Don't get sick...if you're poor in Jackson

Wednesday, February 01, 2012

By Aaron Wallis

Jackson Hole, Wyo.-Living four years in Jackson without health insurance, I’ve had to work constantly to have even minimal access to health care. For most of human history people could get by without health insurance. “I’m sorry Sir, but these leeches are not covered by your HMO. Also, demonic possession is considered a pre-existing condition so I’m afraid you’re going to have to pay for the exorcism out of pocket.”

Today doctors are much better at treating real illnesses. Unfortunately, health insurance costs more than ever and if you’re not covered, well, just don’t get sick.
My first night as a resident of Jackson Hole was spent at the emergency room. A college friend from Jackson invited me out to enjoy the mountain air and get my head clear after a nasty break up with my psychotic parasite of a girlfriend. I’m a pretty good driver but I’d never lived anywhere with snow. The road was clear and I was doing 80 on I-15 near Blackfoot, Ida., when I hit a patch of black ice on a frozen bridge and went flying off the road. I still remember the feeling of inevitable helplessness as the truck rolled three times, crunched in on all sides and came to rest upside down in the middle of the interstate.

I never lost consciousness and found myself hanging upside down still strapped in and covered in broken glass. I crawled out the busted driver’s side window. I could barely stand; bells were ringing in my head and the real world was drowned in flashing lights and morphing colors. Terence McKenna claims DMT is released naturally in your brain twice, when you are born and when you die. I think I got a little dose because that was as intense as any acid trip I’ve ever had. I was quickly snapped back to reality as another car hit the same patch of ice, lost control and spun off the interstate missing me by ten feet.

So there I was sitting on the bumper of an off-duty EMT truck, picking glass out of my face and wondering why I was still alive. Miraculously, aside from a few cuts there was nothing wrong with me.

I arrived in Jackson the next day and started having horrible pains in my neck and lower back. I was initially reluctant to visit the ER because I knew I could not afford it. But after taking eight Tylenol to no avail, I broke down and went to the ER at St. John’s Hospital. This was my first visit to a hospital as an uninsured person and cost almost $200 which was about what I had in the bank. Needless to say I could not afford an X-ray or an MRI. The doctor grudgingly gave me a prescription for 15 Vicodin and some Flexeril. This was after he lectured me on the dangers of becoming dependent on painkillers. Thanks, Nancy Reagan.

Leaving the hospital, I realized paying my bills for that night was the least of my worries, compared to trying to afford the health care that I would need going forward. Back in college I had access to affordable health care at the campus clinic. Worried you picked up the clap after having unprotected sex behind a dumpster during a night of binge drinking? Worry no more with free STD testing and treatment.

My first job after college was with Barnes & Noble. That job had an excellent benefits package. Aside from 401k matching, generous employee discounts, and seasonal bonuses, Barnes & Noble’s United Healthcare managed plan provided full health and dental for $9.95 a week. The plan actually covered everything and the deductibles were quite low.

After Barnes & Noble, I managed a small independent coffee house in an artist studio complex. The developers who I worked for—despite being 1%ers—actually cared about their employees and provided generous health coverage. The plan was with Blue Cross and cost a bit more than my previous plan. But it was still quite good.

About that time, at 27, I suffered the first serious illness of my adult life. I caught Mono from my girlfriend’s kid and was bed ridden for a month. My testicles swelled up to the size of large lemons and my lymph nodes expanded to the size of golf balls. After extensive testing, my doctor discovered that I had almost no testosterone in my blood. Apparently the Mono had damaged my glandular system.

The doctor said it was no big deal; I simply had to start hormone replacement therapy. Testosterone, he explained, was quite expensive due to government regulations that made it a controlled substance in an effort to keep the drug out of the hands of bodybuilders. In the previous few years the price had risen from $50 to almost $300 for a month’s supply. Of course I only had to pay my $35 prescription drug deductible. I started hormone replacement. But in the back of my mind was a nagging fear: What happens when I change jobs, and potentially lose my insurance? I won’t be able to afford this medication. I will have a pre-existing condition and may not be insurable.

For my next two jobs I lied about my pre-existing condition in order to qualify for insurance. The companies never caught the error. But in 2008 I lost my job managing an art supply store in San Diego and with it, I lost my insurance. Fortunately, Tijuana was a short drive away. I soon discovered that my medication was a quarter the price south of the border. I wasn’t the only drug tourist. Many elderly and uninsured people visited Mexico to buy the life saving drugs they could not afford in their own country.

Back to the car accident and my move to Jackson. I was running low on all my medication and Jackson is a little too far from either Mexico or Canada to make a day trip. So I reluctantly made and appointment with a physician recommended by a friend who we will refer to as Doctor No. 1.

