Sunday, April 25, 2010

The thongue thinjury


Thi'm thalking thike thith now becauth I thurt my thod thamn thongue.

I was a minute into a two vs. two pickup basketball game when one of my opponents—swinging around to take a jump shot—delivered an uppercut to my chin with his elbow. I dropped to the floor, capturing the spit and blood that dribbled from my mouth with cupped palms.

I fled to the bathroom to assess the damage. Both the top and bottom of my tongue—imprinted with teeth marks—were oozing blood profusely.

I consider myself a fairly tough person. I’ve had my share of cuts, bruises, and broken bones and I’ve dealt with them—as my father taught me—“like a man.” During my freshman year of high school, my coach popped me a fly ball at baseball practice. Transfixed with the ball’s rotating red laces and graceful earthward arc, I forgot about catching it and let it land on my right eye—an injury that would require eight stitches. Once I chased my little brother who had been impudently masticating his food (my biggest pet peeve) to get a rise out of me. We scuffled in his room, where I crashed my knee through a drinking glass, requiring another six stitches. On a power play in a game of hockey, I slid feet-first into the boards, snapping my ankle.

My reaction to each of these injuries was different than the reaction to my most minor injury today. I felt pain then. Now I just feel anxiety. This is because I don’t have health insurance.

The uppercut was accidental and the guy who nailed me was apologetic, but I was frustrated and told them, with a mouth full of blood, “Thigh gotha go. Thi’m theeding theal thad.”

I spent the rest of the day in discomfort. I quickly tired out rarely-used facial muscles because I couldn’t let the tip of my tongue touch my teeth. It hurt when I exposed it to the air so I inhaled and exhaled through one half-plugged nostril. The thought of chewing dry food made me wince. I bought some yogurt and got worried when I couldn’t taste the French Vanilla flavoring. I figured that I'd irreparably damaged my taste buds before realizing I accidentally bought the “Plain” variety.

Ever since I graduated from college four years ago I’ve been one of the 46 million Americans without health insurance (except for a six-month period when I worked for AmeriCorps). I didn’t even get insurance as a ranger—easily one of the more danger-filled professions.

Because I couldn’t justify paying the ludicrous monthly rates for a service I could hardly afford and would probably never use, I decided to take my chances and go without health insurance. And to my good fortune, I’ve yet to have to visit a doctor.

But these days all my injuries—large and small—cause anxiety. A small bump on the back of my head. A sore knee. A pulled muscle. Could it be something more? What if I need surgery? Have I taken my cheapness too far if I consider removing my own appendix?

To get a doctor to even look at my tongue would probably cost at least $100. To get her to actually do anything about it would cost me immeasurably more. It’s all so discomfiting because an actual injury would ruin my loan-free-college-degree experiment and thrust me back into the world of debt from which I worked so hard to escape.

My friend Wally tore his ACL in a pickup football game. My friend John—who's maybe the most healthy-minded person I know—has been diagnosed with three types of cancer. Luckily, they had insurance, but if I got cancer, I’d either die or have to spend a good chunk of my life—perhaps all of it—paying off medical bills. To be honest, I’m not sure which I’d choose.

While my health-related anxieties are in large part due to my lack of coverage, I think my paranoia has as much to do with the influence of my mother, whose training as a nurse has somehow qualified her to make the most outrageous and whimsical medical evaluations. Last week on the phone, after a singular cough, she diagnosed me with bronchitis with a surety that suggested she made her determination based on careful analysis and scientific objectivity. She’s told me I have impetigo—whatever that is—on at least three occasions. Upon observing the slightest bump or discoloration, she’d say, worriedly, “I hope you don’t have [insert vaguely-related disease].” I always responded mockingly.

“Keep laughing. You think I’m crazy. But you’ll see some day,” she'd say.

I’ve yet to see that day. Instead of making accurate diagnoses, my mother has merely transfused her strain of fear into me. Now I find myself making hasty diagnoses based on information gleaned from internet medical sites.

The French philosopher, Jean Jacques Rousseau, said, “Priests, doctors and philosophers unlearn us how to die.” The fear-infected “bourgeois” of his day invented superstitions and ways to try to conquer death. The same is true today. The fear of death causes a fixation with tomorrow and a forgetting of today.

