Back Surgery and Health Care In America

I haven’t been blogging because just before Thanksgiving, I suffered a herniated disk in my lower back. This is a very painful malady and naturally, I haven’t felt like blogging. However, last week I had surgery and things now, seven days later, I feel so much better I can’t even believe it.

While I was suffering and incapacitated, I had a lot of time to think about my situation and how other Americans might fare in this situation, particularly if they didn’t have health insurance, or if they didn’t have an enlightened employer that provides you with short term disability insurance, guaranteeing your salary for up to three months if you face a medical emergency that prevents you from working. I realized that if you find yourself in that situation with a herniated disk, you would be facing a severe financial (as well as medical) crisis. To my way of thinking, America ought to be better than that — we can be better than that, we can enact enlightened policies that take care of people with medical emergencies, so that it doesn’t become a financial emergency as well.

So let me describe the entire sequence of events, and how it might have affected someone without health insurance and/or without short term disability coverage from his employer.

One night, just before Thanksgiving, I awoke in the middle of the night because of pain in my left leg, which I would later learn was due to a herniated disk in my lower back. I managed to limp and struggle through the next few days, but eventually I realized it wasn’t going to go away by itself. I made an appointment to receive cortisone shots in my lower back from a doctor I had seen before. Fortunately, he was able to schedule me the next day, and on that day, I had so much pain I couldn’t even walk from the parking lot to my office at work. The doctor gave me the shot, which helped a little, but not enough to make me mobile. I called in sick to work the next day, and then stayed at home a few more days the next week.

Right here, someone with no health insurance is in big trouble. I doubt there is anything you could do other than go to the emergency room (and of course, you will be billed for that — beginning of financial difficulties). If you work for an employer that limits your sick leave to a fixed number of days per year and who doesn’t provide disability coverage, you are in further financial trouble. New York State (where I live) mandates that every employer provide some disability coverage through a statewide pool, but in a previous job, I learned that this amounts to $170 per week beginning with your 8th day of absence, hardly enough to replace whatever salary you are no longer receiving.

When the cortisone shot had only limited effect, and I still couldn’t walk around my house without extreme pain, I made an appointment with the back surgeon. Fortunately, I complained and whined enough that they got me an appointment two days after my phone call, although it would not be uncommon to wait weeks to see a back surgeon. He sent me to get an MRI, which I had anticipated. I was quite worried about this because our local health insurance carriers had begun a “slow-down” on approving these types of diagnostic procedures. The doctor complained to me about this, he said the insurance companies are trying to play doctor, and I complained right back saying I’m paying money to the insurance companies for health care coverage, and what right did they have to deny me coverage I actually needed and which they were contractually obligated to provide? We all know why the insurance companies are doing this — they make more money by denying health care to certain people (who have paid for health care) and what is important to the insurance companies is the bottom line and nothing else. But then the doctor asked where I worked, I told him, and he said, “Oh, they never deny approvals for employees of your company”. (If anyone knows why this is, please let me know.) So I was quickly approved for the MRI and went that evening.

As before, without health insurance, I most likely would have never gotten to see the back surgeon, and I would have had the choice of not working, or going to work in extreme pain. If my job involved standing, I doubt I could have done the work at all. My actual job requires me to sit at a computer most of the day, and I suppose I could have suffered through, but it would have been very unpleasant. Fortunately, the back surgeon provided my company with the diagnosis that I was medically incapacitated, and the company’s short term disability policy kicked in, covering my salary for up to three months. Basically, without these two insurances (health insurance and disability insurance), I would have the choice of hurting financially or physically (or both) for a very long time.

Three weeks later, I returned to the back surgeon for his diagnosis. Why three weeks? I presume he was busy, but I didn’t like the way this was handled. I was told by his assistant that if the MRI showed anything, they would contact me immediately and the doctor would see me quickly. That didn’t happen even though the MRI clearly showed the problem, and in fact, I might have waited longer than three weeks if I hadn’t called to obtain written documentation of my condition as required by my employer. The doctor told me I would need surgery, and because this was the week before Christmas, they would try and schedule me for immediately after New Year’s day. Although I was ready for surgery the next day, this seemed reasonable, and I had my surgery early in 2008.

The hospital stay lasted about 24 hours total. I don’t know if there is a medical difference between the operation I had this time (a diskectomy) and the operation I had last time (a laminectomy), but last time the doctor told me my stay would be 2–3 days. Was this another example of the insurance company chopping the length of hospital stays to make more money? I was quite nervous about going home the next day. Nevertheless, I was able to move around slowly on my return home the next day and minimally take care of myself.

Now, one week later, the pain is mostly (but not completely) gone. I was able to walk around Wegmans yesterday without pain (for the previous six weeks, I had to ride the cart around at Wegmans). I expect that upon my return to the doctor for a follow-up visit, he will approve me to return to work.

The bottom line: I will most likely lose 8 weeks of work, I needed a shot of cortisone in my back, an MRI, surgery and a one-night hospital stay, plus numerous prescriptions, to return to health. Without health insurance, I would estimate conservatively that I would owe $15,000 for the medical treatments (if I could even receive the treatments at all). In addition, without disability coverage from my employer, I would have lost 15% of my annual income, something most people can hardly afford.

Naturally, this experience reinforces my belief that America needs universal health care coverage. When you need health care, you receive it. Anything less than this is simply unacceptable, and I have written to my politicians urging them to support this. I have also urged them to move towards a model called “single payer” where the insurance companies (and their profit motive) are removed from the system. Other industrialized nations have systems similar to this, and it is less costly than our own system.

This experience also increases my outrage at conservatives in our country, who have systematically dismantled the social safety net, and fought tooth and nail against expanding any type of social safety net (even for children). Conservatives represent such a mean-spirited point of view where every person has to fend for himself — their policies are that you get the health insurance and disability insurance you can afford, and after that, too bad. What, you don’t have $15K laying around for a back operation? Well that’s your problem, not mine, say the Conservatives. Too bad, next time save your money.

I much prefer a society where we all take care of each other. I hope that our politicians will see the benefits of this point of view. The experience in other industrialized nations shows that this type of universal coverage with “single payer” actually costs less, and the country as a whole benefits. That’s the type of country I envision America becoming some day, Conservatives be damned.