Ask Surly Amy: Cheap Health Care
I live in a city where alternative medicine is a big thing. I work in safety net health care, and many of the clinics I work with offer alternative treatment. Part of my job is helping low-income or uninsured people find health care. Often, only the alternative medicine clinics are taking new patients without a six-week wait. As someone who cares about both evidence-based medicine and health care for all, I am frequently conflicted about this part of my work. On one hand, in my state, NDs have prescribing power, appointments are inexpensive (sometimes even free), and patients may have to wait too long to receive other care. On the other, some of these clinics probably fund their lower-cost care by charging more to other patients, and in any case, I simply don’t agree with most of their methods of treatment. So what’s a skeptic to do?
~Just Not That Into Acupuncture
Dear Just Not That Into Acupuncture,
This makes me so angry and sad at the same time and highlights a fundamental problem with the health care system in the United States. Quality, science-based health care is becoming more and more difficult for the average person to acquire. It is becoming an elusive privilege for the wealthy. Average people are being forced into choosing second rate care because it is that or nothing. How can you blame a person for picking a doctor rather than no doctor at all? You can’t blame that person but you can blame the flaws in the system.
This is also another example of a wedge that the alternative medicine practitioners have successfully used to infiltrate the health care industry. We discussed a similar topic in a post with Dr. Gorski a few months back. The post was titled, In the Workplace Skeptical Activism. The post was about a hospital that offered acupuncture services in the same setting as other science-based care thus creating false credibility for the alt-med practice. Gorski’s advice was essentially this:
If you do want to try to make a difference, you will have to be prepared to get in trouble or even to walk away from your job. If you’re not willing to do that, then you’ll have little choice but to grin and bear it, perhaps with as much passive aggressive obstruction as you feel you can safely get away with. You might be forced to go along with this, but there’s no reason you have to be enthusiastic about it.
Unfortunately, this situation is quite similar only a tad bit more depressing. Your job is supposed to help people get legitimate care who can not afford it. Some of these people are desperate for help. I have been in that situation myself. If you encountered me a few years back you would have found a low income, uninsurable person with a history of chronic illness coupled with depression and anxiety. Would you have told me, sorry there’s nothing you can do for me or would you give me the address of an alt-med practitioner who can at least prescribe me my asthma medicine? Any decent human would want to at least assist in helping me to get my hands on a rescue inhaler.
Sure, odds are, because I was helped and I felt better, I would become a long-term patient of the doctor who can help me breath even if they are recommending sham treatments along with my asthma meds. That is the whole point of offering no wait time and less expensive introductory visits. The average person doesn’t know that they are being scammed with the added vitamins supplements and herbal teas that are added on to the bill on the way out the door. All they know is they feel better after the first visit. Odds are they were not going to feel worse.
I speak from experience. That literally happened to me. It took years for me to realize that the clinic I could “afford” was actually convincing me to purchase products and treatments that had no effect on my asthma condition at all. All I knew was I could breath when I had the resue inhaler that was prescribed by what I assumed was an educated, trustworthy doctor and that I couldn’t afford a trip to the ER or health insurance. Heck, I still can’t afford quality health insurance. Few can these days.
So what can you do?
The best advice I can give is for you to educate people as best you can as to what treatments are reliable and what are just sugar pills and shams. And I realize that you probably can not do this in your workplace much, if at all. But outside of your workplace consider doing what you can to educate people on what is wrong with alt-med as a replacement for science based care. Speak up and speak often. Also, if you see any providers offering or claiming cures for illness that are unproven, take note. Then, when you are off the clock please notify the FDA. You can not stop people from being fleeced but you don’t have to be completely passive.
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*Photos by me.
Am I the only one who finds a perverse irony in the fact that, as a country, we are becoming more and more dependent on eastern “medicine”.
The very “medicine” that we are saddled with came to be because of the Chinese government’s inability to provide proper healthcare to its citizens after the cultural revolution, forcing them to promote acupuncture and other “alternative”modalities, despite knowing that they did very little to help.