Without sufficient funds or coverage, people have to find work to get an insurance plan. Not just any work. But the 40-hour-a-week kind from companies that are well-off and for-profit. And with work comes a home, home repairs, the filling of the home with stuff, the bills for the home and all its stuff, not to mention the back pains, sore feet, and a stationary, uninspiring, and vapid existence. In this country you have to sell your soul to pay for security.

"Drive away the doctors," Rousseau said. "You will not avoid death, but you will feel it only once, while they bring it every day into your troubled imagination; and their lying art, instead of prolonging your days, deprives you of the enjoyment of them… Suffer, die, or get well; but, above all, live until your last hour.”

With all our attention devoted to prolonging life—or in fantasizing about frolicking in pleasant-sounding afterlives—we oftentimes forget to live the lives we have.

I'd like to admit I'm fear-free, but I'm not. Health insurance is one of the few things I want and am willing to pay for (if it was reasonably priced). But if I can't have both a secure and a free life, I’ll thake thy thinjured thongue and thy thances thany thay.

13 comments:

Anonymous said...

Ken, your tongue will probably heal itself-- tongues usually do. It may be more painful 24-72 hours after the injury due to swelling, and then should slowly improve. Also, the taste will likely return, but it may take a while.

With the health insurance issue, you can buy high deductible insurance in your area for around $60-70 per month. You'd likely have a deductible of around $5000, meaning that if you had catastrophic problem (like appendicitis), you'd be on the hook for $5k, and the insurance would cover the rest. You'd be in debt again, for the $5k.

Your current situation is to take the risk and save the $60-70 per month. If you needed an emergency surgery, you'd probably have bills north of $50k to contend with. You could likely declare bankruptcy and have some, if not much, of the debt discharged, though it would impact your credit rating for 7 years. Also, many hospitals will adjust your bill based on your ability to pay-- there is paperwork to do, and you have to inquire about it, but for those who truly have no money sometimes bills will be written off.

Something to understand is that insurance doesn't ONLY mean that someone else will pay some of your bill, it also means that the insurance company has already negotiated discounts with the hospital and doctors, and that by having insurance you get those discounts. In my practice an uninsured patient can try to negotiate with me, and may be successful, but most insured patients will already have negotiated 35-50% off of my regular fees. No one gets more than 50% off, but I can choose how hard I try to collect unpaid fees, and how long I allow people to pay off the debt.

Lastly your county or state may partially fund a hospital in your area. Sometimes the county hospital offers its own health insurance plan, with rates that vary based on your income. Again, there is paperwork, and you have to hunt these things down-- most people don't even know these things exist. If you spend some time researching health care options for the indigent in your community you can find things like this.

My brother is in your situation, and he too has chosen the uninsured option. I was uninsured during medical school too-- I didn't spring from the womb knowing the info above.

Last bit of advice-- do your best to take care of your teeth. I'm sure you don't have much regular dental care. I didn't until about a year ago. I didn't floss as much as I should, and I probably won't be taking my teeth with me to the grave.

Surgeon

Josh said...

I love that you recall your hockey injury was on a powerplay.

I just remember that you skated off the ice...

Anonymous said...

I have three individuals in my immediate family that are medical professionals and they are in fact able to diagnose all manner of illness over the phone, along with proper medications and therapy. I try to never get in a conversation that sounds like it may be leaning toward any possible medical problem. The "on-line medical diagnosis" is akin to reading your horoscope....you can read into it whatever you want. Hope you are feeling better...looks really nasty.

Heb

Mike Troy said...

Heed the surgeon. I have a high deductible plan as he mentioned without the "need" for an employer. Mine is more but I'm older than you. Also, since finding flossers about two or three years ago and use them after every meal - no illnesses.

Ken said...

Surgeon--Some sagely advice. Thank you. I was vaguely familiar with the $60-70 deal, but never had sufficient funds to pay that until about this past fall. I may give it a try but times are getting tight again. The tongue is doing much better. Scabbed over pretty good. It's more annoying than it is painful. Teeth are another issue.. I had a badly chipped tooth repaired in winter for $135. It turns out I chipped another one in the basketball accident. I floss and brush, but having no dental coverage worries me as much as having no health insurance. Thanks again--advice is appreciated.

Josh--Indeed, I remember that day pretty vividly. Your dad carrying my bag; some strange UFO-like lights out in a field. Skating off wasn't that bad if my memory doesn't delude me.

Heb--Horoscope, indeed. I think I made myself believe I tore my ACL based on some very general descriptions.

