June 19, 2009


Let's follow one minor injury (mine) through the American health care system, shall we? It started in September 2007, when I fell out of a tow truck.

I fell out of a tow truck after a long, hard week at work because while I was

driving home from New Jersey across the Betsy Ross bridge, a tire blew out. My auto club sent out a crew but they couldn't change the tire - it needed a special tool, one I didn't have. (Used car.) So I trudge back to the police station at the foot of the bridge, where someone was nice enough to let me use their phone. (Dead cell battery! Oh lucky day!) But then the red-faced shift commander came in and started screaming at me: "GET. THAT. CAR. OFF. MY. BRIDGE!!" He also yelled at me for "tying up our line" and insisted I fork up $300 to get my car towed off the bridge.

I'd just started the job after several months of unemployment and was broke. I told him; he didn't care. I finally made another call and got my auto club to authorize a purchase order to get me towed.

It was a Very Big Truck, a shiny black tractor-trailer with a flatbed. We unloaded the car at my mechanic's, and the driver dropped me off in front of my house. Did I mention the truck was black, and that it was late at night and dark outside? Because here's where I tried to step out of the truck onto one of the decks (black, with no reflective safety strip) and dropped three feet to the sidewalk, onto my ankle.


Much crying and a trip to the emergency room later, I discovered another little oddity of the American Way of Insurance: Since the accident involved a vehicle, all treatment had to go through my no-fault car insurance until it was tapped out. The local hospital did an x-ray and told me it was a minor sprain.

After three months of physical therapy, it wasn't getting better. The physical therapist told me she thought maybe I'd chipped a bone and it was tearing at the ligament. "You should get an MRI," she said.

This, as they say, is where the fun begins.

So I went to my doctor, who tried to order an MRI. It kept getting rejected. Finally, I found out why: Since the original treatment was paid by my car insurance, they didn't know I'd already had physical therapy. So then we had to go back and forth with the car insurance to get them to send the records.

It was just about this time that my insurance carrier announced they were severing the agreement with my university-affiliated practice in a dispute with the hospital over reinbursement rates - and I had to find another doctor.


You guessed it. Back to start! (I know; I'm bored with this story, too. But I want people to understand how many hoops we're jumping through under the present system.)

I got all that paperwork in when my former employer notified me we'd switched insurance plans - and I had to start all over again.

Finally, almost two months ago, I finally got in to see a top-ranked orthopedist. He told me I was fine. I kind of got in his face and said, "Look, I'm unemployed, I'm paying for COBRA and I'm running out of money. I need to know what's wrong so I can take care of it while I still have insurance."

His response? "I'm 99.9% sure you just have some residual swelling and I can fix that with cortisone." Against my better judgment, I let him.

In the follow-up visit, I told him it still hurt when I walked; he told me to take Motrin and scheduled another followup.

About a week after the shot, I was on the couch watching TV (did I mention the 30 or so pounds I put on from not being able to walk?) and turned my foot to one side. I was hit with excruciating pain, like severe labor cramps in my ankle. Then I felt a sudden pop, and the pain was gone.

I called the doctor's service and described the pain, asked if there was anything I should do and was it okay to walk on it?" I got a one-word response from the office clerk who called back: "Yes." Yes what? I asked. She didn't know, she just knew "Doctor said yes."

At this point, I insisted on an MRI. (Yet another $50 copay!) At this point, I didn't trust the doctor and spent some hours pouring over on-line MRI images, comparing them to mine. It looked like I had a damaged ligament and a fracture, but I had to wait for the official verdict.

This past Wednesday was my appointment. (Let me mention here that this practice is run like a high-speed assembly line.) The doctor finally comes in and tells me the ankle "looks fine, I told you the cortisone would fix your problem." I frown: "The MRIs didn't show anything?"

"What MRIs? I was looking at your x-rays."

So now he goes back and looks at the MRIs, comes back in the room and says, "The MRIs do show a fracture and a ruptured ligament." He wants me to wear a brace and go back to physical therapy.


"I don't understand," I said. "How is the ligament going to heal if the broken bone is still rubbing against it?" (And don't think I haven't realized there's a very good chance the cortisone shot is what finally ruptured the ligament.)

And that's when he walked out of the room and didn't come back.

So I came home and made an appointment at Penn to get a second opinion.

That's what happens in our present system., when decisions are made based on profit and insurance instead of your health. Multiply that process by hundreds of thousands, maybe even millions. This is the mess that Congress tells us we want to keep.

By the way, feel free to send this link along to your congress critters!

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