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Friday, September 17, 2010

What's The Worst That Can Happen?

Most people understand that irrespective of how bad things get they can still be thankful for being healthy and happy; "At least you have your health!" as the expression goes. Perhaps it seems odd, then, to suggest that it may actually be worse to be without one's insurance than to be without health.

As a child I rarely (if ever) had concerns with respect to my own health. I was typically happy and had most of my needs and (reasonable) desires met as our family was upper-middle class and my parents were fairly even-handed in their approach to parenting (i.e. fair in accommodating my sister and I so long as we took care of our responsibilities and behaved well). Playing soccer during the fall & baseball in spring and swimming during the summer ultimately meant that physical activity was part of my regular life. Aside from being diagnosed with an ear infection twice and gastroenteritis once I was able to avoid illness and even more serious misfortune (such as the all-too-common broken limb). As a child I was (of course) covered by my dad's health insurance and I only became conscious of the difference between an HMO and a PPO when my dad's employer decided to switch away from Kaiser in the mid-1990's.

Although it seemed somewhat odd to me that I would start having problems after turning 21 such was exactly what I experienced. The first incident occurred while playing basketball during a game of one-on-one with a friend in August of 2001: I found myself to have great difficulty breathing after an asphyxiation sensation and was unable to understand why such a thing would happen (the game was friendly enough and physical coordination, especially the type one would attribute to one's medulla, had never been an issue). Stranger still would be the diagnosis of "exercised-induced asthma" which was written into my chart after a visit to the doctor at the behest of my dad (who viewed the excess saliva production which I was exhibiting to be less a sign of a macho Texan and more indicative of the absence of health).

Over the course of two years I was prescribed Rhinocort, Singulair, Clarinex, Astelin, Albuterol, Flonase, and Advair. I was diagnosed with nose-boggy turbinates, a septal deviation, pediatric allergies to grass and cat dander, a nasal spur, anxiety, depression, gastroesophogal reflux disease (aka GERD), allergic rhinitis, and dyspnea w/exertion (aka exercise-induced asthma). During the course of those two years I visited various doctors offices over 20 times, and underwent an endoscopy, a barium swallow, a head CT scan, a body CT scan, a chest X-ray, a fiber-optic examination of my vocal cords, and had a needle stuck in my arm more times than Iggy Pop.

Perhaps its a philosophical question to ask whether a cancer diagnosis is to be expected after experiencing the same; nevertheless, it was without any particular expectation that on November 20, 2003 (my mom's birthday and two days before my own) I received the news that the previously-taken biopsy of a thyroid nodule on the base of my neck had come back positive and that I had papillary thyroid cancer.

How is it possible that it may actually be worse to be without one's insurance than to be without health? When I graduated from college (in August of 2003) I was forced to find health insurance of my own: the law at the time afforded coverage for individuals who were over 21 under a parent's plan only if the individual was not older than a certain age (23?) and was enrolled as a full-time student. Due the series of (mis?) diagnosis between August 2001 and August 2003 BlueCross/BlueShield (the provider of my father's coverage) rejected my application for individual coverage and my application to Kaiser Permanente contained no self-disclosure of any of the visits which had previously occurred. Although I was covered by Kaiser Permanente when I received my cancer diagnosis (and was thus spared what would most likely have been financial ruin as a result of the subsequent care which was required) my health has been challenged by what is typically a very treatable illness. In some sense the worst part is knowing that the entire ordeal can be attributed to an impetus to re-examine the rules which regulate health insurance coverage for recent graduates rather than taken for what it is (a transgression of human dignity and a failure of humanity).

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