Beautiful Arteries

Is it just me, or does this strike you as sheer irony? Last Wednesday, when we arrived at the MCCG Heart Tower for the cath the doctor ordered, the person at the registration desk handed Daryl a pager-just like the ones you get at the restaurants where the problem likely started in the first place. Sort of drives home the prevention point, doesn't it? They need the pagers because the staff told me they do about 40-60 of these caths every day. That's a lot of folks to keep up with. The menu prices at the hospital are just a touch higher than your favorite chain restaurant, though.

I haven't actually seen the bill yet, but I do have the smelling salts ready. The MCCG billing folks called me a couple of days before the procedure to tell me that their facility fee for a basic heart cath was over 19K figuring their BCBS discounted rate. That did not include the doctor's fee, labs or anything else. In plain English, that meant that the 19K+ was a negotiated rate with BCBS. I suppose that means their 'list price', the amount someone with no insurance would be charged, is even higher. For me, I would be expected to pay my deductible plus 20% of that amount. You can do the math. We could either pay it all on the day of the procedure, or pay a portion and set up a 90 day-same-as-cash contract with the hospital. If we paid it all that day, then they would discount our co-pay (not the deductible) by 20%. Fine. I wasn't thrilled, but I wouldn't have to sell the house to pay the bill. But, I can think of plenty of points in my life where there just would not have been enough money to take care of this bill, in the long term or the short term. I would have had to cancel the procedure and live with uncertainty. As it is, I benefited from a state-of-the-art facility, a competent and caring staff and an excellent doctor. Most of all, I got to hear the doctor say that I have beautiful arteries and needed to look for other causes for the chest pain I was experiencing. That was great news for me, but the question remains: should ability to pay determine whether or not someone can get the medical care they need?

I've been trying to figure out how everyday, 9-5, working people, even those who HAVE insurance (like my kids) could afford the kind of excellent care I got last week. The short answer is, with even a 20% co-pay, they can't. And what happens?If the procedure is non-emergent, like mine, they don't get it done, and then, maybe walk around with a time bomb in their chest. Or, if they have a heart attack, maybe they become one of the many people who are forced to file bankruptcy because of medical bills that would no doubt make a 19K cath look like a Blue Light Special at K Mart. Those unpaid medical bills then get plowed right back into the cost of doing business and contribute to the overall cost to patients. Who pays for it? We all do.

That's why it was ridiculous to me yesterday as I listened to Republicans argue that people should be "free" to choose whether or not they have health insurance. Just like uninsured motorists, people without health insurance impact the rates we all pay. I favor making sure everyone can get coverage and then mandating that we all get covered. I have no problem at all with charging a fine to those who do not comply with that law. Why? Because there's nothing "free" about being uninsured.

And, by the way, the cholesterol medicine the doctor prescribed to help keep the pipes clean cost over $100 a month with insurance. That medicine may help me avoid health problems and more extensive, expensive procedures, but I know plenty of families for whom that monthly cost alone would be a non-starter. So, I am glad that Congress acted last night and took a clear step toward health insurance reform. It is past time.

Sphere: Related Content

The Heart of the Matter

I never expected to spend election week with my cardiologist. Heck, a week ago, I didn't have a cardiologist, but, now I have one, and I'm going to let him thread a catheter into my heart and look around. I thought long and hard about whether I wanted to write about this, but, since six times more women die from heart disease than breast cancer, I thought, perhaps, I would, and maybe that I should. So, here goes.

Let's go back to last Wednesday morning. Like so many other women I know, before I ever hit the shower, I had checked my email, responded to a few, and read the morning headlines. I was tired after getting in late from an Atlanta meeting the night before. My phone buzzed away on the table while I dried my hair and put on my make up. Before I left the house, I spent ten minutes with a friend who was feeling betrayed by her mother. I finally jumped in the car only to find I'd left my phone in the house. I ran back in the house to get the phone, and remembered that maybe I should wake up my son who had class that morning, so I did. On the way to the office, I called another friend who I was worried about, and when I got to the office began to work my way through the phone messages waiting for me there. By the way, I'm not complaining about all this activity. I like it. Us Type-A's, we plan it.

