Doctor, Doctor! The Costly Reality of US Healthcare

Healthcare spending is about 18% of US GDP. That’s at least 150% of what it is in other developed countries. Translation to English: The US spends too goddamn much on healthcare. And what does the US get for all that money? A ranking as the worst among developed countries for health outcomes. The US has too much healthcare for too little benefit. And good luck getting a primary care doctor these days!

The primary victims (or beneficiaries depending on your point of view) of the American system of overdoing health care are elderly people. Just wait until you retire. The American medical-industrial-pharmaceutical complex will decide that your new full-time job should be going to various medical facilities!

Here’s what too much healthcare can actually look like for an ordinary American. Here’s a month in your life of as a conscientious American woman, retired, aged 66. Your husband is 72.

So we’ll start with her annual physical with her primary care physician. It’s a new doctor. The old one quit. That’s because global capitalism does not care about primary care physicians and has been trying to make them miserable for awhile but especially after the pandemic. PCPs aren’t profitable!

The only good primary care physician, capitalism thinks, is one who has been purchased by private equity to be driven into bankruptcy, and turned into ChatGPT because somehow that benefits private equity and, as Milton Friedman told us, that benefits everyone! Yay, losing your doctor!

Of course, losing your doctor in no way relieves you of the obligation to have your annual physical, even if your annual physical is now virtual. If you need an actual physical, that will be another appointment.

So let’s dive into your schedule for the month.

Monday, March 1. You had your annual virtual physical. Your new doctor asked you about your medical history since the last visit with a PCP, and you didn’t really say anything and she didn’t really listen because you don’t want to talk about it over Zoom and she doesn’t have time to listen. Then she looked at your medication list and frowned. She frowned because there are a lot of medications on it and some of them she doesn’t really know what the hell they are supposed to treat. But then she stopped frowning because what the hell, they look fine. She starts to ask you if you are having any problems with any of them but then thinks better of it because she doesn’t really have the time. You don’t say anything either because you don’t know what to say or ask.

Then she asks about your overall health and you finally get your chance. You say, I’ve got this thing on my head. You try to show her over Zoom. But she can’t really see it. It kind of looks like a large freckle on your scalp. You don’t like it. At first she says it doesn’t look like anything to worry about but then you look worried so she tells you to come in for a physical appointment so she can look at it. In a month.

Congratulations, you have broken a speed record for a follow-up for a follow-up appointment according to the doctor’s scheduler. March 2. Whoops! That was March 2 of next year! Ha ha ha. Oh never mind, wait. She can actually see you at 7:20 a.m. tomorrow. Okay.

Now you are going to see a doctor again tomorrow. At 7:20. You are free from medical appointments for the rest of the day. Woo hoo! Grab yourself some lunch.

Tuesday, March 2. 7:20 a.m. You are at your doctor’s office. It was a long way away, but the traffic wasn’t too terrible. While you are there, the nurse tells you that you need your blood pressure checked. So she checks it. It’s too high. 140/98. Someone’s gonna have to talk to you about that.

An hour later the doctor comes in. Where was she? You don’t know. No one knows. It doesn’t matter. She looks at the large, irregularly shaped freckle on your scalp. She says “Have you always had that?” You say “No.” She says “Huh.” Then she says “I’m going to refer you to a dermatologist.” You say “ok.”

Then you say “the nurse said something about my blood pressure.” The doctor looks at your chart. She says “huh.” Then she says “I thought you were taking something for blood pressure.” She looks at the chart. You are taking something for blood pressure. Then she says “I’m gonna give you a prescription for Hydrochlorothiazide.” You don’t say anything because who knows what the hell that means except it is probably a pill. “You can pick it up from your pharmacy.”

It’s 9:14 a.m. on Tuesday and you have escaped the clutches of the medical-pharmaceutical complex for the day. You are rocking and rolling. Except you are going to have to pick up a prescription. Sigh. It’s gonna cost you $17 for a month’s supply. That’s not too bad.

Wednesday, March 3. Free day! Yay. Perhaps you can see the grandkids. Nope, never mind. Their parents are exhausted from capitalism. And it’s the middle of the work week, so you’ll have to see them another day.

Wait! It’s just past 6 pm and you get an automated call from your doctor’s office telling you that you need to get your cholesterol checked. Weren’t you just there? Couldn’t they have mentioned that yesterday? Apparently not. You’ll need to go to a lab.

Also, you just remembered you’re supposed to have a new prescription to pick up. You call the pharmacy. No one’s heard of this supposed ‘prescription’. You’ll need to call your doctor tomorrow. Or you could email tonight. You decide to email tonight. So it wasn’t a free day after all. Almost, not quite.

Thursday, March 4. You go to the lab at the crack of dawn because if you go later there’s a wait. Anyhoo, there’s still a wait. When you get there to have your blood drawn for the cholesterol check, someone asks if you are supposed to get your blood sugar tested too. You say no. They say, well it says here you’re supposed to. Did you fast? You say no. They say “well you need to fast, you’ll have to fast. You need to come back tomorrow.” And they hand you a sheet of paper that tells you that you have to fast. You sigh.

