What We Settle For

At a meeting of public health practitioners several years ago, a pediatrician giving the keynote address used a phrase that has stuck with me ever since – “the hegemony of low expectations”. She was referring to the circumstances of many African American individuals and families in the Boston area, a group she predominantly advocates and cares for. For these folks, what they have come to expect from certain illnesses and disease, and the subsequent health care afforded them as treatment, is so terribly poor that they don’t even realize that a person CAN actually live with a chronic condition, such as asthma, without weekly trips to an emergency room. They have received such poor care for so long, that poor care is their predominant, prevailing understanding of the situation.

Without invalidating the reality of health care disparity in our society, the truth is that low expectations seem to be seeping in to even the thoughts, ideas, and beliefs of the well-insured. At least, THIS particular well-insured individual. Case in point…

Two weeks ago, my doctor’s office sent in the wrong prescription for me to my drug store. It took 5 phone messages (between mine and the pharmacy’s) to his office, 2 follow-up calls to the pharmacy, and one week and one day for them to get it straight. And throughout it all, the office never once returned my calls. Eventually, the drug store left an automated message on my answering machine, letting me know that the prescription was ready. (Note: This is not a negative comment towards my doctor and the care he provides. He is actually a very good doctor and I trust him with my health. It is the system that is broken.)

Compare this to the health care of my dog. Zeb had his teeth cleaned yesterday. He had a pre-op check up and routine blood work done one week ahead of time. We received 4 phone calls, 3 facebook updates, and a half-hour of follow-up care instruction before Lynn could bring him home. Finally, we got a phone call last night before the staff left the office for the evening, just to check on him and give us the phone number for the vet on call.

The most interesting thing about this case, to me, is that it has come to be exactly what I expect. I expect unaffordable and poorly delivered health care for myself and my spouse. I expect competent, efficient and caring health care for my pets. The latter is definitely expensive, but I can still afford it. Why? Because they do not require the invasion of a third party (an insurance company), they make it possible – and simple – to pay the bill on a schedule, and they explain up-front what the costs will likely be before providing any treatment.

Next month will be “Open Enrollment” time at my place of work. We will HAVE to enroll in a health insurance plan for the coming year (it is the law – be careful what you wish for). We have already been told that the options will all be more expensive, have larger deductibles, have more restrictions, and in the end, all result in the same poor delivery of health care that I’ve come to expect.

I’m left wondering how it is that health insurance has become THE great “benefit” of work. It is THE thing that we’re brainwashed into believing is reason to postpone retirement and not risk losing with a job change. It is what parents have been convinced they need to carry for their children EIGHT years into their legal adulthood. It’s passed off as a good thing that young people can be 26 years old and still be dependent upon their parents for what ought to be a primary right afforded to all, i.e. some sense of security in knowing that should you be stricken with a disease or get hit by a bus, getting the necessary treatment to heal isn’t going to bankrupt you.

And in the end, it is the thing that liberals and progressives have been coerced into fighting for, i.e.universal health INSURANCE, not universal health CARE. These are our ideas of “reform”. This is what we have settled for.

I hope my veterinarian is accepting new patients.

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