Last week I went to the dentist. Today I went to my ob/gyn for my annual.
These days, any trip to the doctor is an infuriating, exasperating traipse through our screwed up healthcare system. And I’m a really healthy person, with really good insurance. Still, red tape and insurance bullshit manages to piss me off every damn time.
I had already decided I was going to ask my doctor about the mandatory pre-abortion ultrasound bills currently making their way through the legislature, in particular, the deafening silence from the medical community and ob/gyn’s in general on this and other issues affecting women’s healthcare. But dang, before I could even get to that we got in a debate about socialized medicine.
It started when she told me she wouldn’t perform the ol’ “blood in the stool” test, aka the FOBT, which I’ve had done routinely for 30 something years. This was because, she said, “BlueCross Blue Shield of Tennessee no longer covers it.” Lovely. I repeat: not because I didn’t need it, but because insurance wouldn’t cover it. And that, she said, was because over the past few years insurance has routinely been paying for fewer and fewer things.
This test is an easy, cheap way to detect colorectal cancer. But hey, I’m over 50 now, it’s not like colon cancer is a concern for us olds, right?
Don’t answer that.
It doesn’t matter because she said I need to think about getting a colonoscopy at some point, since I’m an olds, and of course it’s a better diagnostic test. Now, BlueCross BlueShield of Tennessee only pays for one every 10 years if the first one comes back clean. So let’s hope I don’t develop anything in the decade in between tests because apparently I’d have no fucking way of knowing about it.
Okie dokie, let’s hope what I don’t know won’t kill me! Thank you, BlueCross BlueShield of Tennessee! May you all get colorectal cancer and die an excruciating, miserable death.
Yes, Republicans. Do tell me more about bureaucrats coming between me and my doctor. I’m dying to hear.
So then we both commiserated about how awful insurance was. I asked her which insurance company was the best in terms of coverage, since she dealt with so many. She said none of them, they’re all bad. Okay, I said, fine, then why don’t we ditch them all and go to socialized medicine?
“Oh, no! That’s worse,” she said. In England, she said, whether you have a hangnail or cancer, you’re put into the system at the same place. In other words, serious health issues aren’t given any more priority than minor ones. She heard this from a patient who lived in London for two years. Her patient, however, was considered a “guest of the country” and was put to the top of the list, she explained. (I’m a little unclear how the patient would know, plus if that were true, wouldn’t there be astronomical cancer fatality rates there? Which doesn’t seem to be happening.)
“That’s certainly not what my Canadian friends have told me,” I said. “I don’t know about England, but they told me in Canada if something’s seriously wrong, you’re priority. It’s true you might have to wait longer for routine stuff, but heck, I made this appointment a year ago!” It’s true, I had.
“Oh no,” my doctor responded, wagging her finger at me. “I know someone who lives in Vancouver and when she needed something done she went to Seattle.”
Clearly we weren’t getting anywhere, trading our stories about “people we knew.” What I did say was, what do we do? This can’t be the best there is. What we’re doing now isn’t working, too many people are uninsured, and the poor are suffering the most.
“Oh, the poor have TennCare,” she said.
And so it went. Clearly my doctor didn’t know the first thing about people who weren’t her patients. She worked at a nice office in the heart of Nashville’s central healthcare campus, not the Vine Hill or Downtown clinics. Her clients weren’t the uninsured or marginalized. Nor did she know anything about what was happening in the state legislature. I asked her if she was aware that there were bills in the legislature requiring women to get an ultrasound before receiving an abortion.
“Really?!” She seemed genuinely surprised. Jesus, lady! I wanted to scream. You’re a gynecologist! This is your field! Don’t you pay attention to what legislators are doing affecting your own business?
I asked if there was any medical reason why this procedure would be necessary. “They need to do it,” she said, “to determine the age of the fetus.”
“But what if a woman is positive that it’s within the first trimester?”
“They still need to do it, to make sure.”
“To make sure?”
“To make sure she’s telling the truth.”
Wow. So we have this law to mandate a diagnostic procedure because women are liars. Got that, ladies? The government thinks you’re all liars, just like with all of that “legitimate rape” stuff, and so they need to check up on you with a diagnostic tool whose sole function is to make sure you’re telling the truth.
Yes, Republicans. Do tell me more about your belief in “small government.” I’m dying to hear.
Keep in mind, I was just told I wouldn’t get a routine colon cancer diagnostic because my insurance won’t pay for it.
Like an idiot, I asked my doctor if she performed abortions. She told me no.
“Does anyone here perform them?”
“No.”
“So where does someone go if they need one? Someone with insurance, who can afford it, where do you refer them?”
“Planned Parenthood, I guess,” my doctor answered. “Or Atlanta.”
Keep in mind, Nashville is a healthcare city. Healthcare is one of the largest industries here. We have several major hospitals here. The Nashville Chamber of Commerce proudly touts how healthcare contributes $30 billion to the local economy and creates over 210,000 jobs. But that’s all bullshit. None of that matters if you’re a woman who needs an abortion. For that, you go to Atlanta.
I asked why, although I already knew the answer. But I wanted to hear her say it. And she did. It’s just too controversial, she said. “It’s the religious people, they don’t want it,” she said. Insurance won’t pay for it. Hospitals don’t want to have anything to do with it. And finally she said, “doctors have been killed.”
I’m sure “the religious people” will be thrilled to learn they have successfully intimidated doctors in Nashville into not performing abortions. What’s sad is that Nashville is touted as being a progressive city, a patch of blue surrounded by a sea of red. But we’re still a city where women are second-class citizens because our healthcare needs aren’t treated equally.
It’s not just abortion. My doctor told me that as of January 2009, she can’t perform tubal ligations at Baptist Hospital. Baptist is one of the major hospitals here in Nashville and in 2002 Baptist merged with St. Thomas, another major player, so both are now under the Ascension Health umbrella, which is a Catholic non-profit. I had read that because religious hospitals all receive federal funds, they had to offer some kind of “secular floor,” where stuff the Catholics find religiously offensive can be done.
“It was a room, not a floor,” my doctor told me. “A separate room.” And the nurse technician that would assist her had to clock out, clock in again for the hour of surgery, and clock back out again, so she could be paid out of separate, non-religious funds. But as of January 2009, that room is no longer there. Someone who is not a Catholic will nonetheless have their medical choices made by the Catholic church.
Yes, Republicans. Do tell me more about your belief in “religious freedom.” I’m dying to hear.
This is all just so crazy to me. I didn’t intend to write a novel, but we just covered so much ground. What I wanted to know is why the medical profession hasn’t spoken up as the state house and senate legislate their profession. I mean, good lord, every time something happens in Washington we have a flurry of industry associations and phony astroturf groups telling us why it’s a bad idea. Where’s the TN Medical Assn.? Besides offering “doctor of the day” volunteers and lobbying for tort reform, I mean. It seems they haven’t spoken up because the just don’t know or don’t care.
I asked my doctor why people in her profession didn’t speak out. And she said it’s because nothing was ever going to change. That was just it, it’s too big, too hard, too controversial. It’s not going to change. I was so outraged. I just refuse to believe nothing will ever change. I said, what if people said that back in the days of Jim Crow? We’d still have black hospitals and white hospitals. Yes, she said. You’re right. And that was that.
It was the most disheartening conversation I’ve ever had. Apparently the doctors just can’t be bothered. I mean, I don’t know what else to say and I’m way beyond needing to wrap this up. But I guess I had somehow thought that doctors cared about their patients’ healthcare. Silly me.
Southern Beale 