We are increasingly reduced to shuffling deckchairs on this once-great ship of state. Pathetic really, but hardly surprising.
Not to be nitpicky, but we should call it eastern alternative med, as the chinese do plenty of great medical research and are contributing to science and evidence based medicine just like elsewhere in the world. I think there needs to be a shift from calling proper medicine-Western medicine. It is Real/evidence/science based medicine, and it also plays into the hands of the quacks by making it sound as if it is just a cultural bias of the west. But many countries and cultural groups have arrived at the evidence based medicine, and are contributing to our knowledge, global credit is due. Hope that makes sense. Sorry for the mini-rant.
Really, really good points. I agree with you. Science-based medicine can happen anywhere, not just the West. This “East/West” divide smacks of xenophobia.
I absolutely agree, there are many reasons alt-med is called eastern and xenophobia is high on the list. I was pointing out another (communist China’s furthering of “traditional” medicine to the poor after the cultural revolution). Yet another very large reason would be quacks and other proponents playing up the mysticism that comes from the unfamiliar, as the east is to many westerners.
I didn’t mean to make it seem that it is still that way, I simply find it ironic that we are now the ones on the downside and relying on unreliable alternatives.
Meanwhile, in Canada, you go to the doctor if you’re sick. No one cares about your medical history except in as much as it relates to the treatment of your current condition.
I can’t understand why Americans continue to tolerate a system that prices human beings out of basic medical care. WTF?
Ask yourself what you would do. Imagine you live in a country that is relatively prosperous, but with poor health care. Emigration is not a realistic possibility because the only places you can relocate to are worse than where you live. If you can relocate, you can afford services here anyway.
Do you write your politicians? Their campaigns are financed by the people who benefit from the status quo. Petitions have the same issues as writing your politicians. Do you protest? There has already been some of that due to OWS and even then, you can easily be fired from your job if you engage in the “wrong” kind of activism. This is especially true of the people who need it the most. I really can’t fault people for being quiet when being loud means you can’t feed your child(ren). You could try to vote for candidates who actually want to reform the system, but we already saw how watered down that was.
Is there another realistic option I’m missing here? Because it gets really annoying when people ask “why do you put up with it?” when the system is such that it removes our power to do otherwise.
Well, there used to be until the business interests decided to destroy the unions and sell it to us as the best thing for us. Every right you have in the workplace is thanks to unions but in many places simply pointing that out can cost you your job, businesses are that spooked by them. They have their problems, but strong unions would go a long way to strengthening the middle class again. Exactly why they will not be allowed to be strong again without a major change in public sentiment.
I would love strong unions, especially after working at a non-union factory. Worst job in my life.
I’ve been having ear pain off and on for weeks now, but because I’m broke and don’t have health care, I just get to wait and hope it gets better, instead of worse. Here’s hopin’ it’s not something serious and I don’t wake up deaf one day!
Isn’t that awesome, though? I fucking hate how health care in this country is handled.
Oh, and I made too much money for state healthcare … when I was unemployed and getting unemployment. I think I was getting like $200 (probably less) a week on unemployment, but I made too much to get state health care.
Can we move to Canada?
Skepchick Commune in Toronto? LOL
Marilove, I recommend ear candles. Worst case, they do nothing. Best case, you get severe ear burns, go to the emergency room, get treated for the burns, they discover your real underlying problem (or maybe just prescribe antibiotics to keep your burns from getting infected, which just by chance cures your ear infection as well), and you get better.
That’s one of the worst problems with alt-meds. They don’t do anything and eventually you crash, go to the emergency room and get much more intensive (and expensive) care for something that could have been much cheaper and less invasive to treat earlier. But sugar pills, poking people with needles[*] and rubbing their backs and feet is cheaper than actually testing people and treating them with real medicine, so insurance companies and state health plans go for the quick, cheap solution and hope to postpone the more expensive stuff and hope the condition is self-limiting or fatal, and if not they slough the cost off on the hospitals or force the patients who can afford private insurance to pay for it through higher premiums.
