The American Health Care Kiada: Rolling the Boulder Up that Hill for Infinity, Continued...

 

The United States health care system is the worst I have ever encountered and I lived for awhile in Russia. I was reminded of this empirical fact again recently when I wanted to transfer my rheumatological care from the Centre for Rheumatology in Albany to Albany Medical Centre.

Why did I want to transfer care? Well for several reasons. The Centre for Rheumatology uses an online portal system devised by the minions of one Jamie Dimon and it is awful. Why is it awful? Well the Centre did not do the obvious thing to do, namely ti set up a pay system through our already existing portal accounts. They set up one which we had to go through a series of puzzles to finally get to a level and a point to pay them for services rendered. When the Centre did try to do what should have been done in the first place (setting up a pay system allowing us to pay through the portal—and remember the portal has all the necessary information so we don’t have to go through a series of puzzles to get to a point when we can pay—it messed up the accounts system and sent us bills for services we had already paid for. In response I threw up my hands and decided to go back to my GP to get a referral to rheumatology at Albany Med.

Actually, this was the second referral to rheumatology at Albany Med my GP sent to them. She initially referred me to rheumatology at Albany Med but Albany Med denied the referral claiming that my insurance denied coverage. This had to be a mistake since my insurance (Medicare and employment pension) did not deny me coverage at the Centre for Rheumatology which I got a referral to because I did not want to deal with the bureaucracy at Albany Med anymore given the incompetence (something inherent to bureaucracies since humans are inevitably involved in the processes related to them). 

To make a long story even longer I was denied care for my fibromyalgia at Albany Med again but this time for a different reason than the insurance. Interestingly, I never received a call or a text message from Albany Med saying that that there was a message in my Albany Med portal saying that I was denied care for my infirmity. Given this I called to make an appointment for rheumatological care at Albany Med. The customer service operative I talked to told me that she had no referral so making an appointment was a no go. 

So, thanks to the bureaucratic unmerry-go round I contacted my GP’s office again assuming that the referral did not go through for some reason. Another referral was sent. The person helping me informed me through all this informed me of another relevant bureaucratic puzzle level in Albany Med referral process. All referrals to Albany Med, I was told, have to go through a central referral office which takes a look at them and passes them on if they pass go in the game of health care cartel life.

Anyway, I thought I have better look in my Albany Med portal to see if there was anything there. And there it was. There was a document relating to the referral sitting there waiting for me to read it. And read it I did. The document said that I needed to print out said document and bring it with me. 

There was a problem, however. I don’t have a printer. So, I called Albany Med was again. The person in rheumatology I was transferred to by Albany Med’s general customer service operative told me the referral had been denied. This time it had apparently been denied not for insurance reasons as before but it was denied because Albany Med’s rheumatology department does not treat patients with a diagnosis of fibromyalgia.

Why Albany Med could not have sent me a text message saying this or sent a message in my portal saying this instead of the download allowing me to avoid the download document prompt in the first place is beyond me. Well, on second thought, it is not beyond me. This is how bureaucracies, public or private, work. Computers and the internet have made it all worse. Their motto seems to be why save the “consumer” time and aggravation when you can have them go round and round in the unmerry-go-round that is bureaucracies?

Memories of Old Days: Illness as a Reality

 

From 1954 to 1967 I had a pretty "normal" adolescence. By that I mean that my adolescence was pretty much like that of my peers.

I don't, of course, remember much from before 1962 and the years from 1962 to 1965 are kind of a blur with little chronological context stuck in my memory. I remember hiding in these, what seemed to pre-teen me, monster shrubs along the front of our house in a large village of around 1200 people lying along a river plain. I remember watching the Wizard of Oz by myself on the television and being so scared by the Wicked Witch that I learned to tie my shoe laces for the first time. I remember learning to ride a bike that my Dad bought for me. I recall one day racing a car home on the bike and apparently forgetting how to use the breaks on it. I did stop but not thanks to the breaks. I was stopped by the brick steps that rose up to our front door patio. I remember crying afterwards because parts of my nose were detached from my face. I remember my Mum running out, picking me up, putting me on the kitchen table, and calling the doctor. The doctor came over and sewed my nose back on while I was still awake and crying. The scars are still noticeable if you look close enough. I remember the first day of school. We lived on the north side of the village so I and a friend (Mark Mattson?) walked across the river and took a left. The school wasn't too far down the road that ran along the south side of the river. I recall walking to a railroad trestle that crossed a deep gorge and looking down, way down to the river below.  It was amazing. I remember the Beatles, buying Beatles records, and going to see the movie A Hard Days Night with my sister at what seemed like a huge cinema to us little ones. I remember massive snow falls and building forts in the snow after the snow stopped. I recall running around in the woods sometimes alone, sometimes with others I recall my sister and me investigating what maleness and femaleness were like. And I remember the assassination of the then US president John Fitzgerald Kennedy. That was shocking.

