I went to my first doctor’s appointment under the Healthy Indiana Plan yesterday, and went to the Volunteers in Medicine (VIM) clinic to get my records from the checkup I had there a year ago.  I wanted to write about these experiences and it seemed convenient to frame it in the metaphors of ‘a tale of two cities’ or of ‘hell and purgatory’ (sadly, there’s no healthcare heaven to be found in either of these places).  I realized though, that this such framings don’t do justice to the many different experiences that people can have with healthcare, all of which need to be improved.  A race to the bottom or a game of “who’s got it worse” isn’t very productive.  Having no experience is a kind of healthcare hell.  So is working a job with inadequate wages to maintain health coverage.  So is having state subsidised healthcare for your kids, but no support for keeping you as a parent healthy.  So is having insurance, but it not covering important and neccessary procedures.  So is not being able to select health providers that respect your experience and values.  Sitting in the VIM clinic, I realize that even though I’m subject to many of the same shortcomings of a volunteer-run community clinic that everyone else in the waiting room is facing, the simple reality that my job doesn’t particulary care when I come into work that day makes my health care experience dramatically different than others.  It also reveals that giving people mobility with their health and care is inseperable from mobility with employment, childcare, and a bunch of other things.

The VIM clinic is clean and pleasant, but a sense of stress permeates the reception and waiting area.  I think the VIM clinic is a necessary community resource and respect all the physicians and other volunteers who make the place go, but it is a band-aid and not a cure for the health care needs of Monroe county.   The times that I have been in there have always seemed hectic.  Patients become quickly frustrated when their records are lost, information about appointments was ambiguous, or expectations about timelines and procedures weren’t clearly communicated.  People working the counter try to respond politely and empathetically, but seem on the verge of cracking after being faced with the constant questions and demands that seem beyond the clinic’s available resources to coordinate all the records, appointments, and volunteer providers.  The woman in line in front of me is asking about what seems to be three different appointments.  She was supposed to get a call back about one last week, but never got the call.  She is told that a doctor can see her today, but that since she is a walk-in, she will have to wait.  The woman periodically returns to the counter asking if they can give her any idea of what time a doctor will be able to see her.  She is told she will just have to wait and she returns to the seats, looking nervously at her watch.

I once heard a cocky critic of universal healthcare say that it was totally unreasonable for Americans to expect both the same quality of healthcare they had been receiving and that it be available to everyone.  He also said that the quality of healthcare in the U.S. is so much better than that in countries with nationalized healthcare.  What little I have seen of foreign nationalized healthcare systems seems similar, in some ways, to what I see at the VIM clinic.  Doctors have strange hours, and you might have to get bounced around a few times before finally getting to see the correct doctor.  It seems amazing sometims that such a system works.  And, despite high taxes (and attempts to evade them), and some inadequacies with the care, people do get healthcare, and it’s free.  I think the biggest difference with with more universal care, though, is that the experience is more universal.  When there are problems with the system, there is a collective knowledge about how to navigate around them.  It seems more likely, too, that problems are recognized as systemic and there is more posibility of a socio-political push to remedy them.  In the U.S., with the “beggars can’t be choosers” ideology that underlies so many of our systems, health care consumers are too often blamed for the quality of their healthcare.  We struggle to find a better health care situation for ourselves and our families, and in doing so, have little time or energy left to learn how to be health care advocates for ourselves and others, or to understand exactly why the system is so broken and what we need to push for to improve it.  The frustration experience of dealing with disorganization or waiting to see a doctors at free clinics or the total lack of accountability and run-around that one gets dealing with institutions like Indiana’s now-privatized Family and Social Service Administration is one more way that our culture punishes those whose lives do not match up with the equation of “hard work equals prosperity” that underlies our American mythology.  Sadly, more and more people in America are finding that they’re left out of this rosy picture.

The complex that houses the offices of my primary medical provider that I chose (with a lot of effort) seems more like a hospital.  It is a large and sprawling and awash with muted pastels, potted plants, and out-of-date sports magazines.  I get lost trying to find my backpack before I realize that the reception desk and waiting room where I’m looking is identical to the one just down the hall where I left my backpack.  It doesn’t feel particularly friendly, but it also seems like it just works in a way that the VIM clinic doesn’t.  At least, I don’t feel the same sense of stress here.  The woman that takes my information at the counter seems busy, but collected and she greets me pleasantly enough.  I’m at the right place, they’re expecting me, and despite the trouble I had getting assigned to this doctor, they take my insurance card without complaint.  This is a relief because, for the past two weeks I’ve been more and more worried about the cyst on the back of my neck that managed to double in size and become inexplicably tender at the end of August.  It surely must be infected and its time to have it removed.  I go to see the nurse and then the doctor and both seem competant enough but spend more time entering information into a database on their laptop than examining me.  The doctor takes a quick look at my neck and says that I’ll have to see a surgeon.  She warns that many providers in town don’t accept the Healthy Indiana Plan insurance, so finding one might be tricky.  With that, the exam is over.  It seemed prefunctory, but I can understand that in today’s healthcare system, the role of many doctors is just to redirect patients to other specialists.  An appointment is made with a surgeon and I’m happy that things are finally moving along. It’s nice to just not feel a sense of collective nervousness in this place.  However, when the person scheduling my appointment calls the surgeon, she finds that they don’t accept the HIP.  She says she’ll call the HIP and find out what to do an call back if the surgery needs to be rescheduled. I’m relieved that I don’t have to try to negotiate this myself, but I’m still nervous that she might not call back.  If I want one thing from the healthcare that I receive, I want to feel like others are looking out for my well-being and that I don’t always have to be suspicious or my own constant advocate.  I guess I’ll continue and wait and see if I’m any closer to that reality.