This is one of the reasons why America pays more for health care (% of GDP) than any other country but gets crap for it. (34th in infant mortality, 36th in longevity, or even worse if you go by the CIA figures cited here.)
Haha, nah. I don’t want to do that candle thing. FIRE AAH!
I am going to get some Sudafed tonight. Some say that might help, if it’s just clogged or whatever.
It costs $80 just go to the clinic at CVS to get checked. I do not have $80. I’m hoping it’s just clogged, and the Sudafed will help. If not, eventually I’ll make it to a clinic whenever I have the money.
Also, even if I do go to the hospital, it’s not free. I already have thousands of dollars in hospital bills I can’t pay due to a serious infection I had last year that kept coming back (ANAL ABSCESSES ARE FUN YO).
Seriously, though, being poor when you’re sick SUCKS. I went to urgent care three or four times for the anal abscesses. It came back three times. The first time I went, I knew what it was (thanks, internet!), but the “doctors” at urgent care REFUSED to drain the infection. They told me it was just “a bit infected, here are some antibiotics.” Two days later, I literally crawled in, begging for pain killers. They gave me the pain killers, but still refused to drain it. Went to the hospital a few days later because the infection broke … everywhere (it was so gross). The doctors at the hospital were AMAZED I went that long, and also disgusted that the urgent care refused to actually treat me (and I paid UC like $100 … so basically they got my money and shoved me out the door).
Infection came back. I went to Urgent Care, demanding they drain it, but AGAIN they refused. Charged me way too much money for fancy antibiotics.
Two days later I was back at the hospital. They drained it, and were once again shocked that UC refused to drain it, even though I begged them to (I was so pissed).
The infection came back AGAIN. This time I said fuck it and just went straight to the hospital. They gave me some MAJOR antibiotics that time, which totally sucked for weeks, but it finally knocked out the infection.
But seriously. Fuck Urgent Care. I will never go back. Even though I knew exactly what was going on, and even though it came back and it was obvious what was wrong, they refused to treat me properly.
I could have died. The infection was REALLY bad the first time, so bad that the doctor at the hospital said that if it hadn’t finally broken on it’s own, it likely would have gotten much, much worse and I would have gotten very, very, very sick and the infection would have then entered my blood stream….
Being broke and not being able to afford decent health care generally means you get second or third rate care. It sucks.
(Can you tell I’m bitter?)
That really sucks!
I’ve never been poor enough not to have insurance, but I’ve been told most people in that situation rely on hospital emergency rooms for primary health care. Maybe that’s bull, and what actually happens is unless the cops spot a poor person lying unconscious on the street and call an ambulance, they actually don’t get any health care at all? (Or their family doesn’t eat for a week?)
Also, what is “Urgent Care”? Is that the local term for “Emergency Room” or is it a generic term for a clinic between a regular doctor’s office and an ER, or is it a specific private business or state program? Or why don’t I Google it myself? … Turns out to be a generic term for a walk-in clinic that provides emergency (unscheduled) treatment, but at a lower level (and cost) than a traditional hospital ER. If it’s something they can’t cope with, they are supposed to transfer you to a real hospital. Are the UC’s in your area for-profit? Do they have any concept of patient service or do they just try to charge as much as they can for as little as they can get away with? Do they get into trouble with the state medical licensing board when they screw up?
P.S. Get well soon. I hope your ear thing isn’t anything serious.
It’s a little bit of both. Generally, if it’s something mild, you don’t go to a doctor. If it’s something that needs to be taken care of, you either find a cheap clinic and/or Urgent Care, or you go to the hospital. It all depends on many factors, though. What is nearby? Are there affordable clinics near by? Are you aware of them? And even if there are affordable clinics nearby, the hospital is sometimes a better bet because the staff at clinics and urgent cares aren’t always awesome (as I found out), and they don’t always listen to you, even if you know what you’re talking about.
