The American Health Insurance Sandwich

Current events in New York compel me to write this right up front: cold-blooded murder will always just be cold-blooded murder. Such heinous crimes are never “ok” and certainly not to be celebrated.

But…

I can certainly understand mounting, unending, percolating, seething, and never-abating frustration with the whole medical scene in these United States. I have no quarrel with any one person. I’ve never met anyone who twists their mustache saying “I got into health care so I can screw people over.” It’s quite the opposite. But these systems have become giant animals who’ve taken on a life of their own running counter to the original mission of taking care of our fellow humans.

I think many people assume that an average person must only deal with it occasionally, or only needs to deal with one provider, or only needs to deal with one insurance company. Those of us down in the trenches know better. In my experience, multiple medical care systems and insurance go together as a giant shit sandwich layered with flavors of frustration.

Consider our sandwich bread, a dough made from the recipe of a middle-aged man recently “invited” to retire early by his company. Fine, he’ll just get continued COBRA coverage out-of-pocket for him and his family under that same company plan. Switching on COBRA near year’s end, smack dab in the middle of everyone’s open enrollment, is not an odyssey he would wish on anyone. “You cashed my house-payment-sized check last month but I’m still not shown as covered. Can I get a prorated refund?”

“I’m sorry, sir, but we don’t do that sort of thing.”

This becomes two slices of stale bread, one each for him and his family, bookending our sandwich together.

Let’s layer on the condiments. This same gent has Veterans Administration care to deal with for a handful of his own service-connected medical issues. This constant frustration layer sits at a low simmer as he builds up patience enough to submit yet another claim for a service-connected problem every 4-5 years of the last two decades, only to get denied each time.

A permanent dent in your ribs shaped like a jingle-truck bumper, you say? Environmental symptoms that started immediately after spending a year in the sphincter of the earth, but they just don’t fit neatly into this box on my form? Nope… denied. This layer smacks of nasty old mustard. It’s always in your fridge; you only taste it occasionally. It’s definitely not for everyone, many people never taste it, they only hear it’s not good. But you never throw it out.

Now for the meat of our sandwich, what MAM [Middle Aged Man] spends most his time digesting. Our intrepid diner manages the care for his two elderly parents. Parent #1 is in the Medicare system, P2 gets care from the VA. P1 lives in a full-time ALZ [Alzheimer’s care facility] whose staff deserve sainthood and earn every penny of the four-figure monthly Medicare-unqualified fee. The good news is that P1 took out a nursing home insurance policy years ago. The bad news is that P1’s state law does not define ALZ care facilities as nursing homes.

Thus, P1’s nursing home insurance policy only pays out at half the rate since they define this full-time, locked-in medical and life care as “assisted living.” I think any reasonable person would consider locked doors, 24-hour staff, and occasionally subduing a crazy naked pugilist senior as a bit more than “assisted” living. Even though this place is better than any classic nursing home ever, no dice, only the 50% rate is authorized. This first layer of lunchmeat is definitely spoiled.

Would you like a little slimy old lettuce on your sandwich of fun? Here you go… P1’s dentist office has no idea how to deal with ALZ patients. P1 still needs dental care. You can imagine the frustration and even hilarity that ensue, simply for getting a tooth filled or pulled. Slimy black lettuce indeed.

Back to P2’s care layer in the sandwich. Enter the VA team that is three states away from MAM’s VA care team so it’s all different players. This lunchmeat is right on the expiration date. Sometimes it’s ok, sometimes it’s gross. One little spoiled bit in our meat slice metaphor: P2 is well past the age where he’ll do any online scheduling or run a smartphone. P2 also gets various VA-provided in-home health assistants who, individually, are great. Collectively, VA home health care has no visibility on other VA appointments at their clinics. They are two different systems, you see. So, these appointment times often conflict.

P2 doesn’t care, he’s old, he goes to his appointments without sitting around waiting for, or even contacting, home health. They’re all with the VA, they should know each other’s schedules, right? Nope. Every so often, P2 misses so many cumulative home health appointments due to VA clinic appointments that they cancel him from the home health system altogether. Then P2 and MAM start the process all over again needing referrals, signups, and more in-person appointments just to get back to where they were. This definitely takes our lunchmeat past the “use by” date. Eew.

What sort of cheese would you like on your sandwich? How about the moldy kind where, in the same small community, the VA system and the civilian health system do not talk to each other. In the event of a tumble or other EMS call, guess where both P1 and P2 get delivered by ambulance? Yep, into the civilian health system. P1 takes it all in stride. P2 is a veritable alien in the civilian system with nearly no VA files with which the civilian specialists might make their diagnoses. After a medical event, it’s up to MAM to spend hours on the phone and in-person trying to get the two systems to share information. Now, as an added bonus for playing, Medicare sticks its nose into P2’s civilian care. A new player has entered the chat, and they’re a pain. MAM and frontline med staff get to arbitrate between the VA and Medicare. This cheese went bad long ago.

So, gentle reader, there sits our figurative sandwich. Every week, sometimes every day, our illustrious middle-aged-man must take a bite. How many bites can he endure before snapping? As many as it takes because he’s not a criminal. While none of it is free, it’s all definitely first world problems to have at least one, sometimes more, medical care systems presumably available to help. MAM, his family, P1, and P2 all have pretty benign conditions in the grand scheme of things.

One can be grateful but that doesn’t mean one has to like it. That doesn’t mean that, taken all together, this doesn’t become mind-numbing. That doesn’t mean he has no frame of reference for a lesser man resorting to violence after countless bites of that ever-growing meal. That doesn’t mean he won’t yell at his computer screen or cuss at his muted phone occasionally. Lord help any sandwich diner in the throes of cancer, chronic pain, children’s disability, hospice, or any other countless horror stories. Everyone’s sandwich of medical system frustration looks a little different.

If you are grinding through your own sandwich, know that it’s ok to set it down and step away for a bit. It’s not going to get any better so go fill up your cup before sitting back down at that plate. Some days you can’t stand a single bite. Other days you’re ok wolfing it down for hours. You keep going back because others depend on you and depend on these systems, as flawed as they may be.

If you know someone eating their own sandwich, check on them. Some days might just be more than they can swallow.

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David is a father, husband, son, boss, writer, beekeeper, outdoorsman, occasional teacher, compulsive elk hunter, Afghanistan veteran, and living proof that anyone is trainable. He is a 1994 South Dakota School of Mines graduate. David spent 12 years in the Army and Army Reserve as an Engineer Officer before that career was cut short with Afghanistan injuries. He spent decades as a consulting civil engineer working in communities all around the American West and now oversees his firm’s engineering department. David continues to amaze both friend and foe being an engineer who can write a story.

As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.