Define "good insurance"

“No, she doesn’t take that insurance, so a consultation visit without any procedures being done will be between $295-$395.”

That’s what the pediatric dermatologist’s receptionist said when I called to make an appointment for my 4th grade son, Liam, who has some skin discoloration we want to have checked out. The pediatrician thinks it might be vittiligo, which in the worst-case scenario can be a symptom of an auto-immune disorder, so as you can imagine, we’re trying not to be freaked out but are anxious to get a full diagnosis (Yes, vittiligo is what they say Michael Jackson had, in addition to a host of other issues, and while Husband and I loved “Thriller” as much as the next guy, we’re hoping our son isn’t headed in that direction). 

This dermatologist is the eighth one I’ve called: three weren’t taking new patients, two didn’t see children, one didn’t have any appointments until the end of November, and two (including this one) didn’t take insurance. The ninth person I called did see children, did take our insurance, and did have an appointment—the first week in October. 

So much for the critics who say that if Obama's health care reforms go through, we'll be living in a socialist state where it will take months to see a doctor. 

I was surprised by the fact that doctors didn't want to take our insurance because we’ve always thought we had “good” insurance: it covers most things, it doesn’t cost us a complete fortune each month, and it doesn’t require a ton of paperwork on our part.

It’s a funny phrase, though, if you think about it: “good insurance.” Isn’t “ensure” one of those words that you don’t qualify, like “pregnant?” I mean, you’re either pregnant or you’re not; and if you “ensure” something, then you are making certain of something. You’re not being sort of certain, or a little bit certain, or certain-under-specific-considerations, or certain-until-you-spend-this-much-money...you’re just certain.

Liam’s skin condition isn’t my biggest worry at the moment, however, because I’m writing this on the rooftop pavilion of the Cleveland Clinic, (yes, the hospital that Obama visited as part of his health-care-reform tour). My mother is here too, somewhere on the fourth floor, where she will be undergoing what her heart surgeon says is an “easy” valve replacement. He says easy, but to us, it’s mom on the operating table for five hours and then the ICU for a few days, and the step-down unit for a few more days after that, and then a recuperation period of who knows how many months.

Easy? Who knows.  But expensive? You betcha. In addition to the medical costs (and the mind boggles at what those will be), let’s think about the cost of driving from Indiana (where mom and my stepfather live) and staying in Cleveland for a week to ten days, depending on her recovery process. All of those expenses are, of course, out of pocket. The medical expenses—and they will be legion—will be paid for by Medicare and the supplemental insurance that mom pays for every month.

Mom figures that the total bill for the cow valve currently being put into her chest—barring any complications—will run somewhere in the neighborhood of a hundred thousand dollars--more than it would cost to buy a really nice apartment in Cleveland, and more than enough to bankrupt her if she had to pay for the entire thing (or even a fraction of the thing) on her own. 

Mom’s not rich, but because of the combination of Medicare and supplemental insurance, and because she can afford to get to Cleveland, she gets to be operated on here, in this world-class facility by the same surgeon who operated on Robin Williams (Mom found this fact oddly gratifying, I think because she figured that if her doctor were good enough for Robin Williams, he was probably one of the best surgeons money could buy).

Isn’t that precisely the problem, though? What does it say about us as a society that we put health care in the same category as cars, houses, and televisions? Should health care be a luxury, like a BMW or a flat-screen TV? So those who can afford it get “the best” and everyone else has to make do with “good enough” ... or with nothing? Doesn’t that seem like a continuation of the mindset that Jacob Riis and other early 20th century reformers campaigned against: social Darwinists who argued that the poor were unhealthy because they were morally inferior and came from lesser stock, while the wealthy were healthy because they were just "better"? Is that the world we want to live in?

Shouldn’t I be able to find out if my child has an auto-immune disorder without waiting for two months, or plonking down four hundred dollars on my already over-taxed credit card, just for a consultation?  And while clearly, judging from the quality of the Cleveland Clinic, Medicare provides “good insurance,” wouldn’t it be nice if we could all have access to this quality of care, before we’re sixty-three (or older)?

There’s been a lot of criticism that Obama’s health care reforms push us towards a “socialist” model of health care. But I wonder if in order to achieve a truly democratic system, in which everyone is guaranteed the same level of good care, socialism might not be the answer. Did you read Sara Paretsky’s essay in the NYTimes a week or so ago? Her husband needed a full cardiac workup while they were vacationing in France, so they went to the emergency room in the little French town where they were staying. The total cost for his visit, including EKG, x-rays, technicians, nurses, doctors, and ten hours in the ER? $220 bucks.

That’s good insurance.

This is an original post to the NYCMoms Blog. When Deborah Quinn gets back to New York from Cleveland, she will get a full physical, take her kids for their check-ups, and resume posting to www.mannahattamamma.com.