Then everything changed in 1966 and 1967. We had moved to the big city in the meantime and I got involved in track. I was a good 75 metre runner but since two of my classmates were substantially taller than me, had longer legs than me, and were just as fast I never finished above third. I was, if I can be immodest for a moment, quite good at long distance running. One beautiful and sunny day I was doing a long distance run. I was leading, as I almost always did, but suddenly I could not breath. I had to stop and sit in the grass. My parents took me to see a doctor and I was diagnosed with hay fever. 

In the next meantime we moved to an even bigger city. My breathing problems continued. Dad took me to the Methodist Hospital in Oak Cliff, a city that had been incorporated into Dallas. They diagnosed me as having asthma and put me on cortisone. Cortisone was great and it made me feel like I could do anything I wanted to do. On the down side, It also had side effects, in my case blown up cheeks. So I was taken off cortisone and put on a portable nebuliser instead. 

My doctors soon wanted to investigate other theories as to why I had breathing problems. They did a skin test for allergies which, as a recall, was negative. They put me on an all soy died which wasn't very good at the time and again the results were negative for allergies. They supposedly fixed a problem with my esophagus. All the while I continued to use the nebuliser, something that largely kept me stuck inside when I was not at school since I had to take it three times a day, morning, after school, at night.

The nebuliser treatment wasn't very helpful. I recall that I had bouts of breathing troubles periodically. On one oocasion my breathing got so bad that Dad had to take me to Methodist Hospital where I was given what seemed like a massive dose of epinephrine in a very large syringe. I watched as the doctor put in into the pit of my arm. I recall vomiting from it when I got home, something that helped my breathing. I also recall having immense difficulty simply walking up the stairs of my junior high suffering as I went up and having to stop and to catch my breath at each landing on the way up.

In the 1970s my asthma treatment changed and changed again. I was put on kenalog but when the kenalog shot wore off I generally ended up in the hospital. Once the kenalog was no longer helpful I was put on albuterol, theophylline, and prednisone. I recall one day being taken to Parkland Hospital where I was given what to me was the most awful and painful thing I had ever experienced: a blood gas test by someone who really did not know how to do it. Man did it hurt. It was not until the 1990s with the introduction of advair and singulair into my asthma treatment regimen that I could actually live a somewhat normal life if with limits, limits learned over the course of forty years.

Thinking back on my illness I think that having asthma played a major role in making me who I am today. It made me introspective, introverted, distant, bookish, and a cinephile as I read and watched movies a lot because I could no longer do what my siblings and the neighbourhood kids did which was to head outside in the neighbourhood to play, play which involved a lot of running around and the playing of semi-organised games of football, the Texas religion.

Life as Crisis Management: The American Health Care Merry-Go-Round Kiada

 

Like so much else in the United States health care and medicine, a service industry similar to another once upon a time service bureaucracy in the US, America's universities, has been, and particularly so since the late 1970s, corporatised and McDonaldised. 

I am actually old enough to remember when it was different. My General Practitioner (GP) when I had the unfortunate experience of moving to a state that, it turned out, had only recently emerged from the ideological stone age only to shortly return to it again by the 1990s, Indiana, was independent. He was his own man He was own employer and living the American dream. And he had his office in a house near the county run hospital in that litte Hooser town that I had moved to from Big Tex.

I had, of course, been to doctors before but only rarely. When I was young, for instance, I rode my bike into a brick stairway and almost tore off my nose, something which required the doctor to come to our house and stitch it up. Think of that, doctor house visits! How backward!

In 1967 everything changed in terms of my health life and my life in general. One day while running track I could not breath. Eventually, after some false starts—including the idiotic your mother did it to you or it is psychosomatic diagnoses—I was informed that I had asthma. 