Later that day you check to see if your doctor has responded to your email or if your pharmacy has heard about your prescription. Nope!

Friday, March 5. You go back to the lab, not at the crack of dawn but you have fasted and you are very grumpy. Someone at the lab looks at your paperwork and tells you that you didn’t really need to fast. You almost lose it. But you don’t. You eat a bunch of pastry when you get done because pastry is soothing.

Then you get an email from your new Medicare Advantage plan saying that you get certain benefits because you’re fat! Congratulations. You should check with your doctor to see if you can get a GLP-1 at the low low cost of hundreds of dollars a month to make you less fat. You do not follow up on this but you do eat more pastry. After the pastry, you wonder if you should go to the gym but you don’t.

Saturday, March 6. The pharmacy calls, your new prescription is in. You pick it up. The pharmacist asks you an alert question. Why do you have a prescription for a new diuretic when you already have a prescription for one you’ve been taking. Did your doctor tell you to stop taking the old one? You don’t know. Eventually, the pharmacist gives you the new diuretic but is dubious about you taking it until you know why you have prescriptions for 2 different diuretics. When you get home you email your doctor again.

Sunday, March 7. It’s your birthday and you’re having a party! You do not think about your health. You eat too much, drink too much and get a bunch of gifts. You had a good time and probably spiked your blood pressure what with the drinking and arguing with your sister, a birthday tradition.

Monday, March 8. You get a text message telling you that it is time to get a DEXA scan. You do not know what a DEXA scan is. You email your doctor. Later that day, your doctor actually replies. No wait, it is a nurse in the doctor’s office. You should stop taking the old diuretic and start taking the new one. Also, you need to schedule a DEXA scan with somebody. It is a bone scan to see if you have osteoporosis. You schedule one for next week.

Tuesday, March 9. You take your new diuretic. You think it makes you feel weird. Kinda dizzy. You’re not thrilled with it. You call your doctor. Someone in her office says to take for it a couple of weeks and you’ll feel better. You ask about the freckle on your head and a dermatologist. The person in her office knows nothing about it but will check.

Wednesday, March 10. You get a card in the mail that says you need to schedule a colonoscopy. Oh no! You call the number. They can get you in next month. You were hoping they couldn’t get you in until next year. Sigh. You are gonna have to pick up the prep medication. The prep!

Thursday, March 11. You go to your husband’s annual physical with him just to be companionable. He has a new doctor because the old one quit. Of course. The new doctor wants to know why your husband hasn’t had his prostate checked. You don’t know. Well, whatever, the doctor wants it checked. Now. In a miracle of efficiency, he gets a PSA check that day at the on-site lab. You can spend the rest of the day relaxing. Wait, no you can’t. Your husband gets a call at the end of the day that tells him that his PSA indicates he may have prostate cancer. What?! They want to schedule a biopsy. For 2 months from now. What?! You’re reeling.

Friday, March 12. Your cholesterol and blood sugar tests results are in. You don’t know what the cholesterol tests mean but you do see that the blood sugar test indicates you have pre-diabetes. God damn! Although you try to reassure your husband about the prostate cancer, you are not personally reassured. When you check the mail, you see a little postcard reminding you to get a mammogram. You call the number of the postcard in a daze. You get an appointment for one in May. Whatever. Fine. You don’t really like mammograms anyway.

Saturday, March 13. You have a free day to worry about your husband and his potential prostate cancer. It occurs to you that you won’t actually know whether he has it until April! Time for some googling. You decide after thorough investigation that it isn’t going to do any good to worry. You worry anyway. Your husband won’t talk about it. In fact, he won’t talk about anything. This makes him grumpy around the grandchildren. Sigh.

Sunday, March 14. You go out to dinner with another retired couple. The wife tells a grisly story about someone they know who got Hep C. She urges you to get a test for Hepatitis C just in case. Your husband still doesn’t talk, but sometimes there are worse things in life. The wine was good at any rate.

Monday, March 15. Time for your DEXA scan. It’s a 1 p.m. It takes awhile to get to the facility but the whole thing takes like 7 minutes. It’s weird, you drove all that way for 7 minutes. Kind of irritating. You did ask one of the techs if you should get a Hep C test. He says yeah, and HIV too. You are offended. You do not have tattoos and he does. You email your doctor to see if you can get a Hep C test. You get no answer. After that, you email your husband’s doctor to see if he can get a biopsy sooner. He has no idea but doesn’t think so. Your husband has started talking again. To his brother. This is your new normal.

Tuesday, March 16. Your doctor responds to your email. You can have a Hep C and HIV test and you should probably have a lung cancer screening too because you smoked for 32 years. Also you have prediabetes. You should do something about that. She wants to see you for a follow-up appointment. Someone will call you. No one calls you. You are in a bad mood because of your husband’s prostate cancer and your prediabetes and being reminded that you smoked. That was a long time ago though. Thank god no one is asking about your drinking you think as you have a second glass of wine.

