Sick With and Without Insurance

As I mentioned in a few comments while it was happening, I was sick for six weeks from mid-January to the end of February this year.  I came down with mono… so I can finally cross “having mono” off my list.  (What can I say?  I’m a late bloomer.)  But as I interacted with my doctor and ran through a series of tests to diagnose the problem, I couldn’t help but compare my experience to the last time I had something more than a cold, five years ago.  My experience then was so different, it may as well be titled “A Tale of Two Illnesses.”

In 2004, you see, I did not have health insurance through my employer.  I had changed jobs partly out of commute (old job:  1 hour each way by car, plus tolls on the George Washington Bridge; new job: 20 minutes by bus through Central Park) and partly for more money.  But I and all members of my new department – including some who had been there for years – were what you might call “perma-temps,” with an hourly wage instead of a salary.  On the plus side, when I worked late (which I did often), I would get overtime.  On the minus, there were no options for health insurance.  I was in my late 20s and therefore belonged to that group known as “the invincibles,” a demographic that those seeking to downplay the seriousness of being uninsured tend to portray as cocky and willfully unrealistic about the risks of injury or illness.  But believe me, invincibility didn’t enter into the equation.  What did was cost.  I was able to find a reasonable individual insurance plan, with co-pays up the wazoo, decent emergency room coverage, but poor primary care coverage.  Even so, the premium was high.  A few months of paying for Manhattan rent, student loans, car loans and New York state car insurance plus a premium began not just outpacing the money I had coming in, but eating into my savings.  After two months, I made the difficult choice that health insurance would be the odd man out.

So of course, I almost immediately got sick.

This was probably predictable – I was, after all, working in an office in a hospital, and regularly shared space with patients in the cafeterias, elevators, hallways.  Who knows what germ I was eventually exposed to? I tend to be self-sufficient while I’m sick – I rest, drink fluids, take Tylenol for pain, and feel secure that it won’t stick around for more than a few days.  Except this one lingered.  And lingered.  And lingered.  I had a cough deep in my chest, a sore throat that waxed and waned, occasional dizziness, aches, fatigue, the whole nine yards.  One week passed, then another with at best minimal improvement.  Then the fear started to set in – what if I had something that needed an intervention?  How would I pay for a doctor’s visit?  How would I pay for tests so the doctor could tell me what I had?  How could I also pay for a follow-up?  What if something serious was found – how could I get coverage after an ailment was discovered?  When I finally felt like myself, a disturbing four weeks later and exactly five days before the “final straw” date I had set for myself before I would suck it up and charge a doctor’s visit to my credit card, my relief was as much mental as physical.

Flash forward five years.  I have quite generous insurance through my employer and my union, with a broad network of specialists as well as my PCP.  When the mono set in, it felt like a normal cold.  When the fever wasn’t gone four days later, I was able to get an appointment with my doctor right away.  We went through test after test, and hypothesis after hypothesis.  Physically, I still felt lousy, but mentally, each negative test felt like an act of affirmation.  Blood work shows no hepatitis or lupus?  Check.  Ultrasound shows no blockage in the kidney, but an enlarged spleen?  That’s useful to know.  Finally, the mono test and Epstein-Barr virus screen came back positive, and the path to treatment was clear.  I paid my co-pays, my insurance company made up most (though unsurprisingly, not all) of the difference to my doctor, and I never contemplated going into debt.

Neither illness was that threatening, in the grand scheme of things, but my own experience tells me our health insurance system is arbitrary, at best.  After all, I’m the same person I was five years ago.  I work out as frequently.  I eat a little better, but not that much better.  I get too little sleep then as now, but avoid other stressors and drags on my health.  I work for a similar job, and get a similar level of compensation.  I pay my taxes, including the payroll taxes for Medicare and Social Security.  I still have a Manhattan apartment and other small debts.

What, then, is the difference between insured me and uninsured me, aside from one job offered insurance and the other did not?  Why should one have the piece of mind of health care, diagnosis and treatment, and the other be filled with fear and uncertainty, coughing into the night while calculating what the cost would be of getting better?

(Photo credit:  The Consumerist on Flickr.)