Adventures in Government Health Care

It hasn’t been all that long since we were all regaled with the wonders of government health care. As an Army wife, I believe I can shed some additional light on the topic. (Also, I need to vent.)

The medical plan for the military is known as Tricare. There are varying degrees of hell Tricare; being overseas (or, in our case, in Hawaii) means that you are stuck blessed with the all-inclusive package, which gives you unlimited access to military clinics and hospitals, along with absolutely no control over into whose hands you are put. This can lead to infuriating fun experiences, such as the one I’m about to tell you about.

A little background is in order first: I have asthma. More specifically, I am an exercise-induced asthmatic. It’s genetic – my father has the same variety. The severity of my symptoms are in inverse proportion to how in shape I happen to be. This means that, at the present time, preemptively using an inhaler before working out is a necessary precaution if I don’t want the highly unpleasant sensation of gasping for air through a single coffee straw.

The inhaler in question is a ProAir. It’s a pretty, red albuterol inhaler, useful for sudden asthma attacks, or for asthmatics such as me who can more or less plan their attacks in advance. This is not medicine you can just pick up off the street; you need a prescription for it. And I have had a prescription for this inhaler, or one like it, ever since I was diagnosed with asthma at age 14. I am what you would call an old hand, at least in this regard.

Seeing as my family has recently found itself living in Hawaii, my husband was quite keen to get both himself and me scuba certified. While filling out the paperwork for the class, I found that, due to my respiratory condition, I would need a doctor’s okay to get certified. I met with my Primary Care Provider to discuss the issue; he didn’t feel comfortable signing off on an asthmatic he had just met that day going diving, and so he sent me over to Tripler Army Hospital to talk with someone at their pulmonary department.

The doctor at Tripler was a rotund, genial man. He told me that there had, up until recently, been a strict prohibition on mixing asthma and scuba, but that those tides were turning a bit, and there was a growing number of people who were saying that someone with their asthma well under control could handle it. He then told me that he’d like me to come in another day for an asthma stress test. As I understood it leaving the visit, he wanted to put me on a treadmill sans medication and see what happened. This seemed a little odd to me, since I knew what would happen; but I figured, “He’s the doctor,” and agreed to come back. The soonest appointment was in a month.

Yeah. I got to sweat about that for a month.

The month passed, and I went in for my stress test. (I came well prepared, having gotten very stressed ahead of time.) The doctor had left no instructions whatsoever for the test. I told the nurse what I thought it was supposed to be; she said that that made no sense. She said that since I was there to be cleared for scuba diving, and I would be using my inhaler before diving, the test would be more informative if I was given medication beforehand, to make sure it was effective. This made more sense to me, as well, and since the doctor had left zero instructions on the matter, I figured I had simply misunderstood him. I did a before breathing test, ran on the treadmill, did the after test, and was off on my merry way, a follow-up appointment in a week.

It has now been almost twelve hours since that follow-up appointment, and I am still fuming.

Over the course of our post-exam interview, I learned that my initial impression had been correct – that the original idea had been to put me on a treadmill with no medicine and see what happened. I was then told that, if I had reacted like a normal person to the treadmill, I would be cleared to dive; but if I had had breathing trouble, I would not have been cleared to dive.

Just to be clear: If I, an asthmatic running on a treadmill without medication, had behaved at all like an asthmatic running on a treadmill without medication, I would not have been cleared to dive. In other words, his requirement was not for me to have my symptoms under control and/or well managed. No, his requirement was for my symptoms to be gone in their entirety.

Guess what, dude? If that were the case, I wouldn’t need your damn signature!

Also, I know that fourteen years is just a blip on the radar screen to a lot of people, this particular doctor included. But for me? That’s half my life. Half. And for HALF of my life, I have been able to tell you exactly what would happen if you put me on a speeding treadmill without an inhaler. In fact, I did tell him, during the initial visit, exactly what would happen if he did that. But no, we can’t take the patient’s word for it! No, let’s get her hopes up that she might be able to go diving after jumping through some hoops, stress her out for a month, make her drive all the way down here (twice), and waste hospital time and resources to establish a fact for which there is fourteen freaking years of precedent, with a standing prescription as proof!

Efficiency!

Now, I’m aware that one incident does not a pattern make, and that everyone has medical horror/facepalm stories to tell. And I can also tell you that there are a lot of kind, dedicated, knowledgeable people in military healthcare. I truly wish I could say that this experience is anomalous to the rest of my Tricare experience. But I would be lying if I did. My generally healthy family has been under the umbrella of government health care for not even two years, and I can tell you from experiences (plural) like this that it is inefficient, disorganized, full of red tape and headache-inducing. There are plenty of people in the system who are so enamored of their own job security that your needs are secondary (or tertiary) concerns. Taken together, it’s a solid case of “You get what you pay for.”

I’ve been a (low-income) participant in both private and government health care, and I can tell you unequivocally that the former far exceeds the latter. Single-payer advocates used to just annoy me; now I get indignant when I even think of some educated idiot on TV extolling the virtues of government health care like it’s the Holy Grail wrapped up in the Golden Fleece and Harry Potter’s invisibility cloak. And I start positively fuming when I think of my friends and family who would support single-payer saying, “Well, it’s better than nothing, isn’t it?”

Is it better than nothing? Sure it is. And dog food is better than starving – but that doesn’t mean you force everybody onto the Purina diet.

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