The Joy of Paying for Health Care

Two weeks ago I had an appointment with a health care provider. I didn’t actually need to see a doctor or other provider. But my insurance company requires an annual visit whether I need it or not. If I don’t comply, I don’t receive coverage for my sleep apnea treatment. Next year I’ll probably forgo the visit since it appears the cost of the annual visit exceeds the savings I derive from having coverage.

Such are the calculations one must make in America today. We have a truly screwed up health care system, which is essentially dominated by private insurance and pharmaceutical companies. So we end up paying more than any other people in the world, yet we die sooner and are generally unhealthier than our counterparts in other developed western countries.

The health care provider I saw says the system will change. He, too, is frustrated by our system, and in particular with insurance companies. I asked when. He said probably in 12 to 15 years, but he wasn’t sure meaningful change would come about in his lifetime.

I thought he was unduly optimistic. I reminded him of the extreme passivity of the American public. We are very tolerant of high-cost, underperforming systems. You see it in health care. You see it in education. We’re so convinced we have the best of everything (we’re #1, of course), we’re blinded to reality.

But I’m not complaining (even though it may seem like it). To the contrary, I’m sincerely grateful and delighted.

The scene when I checked out out of the doctor’s office makes my point. The lady at the front desk sheepishly broached the subject of payment. She said it appeared I have a high deductible plan and, therefore, would owe $160.56.

She asked if that seemed right. I said, “I have no idea. I don’t keep track of my expenses.” I added, “If that’s what the numbers from Blue Cross/Blue Shield show, then that must be the case.”

She then went on to tell me how much we had spent this year towards the deductible and offered some other gratuitous, apologetic comments. Clearly, having to collect $160.56 made her uncomfortable. She seemed to expect resistance, but none was forthcoming.

I handed her my payment. To put her mind at ease, I added, “I’m fortunate. I can afford it. I’m concerned about the people who can’t.”

And I am. But I also know they don’t need my sympathy. Or acknowledgement of their predicament. It doesn’t help them pay the bills.

Paying my $160.56 bill was a stark reminder of how lucky I am and how unlucky many other people are.

If I were a better person, I’d do more to alleviate the gross inequity that exists in our country and the world. Perhaps before I die I’ll muster the goodness, strength and will to do more about it. I hope so, but I’m realistic, too. I know that I’m fundamentally a selfish, insecure person.

Naturally, no one wants to be poor. Most of us want to enjoy the finer things in life. I want my carbon fiber bike, to be able to dine at nice restaurants, to have a nice house and car, to travel, to have enough income and assets to live comfortably, etc. But I also want other people to have enough. There seems to be something fundamentally unjust about some people having so much and other people having so little.

I realize I have what I have principally because I’ve been lucky. I was born in America. With white skin. Male. Healthy. With genes that allowed me to excel academically and with an emotional need (not necessarily a healthy one) for the status and rewards that such excellence can afford. I had two parents at home — a stable, secure home life — with a strong community surrounding me. I was born with a complaint nature (very important in advancing in the business world), or least was susceptible to having one beat into me. Simply put, I had loads of advantages. I was lucky.

Many of my fellow citizens weren’t so lucky. Many couldn’t imagine being able to pay a $160.56 doctor’s bill with the blink of an eye.

I lived the American Dream. Most people haven’t. I’m reminded of the words of a guy from upstate New York who told Chris Arnade, “There’s no American dream for anyone who isn’t a lawyer or banker.” That’s not accurate, but it’s close.

It seems I’ve been struggling with this moral dilemma my entire adult life. And it seems I’ve constantly been coming up short.

I have the usual reasons. Nothing I can do will fundamentally change the situation. We’ll always have inequity. “The poor will always be with us.” Life isn’t fair. You can’t risk your or your family’s security for a stranger.

The problem is, none of these reasons puts the matter to rest. There is always a doctor’s payment to be made that reminds me of my good fortunate. And of the bad fortune of others.

Sometimes I unconsciously smile at the thought of my good fortune. Sometimes tears well up in my eyes at the thought of my good fortune and the bad fortune of others.

What should I do about it remains the question. But lately I’ve been trying to avoid “should” because life has taught me it’s an extremely hazardous word. It can pull me down, making me feel completely unworthy — a total fraud and failure. Nothing good comes to oneself or others by residing in such a place.

Yet the word keeps rearing its ugly head. I can’t seem to exile it.

I want to have it both ways, of course. I want to relish the benefits of privilege without the guilt or sense of responsibility for others. But no one can have it both ways.

So I’m left with a sense of joy when I pay my doctor’s bill out of my own pocket. Until later, that is — when the joy evaporates only to be replaced with the same questions with which I’ve been struggling my entire life.

So, Vera, what have I learned through all of this?

Perhaps nothing. Or, perhaps, I’ve learned that I’m fortunate to be troubled.

It’s hard to think of oneself as being fortunate by being troubled. And perhaps it’s a self-delusion, a gimmick to help me feel as though I’m not totally morally bankrupt. Or perhaps it’s an assurance of something else, another voice, another vision of what the world could be. And perhaps should be. I really don’t know.

For now, it seems my struggle with continue, with the realization that, compared to what many people are forced to bear, it’s really not a struggle at all.

In the meantime, I wonder if I’ll become braver and more reckless with age.

I hope so.

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