Then, it happened again. It wasn't bad, but it was there. I wanted to ignore it, to find something else to call it, but truth be told, for several weeks, I had occasionally been experiencing this ache right in the middle of my chest. Chest pain. There, I said it. I had mentioned it to my husband a couple of times over the last month, and then, that morning, as I was returning phone calls, it started again. I told Daryl that I was tired of worrying about what this might be and was going to the MedCenter to let them check it out. No, no, no. No need for him to come. I was sure that I was just being overly cautious. It was probably my stomach, not my heart, not to worry. And, so, I drove myself there. I thought I was going to walk in, get an EKG, have the doctor tell me all was well and to follow up with my primary care doctor. So much for thinking.

In case you've never done it, when you sign in at the urgent care center and write the words, "chest pain" on the problem list, people move very quickly. They had me in the back doing vitals before they could get my insurance card and driver's license back to me. I knew the doctor who was on call, and was glad it was him, someone I had seen before. "How bad is the pain, on a scale of one to ten," the nurse said. "A two," I replied, meaning it. "It's very occasional, non-radiating chest pain when I'm at rest. And I really think it could be my stomach." They were already hooking up the leads for the EKG. By this time, the doctor was in the room. "Know anyone who had a heart attack at your age?" "Yes," I said, "my father had a heart attack when he was 52." "Ah," said the doctor. What do you mean, "Ah?" Sensing that this bit of information might take my visit down a path I had not planned on, I countered, "but he was a smoker, and I am not. But, then there's my sister. She had a heart attack earlier this year, but she's eleven years older, and has had other health issues. Did I mention that I really think this could be my stomach?" By this time, he was listening to my chest, and telling me that they would do some blood work and get a chest X-Ray. The nurse wheeled oxygen into the room. I didn't know who it was for, certainly not for me. "Just a precaution," she said, as she started an IV. "Did I mention that I think that this might be my stomach?"

I pulled out my phone and sent a text to my husband and told him I was fine and he didn't need to come. Lie. I sent a text to a girlfriend who knew I was lying when I said I was fine. Twenty minutes later my "sister" was there to see me. Thank God.

Tests done, the doctor came back with good news. I had not had a heart attack in the last few hours, and he thought the EKG looked pretty good. But, with the family history, he wanted me to see a cardiologist. He'd make the appointment, then we could leave. Good idea, leaving. I agreed. He gave me prescriptions for pain meds that I did not fill and told me to go home and rest which I did not do. Stubborn.

What I did do was keep the appointment with the cardiologist. At the first appointment, he said he could see that I was stressed. Tears. He told me to depend on the man upstairs, pointing. Panic. Well, the imaging lab was, technically, upstairs. He walked me out to the desk and began shifting appointments around to try to get tests scheduled ASAP. Panic! Then, he wrote a prescription for nitroglycerin. I couldn't understand why he was handing me someone else's prescription. Denial.

I spent lots of time with the cardiologist last week doing a repeat EKG, blood work, stress test, echo. I was certain when I left his office after those tests I was in the clear. Not so much. With the family history, some numbers in the blood work he did not like and not entirely normal test results, he wanted to schedule a cath for Wednesday. I tried to bargain. "I just need to make life style changes, diet and exercise, maybe take one of those cool cholesterol medicines I see on TV, right? I have a gym membership." He wasn't buying it. So, this time next week, I will either be reporting that they looked around and all was fine, or I will have some new jewelry, the kind you wear inside your blood vessels. Not exactly the gift I want for my almost-here 50th birthday. Did I mention that I'm too young to be having any of these issues?

They say that women experience heart disease differently than men. I think that we learn early on to push through pain and discomfort to do what we have to do, to take care of who and what we have to take care of. From the first day we deal with menstrual cramps while we take that big history test until we deliver our babies, women push through it all and get it done - all of it. We take care of other people while ignoring our own needs - and our own bodies, and it's not a virtue. I believe I have officially learned my lesson. Bargaining. No matter the outcome of the test next week, I don't think I will ever again think of my heartbeat as a given.

Did I mention that I really, really think it's my stomach?

Sphere: Related Content