I've been thinking about healthcare, health outcomes, and American exceptionalism.
Cancer stuff updates will be a little delayed, as everything is sort of up in the air scheduling wise as we deal with delayed testing results and a minor surgical complication. (I'm fine, details when I have something more concrete to say.
But all this healthcare stuff is making me think about America, and how badly broken our healthcare system is on so many levels.
We have a critical shortage of primary care doctors, and have since before the pandemic. And it's only going to get worse, as we treat our health care providers like absolute crap, a problem that has a lot to do with massive student loans, the privatization of health care, the profit motive driving healthcare decisions and management of clinicians, and of course the insurance companies and the lack of a public option.
Doctors are leaving practice in droves, and I can't blame them. The system is abusive and they are being treated as profit centers, not health care providers. This has only gotten worse over the course of the pandemic, as health care providers are overworked, exhausted, unsupported, and seeing their profession and their persons disparaged by those who will nevertheless expect treatment when they fall ill. Even if they won't admit that they're ill with COVID-19.
As for my case--we have decent insurance for America--but in addition to whatever percentage of the bill winds up being ours to pay, every visit I have to make to one of my oncologists is a $50 copay. (They count as specialists. My GP is $25; my shrink is $30. If I have to go to the ER, it's $500 minimum. And probably more.)
This has what economists call a chilling effect on the use of health care: People can generally not afford an unexpected $50 or $300 dollars. For that matter, my previous insurance would only pay for one mammogram a year. Glad I'm not with them anymore, as I have had four so far since August 27th, not to mention a few ultrasounds and some other imaging.
Can most people afford an extra $120 a month for psychiatric treatment? If they can find a therapist who's accepting clients currently, when the mental health of the entire world is a hot slippery mess?
So essentially, my insurance company fines me for seeing a doctor, even when it's essential care. Fines are meant to reduce a particular activity (and of course to raise revenue). We fine speeders and litterers to make them stop speeding and littering, right?
I've been thinking about the Japanese healthcare system, and the prevalent idea in the US that Japanese citizens have a longer life expectancy than Americans because of diet, exercise, and other things we can control through personal responsibility. And the average Japanese diet is probably better than the average American diet in terms of nutrition and health benefits, but somehow these glossy magazine stories telling you to drink miso and eat seaweed never seem to mention that the average Japanese person goes to the doctor ten times a year.
We have this Puritan baked-in idea that if you are sick it is somehow your fault, and we deal with this by stigmatizing illness, by stigmatizing seeking treatment for illness, by treating sick people as if they have done something wrong. Some of it is denial, of course--we love to tell ourselves that cancer is caused by negativity and "you have to stay positive to survive!" and trust me, some of the longest-term cancer survivors I know are wild-eyed cynics of the first water.
It's all superstition. Magical thinking. We like to think we can control our health. That it's a matter of choices, but honestly it's just damn dumb luck. You can push the statistics one way or another (heavy smoking and drinking is not good for you, for example.) but most of it comes down to luck, genetics, and not standing on the wrong street corner when somebody loses control of their vehicle in the rain and shatters your pelvis and femur.
Going to the doctor is not a sign of weakness. It's not "being a wimp." It's just what you do when you are sick, and you aren't punished for doing it. And ne thing that definitely improves health outcomes is getting medical care and being taken seriously by your clinicians.
Odd that making it easy to take care of yourself rather than punitive might improve health outcomes.
TY! As a fellow cancer survivor (2x. Ovarian. Super rare. Fucking sucked.) I have to say THIS. I took a healthcare course at Wharton that focused on empathy in health service provision (or lack thereof) and was running a healthcare service provider at the time. It’s such a goddamned mess. People can’t afford care for their parents once they struggle to live safely and with dignity on their own.
And my own journey? Even with the best case care and some insurance coverage I was left with $15k the first time and $10k the second out of my pocket or I DIE. WT actual F?
I lost my brilliant PCP because she decided she'd had enough of the HMO trying to micromanage her time and approach to medicine, so she quit and took a job with the state where she doesn't see patients but advocates for them.