BARBS

(photo: Ruth Fremson/The New York Times)

I don’t know how to fix, or “reform,” health care in America; I’ll leave that to the professionals (whoever they may be).

But I do know this: there is something wrong with this picture.

One morning earlier this week, I strolled into the Hospital for Special Surgery, arguably the best orthopedic hospital on Planet Earth, for my appointment with a doctor who is arguably one of the best orthopedic surgeons on Planet Earth. I was there because the pain in my left hip that started about ten weeks ago hasn’t gotten better, and I have come to accept that I have reached that magic age where these things really should be checked out.  So, having what these days is probably considered “gold plated” employer-provided health insurance, which doesn’t require even the simplest “referral” by a “primary care physician” (not sure why I am putting these words in quotes but they seem to call for it), I called and made an appointment with this highly-recommended (and highly expensive) specialist. Nice, right?

When I got to the clean, airy, and peaceful HSS, my first stop was the Radiology department, where what I imagine is one of the best x-ray technicians on Planet Earth took pictures of my hip bones with what I presume was one of the best x-ray machines on Planet Earth. I was given a nice clean gown, and gazed peacefully at sweeping views of the East River while I waited for the procedure.

Next, I went upstairs to Orthopedics, where, after filling out the new- patient forms while sitting in a special chair for people with aches and pains (who knew?), I was ushered right on time into the exam room. My x-rays, in digital form, were already up on the flat-screen monitor.

The doctor asked about my symptoms, watched me walk across the room a few times, gave me a short physical exam (”Does it hurt when I do this? How about this?”), talked to me about hip structure, and assured me the x-rays showed there is nothing seriously wrong (garden-variety hip flexor injury–phew). Then he wrote a prescription for twelve sessions of physical therapy–also covered by my health insurance.

When I left the best orthopedic hospital on Planet Earth, having had the best x-rays and diagnostics on Planet Earth, I had paid almost nothing. Just the co-pay; practically pocket change. As I said: nice, right?

But please, somebody tell me what I did in life to deserve it. The answer is, not much; I’m just one of the people lucky enough to be on the right end of a really screwed up health care system, in which some people, for no apparent rational reason, have the kind of health care I just described for a small co-pay, and other people, also for no apparent rational reason (unless you think being poor is a rational reason), are on the other end of the same system. Here’s what that looks like:

These images, which have been in the media all week long, absolutely break my heart.

And here’s the thing:  this tale of two health care systems is not morally sustainable.  And I don’t even understand how it can be financially sustainable.

When I go and consume hundreds of dollars worth of health care and pay only thirty dollars, somebody is paying for that. It may not be me, at that moment, but it’s somebody.  And at some point, that “somebody” — probably my employer — isn’t going to want to pay for it anymore.  And then what? At first, probably, the quality of my insurance will go down, but my fear is that, so long as the system stays the same, at some point, my insurance could completely go away.  All because what I have now is just too good to last. We have certainly seen, over and over again, that things that are too good to be true — mortgages for everyone! consistently high returns on investments that were never really made! — don’t last.

In addition, when tens of millions of my fellow citizens are either under- or completely uninsured, and have to mob a free health care fair just to get a cavity filled or have a vision test, somebody is paying for that, too, one way or the other. People in poor health cost money, whether it’s because they go to the emergency room or because they cannot be productive when they are sick and anxious.

The whole she-bang is just broken, broken, broken. I get no peace of mind just because, for the moment, I happen to be on the better end of a broken system. That system is just waiting to cave in like a top-heavy house of cards. What then? Then, I fear, all but the wealthiest Americans (and I’m not one of them) will be under- or uninsured. Health care will be rationed to the rich even more so than it is today.

I will do (almost) anything to avoid that. I will accept a lower level of coverage if it means the coverage will always be there; I will accept a level of coverage that says that if I want to make the Hospital of Special Surgery my first stop for a muscle strain, I’ll have to pay way more than thirty bucks for the privilege (yes, the HSS is a privilege, not a right). In exchange, I also want to see a tier of care that I have not been able to find: what I’d call middle-class care; care that doesn’t have to be as gold-plated as that which is available at the best places on Planet Earth, but quality care that’s widely available, costs less, and is covered.  And let’s at the same time give basic quality coverage to every American, partly because it is a moral imperative (I don’t want to see any more images like the ones at that health fair), but also because we’re paying for not having it.

This can be done. It just takes courage, leadership and yes, for some of us, short-term sacrifice for long-term security. Bring it on.