He was probably in his twenties, this young man who was sticking the needle into my arm to draw blood. I was still upset from my earlier visit to my RA (Rheumatoid Arthritis) doctor, on the eighth floor. I had seen my doctor (Dr. S), who had said my RA was under control, kept my medications at the same level, sent me for blood tests, and told me to return in three months.
I liked and trusted Dr. S, my RA doctor, although he was taciturn, and I had to press him for more than minimal conversation. I had made it my goal to get him to smile at least once during our time together, and I was almost always successful. Today, he had even teased me back, smiling mischievously as he told me he wasn’t decreasing my meds, even though there were no signs of inflammation, because I was so banged up. (I had explained my many bruises by telling him that I was packing and moving.) He was maybe a decade and a half younger than I, his credentials were excellent (He had even been noted as “one of the best doctors in New York” in New York magazine.), and I had been seeing him for over five years. He hardly ever kept me waiting and dispensed with his examination with the same, predictable routine each time.
My fondness for this white, balding, tall, skinny fellow in the white coat was greatly attributable to the remedy he had offered on my first visit. I had suffered terribly for eight months, often unable to even dress myself, and spending most days on the couch in pain, before my primary care physician had sent me to Dr. S, who looked at my wrists, shook his head in sympathy, and commented on the extent of the pain I must be experiencing. I had tried everything, and I teared up at his recognition of my pain. He gave me steroids. I had wanted to hug him when I saw him a week later, I was so grateful for the almost immediate relief from the drugs.
It was when I went to check out at the end of today’s appointment that my current troubles ensued. I handed the clerk, a new person, the five dollar co-pay I had been paying for five years and she looked puzzled, studying my records on her computer screen at great length and saying nothing. Finally, she excused herself and went down the hall. She came back with Dr. S’s assistant, the handsome young man who never came out of his office, but had always answered every question or request I had had. He explained that Dr. S no longer took Medicare, and I would have to pay for my appointment. He told me the rather large amount. “But no one told me,” I was upset now. If the letter had come, either I had missed it in the upheaval of our packing or I had read it and not understood what it meant. Fortunately, I could manage to pay this bill, at least this one time, but the idea that I could no longer see my doctor was very upsetting. Soon, tears were on my cheeks, and the young man was handing me a bottle of water and some tissues.
I should have known. I had had wonderful medical coverage under a private health plan all my working life and into my retirement. Then, this year, the State of Connecticut, struggling with an underfunded budget, had removed all its retirees from the private plan and now I only had Medicare to rely on. Dr. S is not the only doctor I can no longer see. I also will have to give up my primary care physician. I want to be angry at my doctors, “Why do you only serve the wealthy?” But I don’t entirely blame the doctors for not accepting Medicare patients. Medicare pays a very small fraction of the going rate and allows doctors to “opt out.” This seems like a lesson in how to create a health care system for the very wealthy and another for the rest of us. What happens when all the doctors “opt out” of taking Medicare patients?
When I explained my predicament to the young phlebotomist, I told him of the further indignity that we elderly were likely going to be endure as the State votes to deny Cost of Living increases in our State pensions, he shrugged and said, “Your generation had it good. I don’t expect there will even be any services when I am your age. We have to take care of ourselves.”
He was right. I had grown up in the shadow of the FDR years, with the belief that a society took care of those who were not able to fend for themselves – children, the infirm, its’ veterans, the old. Our children and grandchildren will have no such solace, should they need it. In this young man’s world, it was every person must fare for himself or herself.
I remember my sadness when a hospital in our neighborhood had to shut down because it wasn’t making enough money. I couldn’t get over the idea that a caring and decent society should provide health care; it should not depend on the amount of money the hospital brings in. Some might say that I am naïve, but I believe it is a question of the kind of world you want to live in—one that cares about its’ citizens or one that lets every person fare for herself.
I’m sure my next RA doctor—one that offers services to those on Medicare—will probably be just fine. I’m lucky that some doctors still take patients on Medicare, even if the doctors I see are opting out. Maybe my new doctor will even talk to me more than Dr. S did, but I am still sad. Maybe my new doctor will be one of the young ones, still building a practice, and more in tune with new practices in the field. Still, I value the experience of older doctors and believe I should have a right to choose which doctor I will see.