I am currently in the middle of an episode that really highlights to me how broken our healthcare system in the US has become. Let me start by saying that I not only have insurance, but I have pretty good insurance, thanks to my wife’s employer, who does not skimp on the benefits. So this isn’t some sob story about not getting care because I don’t have insurance, this is about quality of care, and cost of care. You see, on my recent trip to Tokyo, I got a sinus infection, and had to go see a doctor. Of course finding an English-speaking doctor in Tokyo was daunting, but I ended up finding an ear, nose and throat specialist who agreed to see me. Now, this is where things are going to start sounding kind of weird to people who have only ever had medical care in the US. You see, I got this doctor’s name and address from a clinic that didn’t have any doctor in at the moment who specialized in ear, nose and throat problems, so they suggested this guy, and gave me his information and hours. So, I am walking up to his office, with no Japanese insurance, no referral, and no appointment, just walking in off the street.
I walk in, and there is no one in the office, except the doctor, who is doing some sort of paperwork. It turns out the clinic had his hours wrong, and his office is closed today, he just happened to be in taking care of some things. He asks me why I am there, and when I tell him my symptoms and predicament, he tells me to sit down and let him examine me, because it sounds serious. Well, right there my head was spinning. I haven’t walked into a doctor’s office with no appointment or insurance, and been seen immediately by the doctor ever, much less on his day off. So he has me fill out a page of paperwork, and examines me, says I have a sinus infection, probably brought on by allergies, that is tending toward an ear infection. He dose a test to check the pressure in my inner ear, tells me it is too high, and I need to take care of it before I can fly, or I might blow an eardrum. He gives me several medicines, and tells me he wants me to come back tomorrow, when his staff is in, so he can perform some hearing tests, to see if I have lost any hearing. Then comes the part that I was dreading. He says that I need to pay cash, since I didn’t have any insurance. Now, I noticed on the business card they gave me at the clinic, that this guy was not just an M.D. but also had a PhD, and studied at Yale. I knew there was no way that this guy was cheap under any circumstances, and it was certainly going to be worse since he saw me with no appointment on his day off. So, prepared for the worst, I anxiously waited for him to tell me how much it was going to cost. I almost fell out of my chair when he told me the total, including the examination and medicine would be ¥10,000. For those of you who don’t keep up with the Yen exchange rate, that is a little under $100!
Now, my wife tends to get sinus infections fairly often, so I am familiar with the medication, and we haven’t always had good insurance. Back when we had no insurance, in the US, the medication alone would have cost at least $60, which mean this guy essentially just spent an hour talking to me, examining me, and explaining to me what was wrong, all for about $40. Either that, or he charged me a little under $100 an hour, and gave me the medicine for free. Either way, I was stunned at how cheap it was. I have to stop here though, and say that it wasn’t just how cheap it was that stunned me. My experience with doctors, at least over the past couple decades, is that they walk in, bark some orders at you, ask some terse questions, get annoyed if you take too long answering, then shove a prescription in your face, and have an assistant answer any questions you might have, because they are too busy to bother. This level of personal care, where the doctor takes great pains to explain what he is doing, and what is wrong, and why you need to take the medicine, was something I was very unaccustomed to. That level of care, at such cheap prices, was completely unfathomable to me. It got even more unfathomable when I went back the next day.
They sat me down in a sound-proof booth, and did all sorts of hearing tests, measuring my hearing ability, in both the inner, and outer ear. They found that I had indeed had some hearing loss in the upper range in my inner ear, and the doctor said that I had to get it taken care of withing two weeks of the onset of the infection, or I risked having worse, and permanent hearing loss. He stressed that since I was going back that weekend, I needed to see a specialist as soon as I got back to the US, since he didn’t have time to treat it, and by then I would only have a week or so before the hearing loss worsened, and became permanent. They give me some more medicine to get me through the flight, hopefully without the pressure differences blowing out my eardrum. The doctor then sits down with me and goes over a printout of the test results, explaining to me wwhat they mean, and giving me a copy to take back to the US to show whatever doctor I see. This time they tell me the visit will be ¥8,000 (less than $80), and I gladly pay it, quite sure I have everything I need to go back home an get the treatment I need.
So, I get back to the States on a Saturday, resolved to call first thing Monday and make an appointment as soon as I could with whatever specialist could fit me in, and was covered by my insurance. I get out the list of specialist, and was surprised to see that in the entire city of Los Angeles, there were only 10 listed. I start going down the list. The first doctor couldn’t see me until next week. That was too late, according to the very competent-seeming doctor in Tokyo. On to the next one. This number has been disconnected, or is no longer in service. On to the next one. Busy signal, I will wait and call back in a few minutes. Busy signal, I will wait and call back in a few minutes. Busy signal, I will wait and call back in a few minutes. I have been trying to get hold of this office for 20 minutes, on to the next one. Busy signal, I will wait and call back in a few minutes. Twenty minutes later, on to the next one. This number has been disconnected, or is no longer in service. On to the next one. Finally I get someone! The doctor listed can’t see me for two weeks, but there is another doctor in the office who can see me on Thursday. That seems to be cutting it a little close, but I’ll take what I can get. I make the appointment.
Now comes the fun part. I call the insurance company, to make sure I am going to be covered for this. No, in fact I am not covered for this, as I need a referral from my primary care physician, or there will be an automatic $900 copay on any unauthorized visit, and they won’t cover any of the testing costs, and will only cover 50% of anything over $900. So, now I have to make an appointment with my primary care physician, and try and get him to approve me going to the appointment I have already made for Thursday, all with the clock ticking on permanent hearing loss. I see him this morning, and have no idea what to do if he refuses to give me the referral, or insists on referring me to someone who can’t see me this week.
Moral of the story, if there is anything wrong with you, leave the US to get it taken care of, and don’t come back until it is fixed! I now see that it would have probably been cheaper and all around better, for me to extend my stay in Tokyo, and have that doctor take care of it with no insurance, rather than trying to take advantage of the insurance I pay for every month.