Between 1967, when my asthma issues first appeared and introduced me to the joys of the need fir constant medical attention and visits to medical specialists, I was taken, after seeing my GP, to see an allergy and asthma specialist at the Methodist Hospital in the Oak Cliff section of Dallas, the Dallas neighourhood in which I and my family lived. My asthma doctor initially put me on cortisone which had the usual side effects which forced me off of it and on nebulisers.  

When I moved to Indiana my GP replaced the largely ineffective nebuliser treatments with Kenalog, which at first was great despite requiring periodic hospitalisations, and which eventually proved ineffective or of limited help in the long run as well. Because of the declining effectiveness of Kenalog my parents took me to see a Internal Medicinist at a health care clinic south of Fort Wayne. He put me on several pills, including Theopylline, Albuterol, and Prednisone, which I remained on, with limited effectiveness but a lot of nervousness, until the 1990s. 

Around 1993 or so I was put on Advair and Singular by an asthma doctor in Albany, New York. This regimen served me well, so well that I was able to do all my doctoring with my GP. Sometime in the 2000s the physician group I went to became part of St. Peter’s Health Partners—St. Peter’s is a large and increasingly sprawling hospital and health care centre in Albany--and eventually  Trinity Health, a Catholic non-profit health care corporation. They also decided to move up the medical status ladder to Internal Medicine physicians. 

Both of these moves—corporatisation and specialisation--point up something that has increasingly happening in American health care and in American medicine since the so-called Reagan Revolution. This processes was aided and abetted by the religious revival of neo-liberalism and its key utopian notion and symbol that the market was and is god. Deus ex machina! As a consequence the practise of medicine in the US has changed and changed, in my opinion, for the worse in many instances. 

Since around 2020 when I started having stomach and bowel issues the doctors—and I mean doctors plural--I increasingly saw and continue to see in the Capital region of New York, are not independents. Instead they, whether GP or specialist like the heart specialist, the pulmonologists, the allergist and gastro-intestinal specialist I now see--work for corporations like the non-profit Catholic Trinity Health, the apparently non-profit Community Care Physicians (CCP), and, Albany Medical College and Medical Centre, the physician and medical testing arms of the non-profit Albany Medical College and Albany Medical Centre  Like the modern and postmodern Western world in general all of these apparently non-profit corporations are private bureaucracies, modern bureaucracies, which, as Max Weber noted, are the dominant organisation in that putatively best of all possible worlds, the West. By the way, the last independent doctor I went to retired and passed his cases on to Certified Allergy Consultants, which has five locations in the Capital region and which I can find no historical information about. Welcome to the postmodern Western world, a world without history.

What these corporations do in the United States is mimic each other. Albany Med, for instance, has an MRI. So does Saint Peter’s Health Care Physicians, which is part of Trinity Health, and so does CCP. Each of these corporations, of course, and for financial reasons, want you to use their MRI, use their testing labs, use their physicians, and use their own portals, so they can keep, or at least try, to keep the monies from insurance—the private for-profit bureaucracies that really run health care and medicine in the US-Medicare, and the information they gather through health care visits and their patient portals— information, of course, is central to the postmodern core nation economy--in house, in the corporation. By the way, another portal, a physicians only portal, has been developed in Albany to allow said physicians and techs from the various corporations to see what their patient has been treated for by other corporations but this is not mandatory and chance is a factor in whether the various corporations put that important information up on the shared portal. Bureaucracy breeding more bureaucracies because of inherent irrationalities and inefficiencies in the already existing bureaucracies. 

Despite all the bureaucratisation that has come with corporatisation, however, efficiency and effectiveness, which bureaucracies and their new digital aids are supposed to be good at, aren’t always either efficient or effective.  I, for example, recently got a new phone number and set up a new email account and managed to get all these changed in my medical portals—there are four== portal accounts or so I thought. When I was asked to review the health information in my ENT portal I found they still had the old and now outdated information in health information despite having the new information in my accounts page. Redundancies are costly and perhaps unnecessary. Waiting times to see specialists can be and sometimes are long. It took me several months to get into see a skin specialist and Gastro, for instance. And just last week Albany Med's Gastro liver specialists wrote me a prescription for a medicine my G-I "generalist" had already given me, something I took the time to note in my  permanent portal record on Albany Med’s brand spanking “new” and “improved” portal—another bureaucratic tendency the celebration of the ever new and improved--and which had proven ineffective save at making me dizzy and loopy.

And many wonder why “consumers” are so cynical and skeptical these best of all possible worlds utopian days. Next customer, err, patient please. Ding.