Every once in a while, I’m forced to engage the health care system in a more personal way. Yesterday was one of those days. First, one of my children (who shall remain nameless), decided to take a stroll in the mulch on Monday without any shoes. He managed to lodge an enormous splinter in his foot which I couldn’t get out. By the time I saw it that night, it was already starting to look like it might be a problem. On the same night, another child (who shall remain nameless) reported that he was having some pain and swelling in an area of his body (which shall also remain nameless).
Yesterday morning, my wife called the pediatrician, who scheduled a visit for the latter problem. For the former, we made an appointment with the dermatologist for the foot. Before lunch, they had cut out the offending piece of wood and placed a stitch. The nameless part of the body was examined at 3:45, and there was some concern that it might be serious. He was sent to the emergency department, and I was pinged to join them. We all arrived around 5:05pm. At 5:15, a doctor was in the room apologizing about the wait. They did an ultrasound, and the urologist drove up from another hospital to see us in the ED and go over the issue with us. He even drew us a picture. We were out before dinner, dropped off the prescription, and gave the first dose of meds before bed.
What I’m describing could easily be taken as the finest health care system in the world.
People think that you get care because you have insurance. But I can swear to you that no one in this process cared one whit who our carrier was. People think you get care like this because you have more money. Believe me when I tell you that we are far from the richest people in this community. We get care like this because of who we are and what we do. We’re in the system.
The first doctor I mentioned had no sick visits available. But they squeezed in one of our children because they know I’m a pediatrician and they know my wife’s a nurse practitioner. They also know us personally. You have to remember that about a fifth of Americans can’t get an appointment when they’re sick within a week, let alone that day. The dermatologist appointment (for a splinter!) was arranged with a close friend at the practice. When our child was referred to the ED, I’m sure a call was placed to the urologist telling him who my son’s dad was and that I worked in the health care system, precipitating a level of service that few will see.
I’m so grateful for what everyone did. Please understand that I’m not saying one bit of this was fake. Every doctor we saw was unbelievable fantastic and ridiculously skilled. I’m not saying that these providers aren’t just as kind and caring with every other patient. I’m sure they are. We received no scans, no procedures, and no medications that someone else wouldn’t get. We just got them served to us in an ideal fashion.
That’s access. It has nothing to do with insurance or wealth.
We have such potential. For all my complaints here, we have the best trained health care workforce in the world. Our facilities are top notch. Our technology is amazing, as are our medications. The problem is that the way it’s organized and distributed doesn’t work well at all. It’s like we took the world’s best and most complicated Lego set and let a small child put it together without the instructions.
The Affordable Care Act will likely make things better for millions of people. Insurance will give them access to the health care system in ways they didn’t have before. But it won’t give them what I described above. Insurance is necessary, but not sufficient. Tons of Americans are attracted to concierge care (and I can’t blame them) because they bought the insurance, and still don’t get the access they want. Unfortunately, concierge care still won’t give you the level of care that I try very hard not to take for granted.
We don’t have the best health care system in the world. But we could. I long for the day when we can start talking about getting that instead of whether we should give Medicaid to people making less than the poverty line.
Aaron E. Carroll is an associate professor of pediatrics, Indiana University School of Medicine and blogs at The Incidental Economist.
