Proactive vs. Reactive: Why Good Patients Are Broke.
My health management plan is both proactive and reactive. I am proactive by taking steps every day to not only be healthy for 24 hours, but for decades to come. I understand that monitoring, eating healthy, exercising, and seeing my medical team often helps keep my diabetes tuned up and keeps me tuned in. I understand that efforts now will hopefully keep me healthier later.
I'm reactive to my blood sugar bounces, testing as often as I can and responding with insulin, exercise, food, or some dizzingly varying combination of both. I'm reactive to any aches and pains that pop up unexpectedly, like a wrist pain or an ocular migraine.
It's good for me to be both proactive and reactive. This mentality helps keep my health, though already slightly compromised by a diabetes diagnosis that was out of my control, at the best level I can achieve.
On paper, and in my mind, I'm a "good patient." Trying to be, anyway.
So why are so many "good patients" broke?
Being proactive with healthcare isn't part of the natural American view of health. American patients seem to be penalized for staying on top of their conditions. For example, I had a dental cleaning on Monday. My second one this year. Both my dentist, my primary care physician, and my endocrinologist have told me that good dental health is crucial not only to my diabetes management but to my overall health. So, on their recommendation, I have three - four cleanings a year.
Yet only two are covered by insurance. So on Monday, I paid $105 out of pocket and unreimburseable to my dentist's office. This doesn't make me frustrated with my dentist, but with the healthcare system that would be more inclined to have my teeth drilled than cleaned. Yet, I'll keep doing this because it's what's best for my health.
And today, I went to the orthopedist to have my wrist examined. And the doctor - very nice guy with a good bedside manner - examined my wrist and after about a minute with me, recommended a wrist brace, xrays, a cortisone shot, and surgery. In that order.
"Even though I'm 99% sure I'm not pregnant, I am not on the pill and am only using barrier methods of birth control. Can the xrays wait until I'm positive I'm not pregnant?"
"Sure. We can wait for the shot for then, too. And we can discuss surgery at that time as well. You can come in really quickly next week once you're sure you aren't pregnant and we can do the xrays. It will take three minutes and you'll be on your way."
"Okay. Thanks. So will I be charged for a copay next week, then?"
"Yes. Of course."
"Wait, really? Even though it should be part of this visit? No one mentioned xrays to me over the phone, and even if it was something I should have anticipated, I didn't. So now I'm being charged double for being proactively cautious and protective of a potential but highly unlikely pregnancy?"
"Well, yes. Unfortunately. I have to charge you for next week's visit, no matter how short. Otherwise, it would be insurance fraud. And we can discuss surgery, as well."
Great. So now I'll be out $50 for what should have been one visit for only $25. I'll be charged extra for xrays and potentially a cortisone shot, but the surgery would be 100% covered. (Yes, I already called my insurance company to find out what's what.)
Why, Insurance Company, are you so against proactive care? Why do I need to pay more for a brace or a shot or an extra visit when you're more content paying for a several thousand dollar surgery instead? Not enough bang for your buck? Why do you fight me tooth and nail against coverage for a continuous glucose monitoring device? Is my life not worth the investment to keep my legs on instead of paying 100% to amputate them in a few decades? I know I'm expensive as a chronic disease patient, but I'm healthier than 85% of the people I know. I eat well, I exercise regularly, and I am on top of my disease. Yet you deny me life insurance, you won't let me purchase a private health insurance policy, and you would rather see me on an operating table than taking up a doctor's time in an office visit. (And it's not like I'm taking up more than 5 - 7 minutes of a doctor's time, because that's about all we get, on average. Pathetic.)
I am ashamed sometimes to admit that the reason I don't have the money to go out is because I spent it on a dental cleaning or a follow up visit to my doctor. I'm embarrassed that proactive patients are the ones going broke. I hate the healthcare system, and its backwards way of punishing me for thinking ahead and celebrating any decisions to let things deteriorate until I require more "procedures" than "maintenance." Where's the love for the proactive patient? Our reward is being charged double?
My checkbook will be $200 lighter next week, and I'm not even "sick." I'm trying so hard to avoid becoming "sick."
What will my healthcare cost if I ever truly am?