Mike-- Never heard of a flosser till you mentioned it. I'll think about it. I floss maybe once or twice a week; perhaps I should increase the frequency.

Mike said...

Ken,

Like the surgeon says. Even if you had a catastrophic $50k medical bill, there's always bankruptcy. While its moral implications are for each person to deal with on his own in his way; it's financial implications, particularly for someone in your situation with limited assets and savings, pretty much means you could wipe out any (non student-loan) debt just about as easily as you took it on. Sure, there's the 7-year credit-rating implication, but for someone who never wants debt in his life ever again, who cares?

And if you do have any savings you'd want to protect you can throw it into a Roth IRA and it can't be touched by a bankruptcy. So I wouldn't lose too much sleep over the idea of having to pay off a $150k cancer bill.

Anonymous said...

Dental insurance isn't very good, anyway, there is usually a deductible, it pays a small percentage of the bills and then stops at a low annual limit.

The catastrophic insurance is a good idea, though.

VJP said...

Great entry.

Groth tongue though, and you didn't menthion no kithing for you for awhile.
Viv

Anonymous said...

Doesn't Duke have an on-campus health clinic available to students? How is that they let you study there without insurance? My graduate school required proof of insurance in order to complete registration each semester.

Ken said...

Mike--I do have some trouble with looking upon bankruptcy as a way out of financial troubles. From what I know about declaring bankruptcy--which isn't a lot--I get the sense that some or all of one's debts are expunged depending on the debtor's assets and income. Relying on the government to bail me out just doesn't seem the best way to lead a fiscally-responsible life. When people aren't paying their debts back in full, someone else is going to have to. Looking upon institutions as a potential crutch seems like a surefire way to send an economy into chaos. Yet, I suppose we can make exceptions in regards to some health-related issues because our health care system is far from ideal and leaves many without sufficient options. I'd probably have sympathy for those who use bankruptcy in extreme situations. If it's a matter of life or death (or paying debt for an entire life) then, perhaps, bankruptcy is the only means to subsist in our society. However, if we justify making fiscally irresponsible decisions because we're cognizant of the safety net below us, then I'd probably take issue. Again, I'm not sure if I know what I'm talking about.

Anon--I'd add dental insurance to my list of wants. I've had my fair share of teeth issues and don't want to have to yank one out on my own if I can't afford the bill.

Viv--Tongue, except for some very discernible teeth marks, has improved significantly. There has been no kissing, fyi.

Anon--I believe Duke does have a clinic, but I'm not covered by the school. I was covered by my parents' plan up until I graduated from my undergraduate school in '06. I qualify to be covered under their plan when I'm in school and under age 26. Last spring semester my insurance actually reactivated for a couple months, but when I turned 26 this past summer I became uninsured again. From what I know, all grad programs here require or provide health insurance except the Liberal Studies department. I might be making this up, but I heard this somewhere. I'm not sure why this is. Maybe it's because our tuition is far more reasonable than other programs or maybe it's because us humanity students supposedly lack a utilitarian purpose and are thus more expendable. It's probably related to the former, or due to the fact that most Liberal Studies students have full time jobs and are likely covered by employers.

Anonymous said...

I may have missed this somewhere, but don't you qualify for Medicaid?

Ken said...

Anon-- to be honest, I've never looked into it.

obbop said...

Fifty-plus.

No job, at least partially due to horrid economy AND (hate to mention what appears to be an excuse but I am fifty-plus years old and considered by too many as an undesirable hire or unhireable!!!!)

Cost of cheapest self-paid insurance (would be paid with meager savings)....

$1,700 monthly.

Sniff.

But, as so many propaganda-spewing and brainwashed USA citizens spew:

The GREATEST health care system in the WORLD!!!!!!!!!!!

Also heard;

Then why do so many foreigners come to the USA for medical care?

Typical "logic" (ill-logic!!!) of the brainwashed majority or defenders of medical/health systems that provide immense wealth amounts to wealth-skimmers who do nothing to assist the sick or injured.

What a racket!!!!!!!!

Even Obama's plan/scheme did NOTHING to alleviate the multitude of extended paws raking in huge amounts of wealth that We, the People pay via excess health/medical costs.

But, it's the "American Way"!!!!!!

Love it or leave it.

Are you a Commie or something? (wait!!!!! that indoctrinatedly-learned froth is from a different era).

You DO support the troops, right?

It's for the children!!!!!!!!