Wednesday, March 17. You go in for a Hep C and an HIV test. Once again there is a wait. You’re not really sure why you’re there until you remember your friend telling you about your other friend who died! At 63! Died. Later someone does call you from the doctor’s office. You can get a CT scan for your lungs sometime in June. You dutifully put it on your calendar.

Thursday, March 18. You go to the drug store to get some more wine. You are not a snob. They’ve got wine at the drug store. It is nearby, so you are going to get wine at the drug store. While you are there, someone walks up to you and says ‘hey, want a flu shot?’ Eh, what the hell. You get one. And 2 bottles of wine. The wine makes your arm less sore.

Friday, March 19. It occurs to you that you never did get a referral for your gigantic freckle. When you look at it the mirror, it looks like it is getting bigger or changing shape. You can cover almost all of it with hair but not all of it. Maybe you should email the doctor, but first – a glass of wine. You get an automated text message from your Medicare Advantage plan telling you that you should get a pneumococcal vaccine. For some reason, maybe it’s the wine, the word pneumococcal strikes you as really funny. Your husband comes over and starts talking about how his buddy tells him he should really get some gummies for his insomnia. You talk about gummies for awhile and it’s kind of a pleasant conversation.

Saturday, March 20. Free day! Grandkids. Worrying about your husband. You’re tired of worrying. Not really in the mood for wine. Still fat. Maybe you should bake a pie. You do.

Sunday, March 21. You forget all about health for a day. First day since March 7.

Monday, March 22. Your DEXA scan results are available. You have osteopenia. You do not really know what that means. Someone from your doctor’s office calls; what it means is that you are going to be on another medication. Also, you need to come in for your pneumococcal vaccine today. You do. But they also make you get a shingles vaccine. You’re going to have to come back for a second dose of that later. You do not love this idea. Also you need to get a tetanus booster and a COVID shot. Just the idea of all this makes you tired. That evening the pharmacy calls. You have a new prescription to pick up. You pick it up. You look at the instructions. You are to take it once a week. You are not thrilled. As a side bonus, the pharmacist mentions that it’s odd that you are getting this medication given your age and how fat you are. She doesn’t exactly say it that way but that’s the way you heard it. You decide to bake another pie.

Tuesday, March 23. Will this month never end? Oh shit, you have your eye doctor appointment today. It goes okay. You need new glasses. Also, you have cataracts. You should probably have cataract surgery. Not right now, but probably next year. You look at glasses. You do see some nice ones but damn they are expensive.

Wednesday, March 24. Nothing. Free day! No, whoops, wait. You and your hubby are going to get hearing tests. It takes longer than you expect. You do not have to get hearing aids yet. Thank god. And you combine it with your regular shopping at Costco. You stock up on wine. Not a terrible day.

Thursday, March 25. Dentist appointment. You get deep cleaning because you have gum disease.

Friday, March 26. You get a call from the facility that is going to do your husband’s prostate biopsy. They have an opening and they want to move it up to next week. They give him some instructions over the phone. You can tell your husband is now scared and depressed. He is worried they want to move it up because it’s really bad. You know it is your responsibility to not be worried or depressed now so that he can be.

Saturday March 27. You have to tell the kids (your son and your daughter) that their father is going in for a prostate biopsy next week. They do not know what to make of this.

Sunday, March 28. Both sets of grandkids visit along with their parents. During the day you trip on a rug and bruise your hip real bad. Damn it hurts. Sometimes getting old really sucks.

Monday, March 29. The lab results show that you do not have Hepatitis C or HIV. Your hip is still bruised though and you can tell your husband is freaking out about the biopsy. Also, you still don’t have a referral for that crazy freckle on your scalp. Is it too early for wine?

Tuesday, March 30. You call the doctor. You have been taking the new diuretic and you hate it. Also where’s the damn referral for the dermatologist.

Wednesday, March 31. The referral for the dermatologist finally comes. You can see him in July!

Woo hoo! You made it through a month of American healthcare. You do not actually have any diseases. Well, a little gum disease. Otherwise, you have a bruised hip and that’s it. And yet, you have spent the entire month dealing with the American healthcare system. Your husband may or may not have prostate cancer, you don’t know. Kinda worrying!

But cheer up! You have plenty more interactions with the American healthcare system coming. Like having to deal with your unpleasant blood pressure medication. You need to see a dermatologist. You need to get a colonoscopy. You need to get a mammogram. Your husband needs a biopsy. You are going to get a lung cancer screening. You need another shingles shot. And a tetanus booster. And a COVID shot. Hell, they may try to squeeze an RSV vaccine in there too. You never know.

All you really know is that so much has been piled into American healthcare and your schedule that you are on a medical treadmill that you will probably not get off of for the rest of your life. Meanwhile, fingers crossed your husband doesn’t have prostate cancer!