Taking Nothing for Granted

My mother developed glaucoma in her early 40s (discovered when my brother sat on her glasses, necessitating an eye exam) and, because it was discovered early, the worst that accrued to her was daily eyedrops–in fact, her eyesight improved somewhat. My father, who had had eagle eyes all his life, developed macular degeneration in his 80s, and that didn’t end so happily; he became profoundly visually impaired (not completely blind, but close enough). So since my 30s I have considered an annual eye exam to be, not just a good idea, but close to a sacrament.

This year’s exam yielded the welcome news that my maculae are immaculate (a little eyeball humor there), and the less-welcome news that my retinas are slightly thinning, which might be a precursor to glaucoma. In the spirit of eternal vigilance, I went to see a glaucoma specialist this morning, and after four different sets of eyedrops and many many tests involving staring at uncomfortably bright lights, I am pleased to say that I don’t have glaucoma. Yet. I might, or I might not, but my new doctor wants to see me in six months, to establish a baseline for future visits. So: okay. Preventive maintenance, and its cousin, preventive assessment, to the rescue.

And again, I note that I am ferociously lucky. Not just because I have a pretty strong, resilient body (apparently my corneas are slightly thicker than usual, which may provide some protection against developing glaucoma, although because I’m nearsighted that might be a marker for retinal problems down the road), but because I have access to good health care, and decent insurance. I am well aware that not everyone does.

Some of that is simply because I live in a major metropolitan area, with a couple of excellent medical schools and all the satellite medical organizations that surround them. Access to good care is not so usual everywhere. No one is likely to submit a bill banning opthalmic procedures any time soon; we’ve seen that that isn’t the case in terms of reproductive health care, But even beyond the hot-button issues of access to birth control and family planning care, there are places in my O-so-enlightened country where there are medical deserts: where there isn’t a hospital or a doctor within 100 miles, and basic care can mean a several-hour journey. That kind of distance stands in the way of getting good preventive care, which makes decent outcomes–and costs–much harder to manage.

Some of my good fortune comes from the fact that I am insured through my husband’s work–he has union insurance, and it’s good. My older daughter, who aged out of her Dad’s plan four years ago, is now covered by MediCal, and while it may not be perfect, it meant that when her appendix was (unbeknownst to her) busy rupturing, she didn’t think twice about going to the ER. Which is good because, per the doctor who treated her, a couple of hours of dithering might have killed her.

Imagine living an hour from medical care without medical insurance. You dither, and hope the explosive pain in your belly will subside, because it’s a long way to the nearest ER, and going there might start a financial cascade that bankrupts you. And when you finally get in the car and start driving… if you were my daughter, you might arrive too late to be saved, and still incur that same bone-crushing debt. Which (since she was not married at the time, and was no longer our dependent) the hospital would have probably wound up eating.

See, that’s one of the hidden costs of health care: prices are high in part because you’re getting all the insured people and the folks who self-insure and are modestly able to pay, to cover the debt of the people who come to the ER too late and too broke.

In my case: if I did not have access to decent medical care and decent insurance, and I got glaucoma (which, unlike cataracts and macular degeneration, may not cause visual clues that something is going wrong until it’s seriously too late) and it was not treated until symptoms were obvious, I might go blind. At which point (unless the disability support system is dismantled, which some legislators seem to think would be a swell idea) I would require support from the state, probably for more money, for longer, than the odd payment for a check up with the eye doctor.

Universal health care–however it is achieved–makes sense because it saves money. Honestly, it does. Like fixing the leak in the kitchen sink saves you money because the neglected pipe doesn’t burst and flood your apartment and the apartment below it.

Getting medical care closer to the people who need it is another, equally complex issue, but I cannot help but believe that, if the issue of paying for health care services was resolved, it would be easier to find providers who want to work where there are people who need them. In the meantime, I’m happy to pay a smidge more in taxes or medicare benefits or whatever it is, to make sure that everyone in my country can go to the doctor before it becomes an emergency.

 

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