Doctor No. 1 looked me up and down the same way a cop examines a suspect. There was a decided lack of sympathy in his cross-examination. He would not give me a prescription for testosterone based on the fact that I was already taking it; I needed a full batch of tests and blood work.  In my opinion, I’d had expensive blood work only six months before. I was already on replacement therapy.

The primary reason for my visit was my periodic back pain. Doctor No. 1 told me, “Narcotics are not effective for the treatment of nerve and back pain.” I have a feeling that had I been a little old lady, I would have walked out of the doctor’s office with a bottle of pills. Instead—because I have tattoos—I got treated like I was a junkie. Dr. No. 1 refused to give me Vicodin or muscle relaxers without an MRI. But I did not have insurance or $1500 for an MRI. And, so he refused to prescribe me anything.

I left the office with no drugs and a bill for $350.00. This was after a 15-minute office visit. I never paid the bill. The letters from the doctor’s office and the collection agency started showing up with loathsome regularity. I finally wrote the agency and the doctor back. I told the doctor that, because he did nothing, I was not paying for the visit. I explained that he was a disgrace to the Hippocratic Oath by refusing treatment to a person in pain. I told the collection agency that since I already owed Bank of America and Wachovia a bunch of money they could get in line. I also gave the collection agency advice on engaging in self-induced sexual relations. The collection notices stopped.

I started ordering my testosterone online from a company in Germany and took half doses. It cost me $150. That was half the price it would cost me at a local pharmacy. Every time I went to the post office to pick up the package there was a sinking feeling in the pit of my stomach. Would this be the time the customs inspectors opened the package? But I got away with it for more than a year before FDA confiscated my shipment and sent me a notice concerning importation of controlled substances.

 So I scheduled an appointment with Doctor No. 2, who charges an affordable rate to clients without insurance. It is closer to the patient co-payment than the amount billed to the insurance company. It’s only fair, but few doctors are willing to cut the uninsured a break. Doctor No. 2 is in high demand and his waiting room is always full. Obviously, I’m not going to share his name because I don’t want to be waiting even longer to see my doctor.

Despite government, insurance, drug companies, and lawyers making a colossal mess of the health care system, there are still good doctors out there. Doctor No. 2 is one of those few remaining doctors. He is a relic of a bygone era. For starters, Doctor No. 2 did not assume I was faking back pain in order to get a prescription for painkillers and muscle relaxers. He also referred me to a local pharmacy, which compounds medications, meaning it mixes the medicine at the pharmacy. The result of the pharmacy change meant my cost for testosterone went from almost $300 a month to $150 (for a three-month supply). So, if the medication can be made that cheaply, aren’t the drug companies effectively taking me for $3,000 a year? Even cocaine does not have that kind of a profit margin.

Aside from private physicians, another service for the uninsured is Teton County Pubic Health, which, among other services, provides low-cost immunizations and free STD testing. Some people may think that’s a waste of taxpayer money. But it is in the public interest to stop the spread of infectious disease. Nothing beats the peace of mind that comes from passing an HIV test.

I’m sure many people reading this are thinking that I should go get a job to pay for my own health care. Well, most jobs don’t really provide health care anymore. And it’s not like I don’t work, writing for this paper and making art is a full-time job.
But I figure since I don’t really make very much money, I should be able to qualify for Medicaid. That’s why it’s there, right; for poor people who can’t afford health care? I was poor enough to qualify for Medicaid. But there was a problem. Most of the benefits are restricted to mothers, children, the disabled and people with dependents. The assumption: if you’re a man, then you can pay for your health care. Oh, and don’t miss football tryouts.

I did qualify for Medicaid prescription drug assistance. This program allows me to pay a deductible for prescriptions, and the government pays the rest. It works the same as with a private insurance company. Having the drugs I need, and being able to afford them is a major relief. But it unfortunately does not address some of the root causes of many of my health issues. For example, I still need an MRI to get to the bottom of my problems.

Since the hospital is taxpayer-funded, it provides assistance to low-income residents. I’ve applied to get assistance for an MRI and I’m currently waiting for all my paperwork to get processed to find out exactly how much an MRI on a sliding scale is going to cost me. But that isn’t the only problem. Since I’ve worked with welding and grinding equipment, I also need an X-ray in case there is metal lodged in my face.

Of course, after I get the MRI, I’ll finally know exactly what’s wrong with me.  But even then I’ll just be back in the same boat of not being able to afford treatment. I am also not qualifying for health insurance now due to a pre-existing condition. I’m sure there are lots of people who don’t see a problem with the self-employed and low-income residents not being able to afford health care. I just hope they are intellectually consistent and don’t go around feeding elk all winter while bitching about people on food stamps, or paying for drug sniffing dogs to have hip replacements when there are myriad people in Jackson who work full-time jobs and still can’t afford an operation, much less a doctor’s visit.

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