We’re all healthy…until we’re not

On an unremarkable Sunday at the end of this summer, I woke up feeling crummy. I’d had a couple glasses of sangria the night before, which is unusual for me, so I figured I had a little hangover.  I’m definitely getting old if a couple drinks is all it takes to make me hungover, I thought, and dragged myself out of bed to get on with my day.

As the day went on, I felt better, almost normal.  But a little after 3 p.m., I started to feel discomfort in my lower left abdomen.  By four, that discomfort was turning into pain.  By 5:30, I was doubled over on the couch.  By six, I was shaking and I told my husband, “I think I have an ovarian cyst. I need to go to the emergency room.”

We called my parents, who arrived a few minutes later to watch the kids, and then my husband drove me to the hospital.

The hospital is less than a mile from my house but by the time I arrived, I could barely walk. While my husband parked the car, a kind gentleman helped me into the emergency room, where the staff took one look at me and whisked me into triage.  I began to vomit and my blood pressure was reading as low, so when my very worried husband arrived in the ER a moment later, the staff fetched a wheelchair for me and took me back into a room.

It wound up being a long several hours as the medical staff tried to figure out what was wrong with me.  But, after numerous tests, a shot of Zofran (to stop the vomiting), some IV fluids, a shot of morphine (I screamed when the doctor tried to palpate my abdomen), we finally had an answer.  It wasn’t an ovarian cyst.  It was diverticulitis.

Diverticulitis stems from a condition called diverticulosis.  Diverticulosis is when weak points in the large intestine bulge out into pockets called diverticula.  It’s a common condition, particularly in westerners (though mostly in people over the age of 50, which I am not).  Most people who have it will never know they have it because it causes them no problems.  But sometimes bacteria can become trapped in the diverticula, and the resulting infection is called diverticulitis.

Let me tell you, it’s a bitch.  As I discovered, it’s incredibly painful.  I’ve given birth without anesthetic and the pain level was comparable.  But diverticulitis can also be dangerous.  In some people, it can become chronic, resulting in abscesses, fistulas, intestinal blockages, and even ruptures in the wall of the intestine.  It can require surgery to remove chronically infected sections of the bowel, and in extreme cases it can lead to death.

That night in the ER, the doctors didn’t have a lot of information about what to expect for me, and a follow up with my GP didn’t give me much more insight.  The reality is that for all the extraordinary things medical technology can do, in many ways we’re still in the poking-things-with-sticks stage of exploration.  Why did I develop diverticulosis?  Unknown: probably some combination of genetics, the structure of my digestive system, and lifestyle.  Would I have a diverticulitis flare up again?  Unknown.  There are some best practices to follow but ulitmately it’s different for everyone.  My being only in my 30s means that I’m more likely to have an aggressive flare up again than if I were over 50.  There’s no cure for diverticulosis, so for the rest of my life another flare up will be a risk.

The ER sent me home with a prescription for two strong antibiotics and an anti-emetic.  The antibiotics made me feel really terrible for the next 10 days, but they took care of the diverticulitis, and I was able to go back to my regular life.  Since then I’ve remained flare up free but I can tell that this will always be my own personal Sword of Damocles.

If you’d talked to me the day before my guts turned on me, I’d have said I was a pretty healthy person.  I eat my veggies, I drink well less than the recommended maximum, I maintain a healthy weight and my blood pressure is usually perfect.  But conditions like this can lurk in seemingly healthy people, emerging to cause problems at inconvenient times and in inconvenient places.  Suddenly your whole conception of yourself has to shift a little–you might not be sick, exactly, but you’re certainly not an example of perfect physical health.

I’ve been thinking about the way that health crises like this emerge as the Affordable Care Act enrollment period approaches.  This year, the enrollment period will be only half the period that it has historically been, six weeks instead of 12.  The advertising budget has also been slashed literally 90%, so you’re less likely to see or hear advertisements reminding you that it’s time to sign up.  This will almost certainly have the Trump administration’s desired effect: fewer people signing up, an overall more expensive population insured, and higher premiums, all to the end goal of making the program less workable.  (And lest you think I’m just assuming the worst about the Trump administration, they’ve been fairly up front about how much they would like the law to fail).

Lots of healthy people will probably choose to go without health insurance.  After all, if your health care costs in an average year are close to zero, it’s hard to see the point in spending $60 or $100 or $200 a month on insurance, particularly if the insurance requires that you meet a $2,500 or $5,000 deductible before using it for anything more than preventive care.  It’s a lot of money, and I get that.

But some number of those healthy people will turn out to be healthy in the same way I was healthy: just not yet aware that they’re carrying around a ticking time bomb of sorts.  Not to be a Debbie Downer, but the reality is that we will all eventually get sick, the question is just when and how sick.  Going without insurance that you may be able to afford is ultimately betting your financial health that you won’t get sick this year.  That’s risky at best.

In the bad old days before the ACA, someone I know slipped on some ice and fractured his ankle.  He was uninsured at the time and the resulting surgery and aftercare put him nearly $60,000 in debt to the hospital.  Someone else I know let his insurance lapse in the breif period between jobs.  Two weeks before he was set to get health insurance through his new job, he had a heart attack.  The not-for-profit hospital that cared for him put a lein on the house he owned with his 80 year old mother, eventually requiring them to sell the house to discharge the debt.  Neither of these fellows expected to need that kind of care when they went without insurance, because we all think we’re pretty healthy (just like we all think we’re smarter than average, better than average drivers, and better looking than average).

The ACA has some massive problems.  It attempted to increase access to coverage without meaningful attempts at cost control.  In a country with a functional political system, the system would be tweaked, adjusted, even overhauled to correct problems that arose.  Instead, we’re stuck with the system we’ve got, at least for the foreseeable future.  And in this system, going without insurance is dangerous.

Without insurance, the ultrasound, CT scan, urinalysis, blood test, Zofran, morphine, fluids, doctor and nurse care, as well as the first dose of the antibiotics would have cost me thousands upon thousands of dollars.  With insurance, I still had to pay a copay, but that was manageable and left me to recover without the additional misery of wondering whether my financial future was in jeopardy.

If you don’t have insurance and want it, despite the press about how expensive it can be, many people qualify for subsidies through the ACA.  You can find out about your options by clicking here.  You have until December 15th to enroll, so don’t delay.  If you’re already enrolled in a plan, you should check and see what premiums your plan will charge in the new year and if you’re eligible for a plan with a better price before you’re automatically re-enrolled in your current plan.

And in the meantime, we should all be pressuring our representatives to stop lying about what is and is not possible to achieve in the health care system, and pressuring them to make adjustments to the program that will make it work better for the people who need it.  Which is to say, of course, all of us.

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