But yeah, you got it right with Urgent Care. And it all depends on a lot of factors. The area (some are nicer than others), the staff at the time, how busy they are, what is wrong with you… I even asked if they could drain the infection if that is what was needed, before I went in, and they said yes. It’s something they could have done, easily. But they refused, because they didn’t properly diagnose me. “it’s just an infection, here are some pills, it’ll go away on its own.” But that kind of infection NEEDS to be drained. It won’t just go away on its own (not normally, anyway). Ugh.
So, basically … if you’re poor, you try to deal with the small stuff yourself. Generally that means small stuff gets bigger and bigger, until you’re forced into going to the hospital — and then, what was a fairly quick/easy fix when it started, just becomes worse and therefore more expensive and difficult to treat.
This entire, “If you’re poor, you go to the hospital for even a cold!” is pretty bullshit. The hospital isn’t fun. Most people just don’t get the healthcare they need, until things get worse.
I mean, even just going to the CVS clinics (which aren’t quite urgent cares), is $80 MINIMUM to be seen, and that doesn’t count any additional lab work or antibiotics or anything like that. So for even a simple UTI, you’re paying at least $80 — plus lab fees, and antibiotics, etc.
@Marilove: Was it the same UC each time? I’ve been to a few Urgent Care places in my hometown, and found that the quality varies greatly. One was nearby in an old hospital building, kinda creepy looking, not very polite staff, and I’d never go back to unless it’s just to get an amoxicilin prescription or something. Another one that was 15 minutes further away was FAR better on all counts. Had a similar experience with two different ER’s not far from each other. In my case the cost was the same because I have insurance, but that’s a high priority since I have a few long-term medical issues.
Same network, but two different locations. And yeah, the quality does vary greatly, and it can vary greatly even by day or doctor/nurse. I bet if I went to a clinic in North Scottsdale, it’d be far better (I live in Central Phoenix), but that’s not always feasible (it’s like 30-45 minutes away, depending on traffic and stuff).
LUCKILY, I live about half a mile (if that) from a very nice hospital, and they took very, very good care of me. Really grateful I live so close to them.
All i could think of while reading that was “I’d sue their asses.” At LEAST for all the unnecessary hospital bills. You shouldn’t have to pay for medical “professionals” refusing to do their fucking jobs.
I’m not sure how I am expected to afford expensive lawyers when I can hardly afford tylenol.
Ugh, I totally understand what that’s like.
I’m in Anaheim and, presumably, there are good clinics and UC places nearby but I don’t have a car and taking the bus around here is a losing proposition. Besides, I’ve been without insurance my entire adult life so I’m used to not seeing a doctor. This is starting to cause problems, though, between my undiagnosed (but apparent) fibromyalgia, my undiagnosed (but apparent) autism, and some really bad dental problems. I spent the last three days in horrible pain because I can’t see a dentist, and I do this every month or two because I haven’t seen a dentist since I was 12.
Without being able to see the doctor, though, and get some kind of medical history it’ll be impossible for me to get disability benefits. I used to work in IT but with how my pain is manifesting I can’t do what I used to do anymore. I need to take frequent breaks from typing or talking to people, I frequently lose the ability to focus, and I sometimes have trouble hearing anything on my phone. Hard to go back into customer support this way. Disability, though, only comes to those with medical histories.
Right now I’m living on unemployment and hoping to make something out of my writing. It’s not working out yet but I’ve got until December to replace the $1600 a month I get in UI with something else.
Forgot my snarky footnote:
[*] I wonder if there is a correlation between anti-vaxxers and acupuncture believers?
Remember when “non for profit” was not the sign of the devil? What ever happened to that?
You know, it was not very long ago that you could distinguish a real science based doctor from a quack very easily.
Real doctors were forbidden to advertise and all they could have was a brass plate with letters only so high whereas quacks could go the whole hog with large fluroescent signs, advertising and so on.
Nowadays big clinics seem to be almost indistinguishable from quack clinics on that basis.
I assume the same trend is visible worldwide?
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