
to learn to parent a child with
permanent vision loss and absorb upwards of $30,000 in medical bills.
My family had to bare this Burdon alone and it put a tremendous amount of stress on the family system. No family should have to choose
between purchasing new school shoes and paying for surgical procedures
for their kid.
Children are a critical component of healthcare reform. All
children- regardless of citizenship or the income of their parents are
entitled to healthcare.

Now, back to those fake eyes of mine. In healthcare terms my eyes are
called, "durable medical equipment." This means that they are, well I
guess it means that they are durable...
My eyes are made of acrylic and are meant to last from between five and ten
years. I have to replace them, but not very often.
My prosthetic eyes cost $2000 each.

When I was a young adult I was on Medicaid, a public benefits program
for poor people. When I needed a new pair of prosthetics Medicaid paid
100% of the costs. I am grateful to have been able to get my eyes paid
for with tax payer dollars.

Oh, but that isn't the end of the fake eye story...
I have been working for quite some time and have been lucky to have
health insurance through my employers. Kaiser is my HMO. About 5 years
ago I needed to get a new set of eyes made (these are the ones I am
sporting in my Facebook picture btw)
In order to get durable medical equipment through my HMO I had to get a
referral from my primary physician.
My Kaiser doctor wouldn't write me a DME referral; she gave me a
referral to ophthalmology. Funny thing is that the ophthalmology department
didn't really want anything to do with me, they prefer that their
patients actually have eyes, so they sent me back to my primary care
doctor.
This went on for a while. I eventually changed primary care doctors and
finally got the DME referral I needed. I had my eyes made, but I had to absorb $800 of the
costs associated with my new eyes. This does not take into account the
cost in lost wages when I needlessly went to ophthalmology or navigating Kiser's
bureaucratic system. HMO's don't typically cover DME adequately. In addition, I'd have a very hard time getting health insurance on the private market simply due to my eye condition. Healthcare reform must address durable medical
equipment needs.


Now, here is the thing about Kaiser... The above story aside, I love
them. Other than my eye condition, I am exceedingly healthy. I've never broken a bone,had an operation not related to my eyes and I work out constantly.
I have been injured from playing sports. I needed an MRI physical therapy and
help with pain management when I tore my shoulder. I trust my primary
care doctor and my OB. I can use Kaiser's web site to check on lab
results, make appointments and read about the new strain of the flu.
Plus, Kaiser recently started carrying talking prescription bottles.
I am training for a marathon in December and I have the best healthcare team around me at Kaiser I could ask for as I push my body to its limits. Kaiser also offers classes. I have taken two classes through Kaiser and
I thought they were great. So those HMO's aren't all bad.

I hate to get bogged down in details of profit because really, most
of the motivations behind healthcare reform are about profit and either
redistributing it or increasing it. We can't put the healthy people in one place and the less healthy in another- that just won't work out in the aggregate. I am worried about people being put in boxes and falling through this crack or that and ultimately we end up with reform that is worse than what we currently have. I am not a commodity, I am a person who happens to be blind. I believe that all Americans are entitled to comprehensive healthcare coverage.

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