It is so gratifying that a few individuals have commented on my first post. It makes it easier to write this one. First and foremost in every decision about change in employment I made was the availability of a good group health plan. I was not free to consider leaving the government until I qualified for retirement from the government which includes continuing with the same health care coverage. As I have always been employed by big employers with good plans, I really didn’t understand the complexities of being insured with personal plans. I had a bit of understanding from the years I spent delivering health care when individuals wanted to schedule surgery at the end of the year after they had used up their deductible and the uninsured who literally earned $2 too much per month to qualify for Medicaid but did not have enough money to afford private insurance that would cover preexisting conditions. I have 2 examples that were very impactful on my understanding.
A young woman who was on Medicaid and food stamps needed a surgery to use a segment of intestine to enlarge her bladder. This was several decades ago and at that time the standard of care was to do 3 days of clear liquids with laxatives to clean out the intestine prior to surgery. She received all of the standard written instructions. During her surgery, she became incredibly unstable and we had to stop the surgery and close up the incision – the first and only time this ever happened to me. She later told me that because her food stamps would not cover food for her kids and the clear liquids (apple juice, jello, popsicles) for her, she just bought their food and drank only a bit of water during her bowel prep. While I don’t know for sure that this was the cause of the problems during surgery, when it came time to reschedule the surgery, I gave her plenty of cash to buy the clear liquids and the surgery went very well the second time. From that time forward, I was much more careful about trying to respectfully determine if patients had the resources to comply with what I was asking of them. For someone living on the streets, it is obvious that they many have difficulty complying with treatment to similar situations exist for persons that have stable housing. Difficult choices have to be made. Fortunately there is increasing awareness and research being done to understand these social determinants of health.
The second example is related to my helping my son and soon to be wife find adequate health care coverage. There were healthy, self-employed musicians in there mid-twenties. Up do this time when I heard someone say they were saving to have a child, I really thought they were getting a head start funds for daycare or college. I had no idea that in the private personal insurance world, affordable policies excluded pregnancy coverage for young women unless they purchased the pregnancy rider at the beginning which may be years before pregnancy. You would not be allowed to purchase the rider at a later time. How unfair!!!!
When I was practicing medicine, I was subject to the sound bites about how horrible single payer systems were and while I didn’t necessarily believe it, I didn’t have/take the time to inform myself. When I was practicing in Seattle, I would occasionally see persons from Canada who would come because they were upset about the waiting time for an elective surgery.
I have subsequently taken time to learn more and am a huge supporter of a single payer system. Health care cannot possibly be affordable if private insurance is allowed to insure the healthiest and make huge profits while public funders are left to cover the most unhealthy. There needs to be one risk pool. The owner of the single risk pool does not have to be the government, but it is hard to imagine a private entity being willing to do it if their profits will be less. In my mind, we need a government-based single risk pool to cover health care delivery.
My career path was through larger employer based health insurance benefits which I knew was important, but did not fully appreciate until very recently was at the core of my being able to take the risks that I did. It also is one of the many aspects of my privilege.
These will get shorter over time as I have less time to write but this is fun.
Tamara Unleashed 
One of my favorite Mark Twain quotes, “I didn’t have time to write a short letter, so I wrote a long one instead.” 🙂
So less time doesn’t equal less writing. 🙂
Anyway, quality of the content matters more to me than quantity. And I appreciate the quality here!
Looking forward to more when the inspiration arises.
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Appreciate a provider, or former-provider, acknowledge not being too familiar with health insurance structure, cost and limitations. My sense, and purely anecdotal, is that many patients assume their provider is either fully aware, or both aware and complicit.
The conversation often assumes health care is a basic need, but so often attempts to measure access to health care begin with the question of whether an individual has insurance….access to health care requires access to insurance. That is such a sad state.
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