The Poorest Rich Man

Navigating American healthcare with a credit card

I Don’t Care Anymore

I am not an activist, a political writer, or a think tank. I am a woman who owns a small business and supports farming initiatives.

Friday evening, I had a health scare and it landed me in an emergency room.

I’ll get into that more in just a bit, but in the aftermath, I was at a follow-up appointment with my regular doctor who I’ve been with most of my adult life. He’s brilliant and nervous and Mediterranean. He took me on fresh out of med school and he has a habit of worrying enough for me that I don’t need to worry for myself.

“I’m writing about the medical world this week,” I said.

“Would you like to interview me?”

“I would, but wouldn’t that open a can of worms for you?”

“I really don’t care anymore,” he said.

And that was the second time this week I heard someone sum their feelings up about the medical world by stating a complete absence of feeling. I’m quoting him here because he basically gave me everything I needed in one line.

We hear a lot of facts and figures about the health industry in America. We hear horror stories, mostly when families must raise private funds to pay for medical emergencies. My story is boring, but it’s my story. And people across the nation are living it every day.

This is a boring, normal healthcare story. Hear me out.

Photo by Kelly Sikkema on Unsplash

Assumptions and Gatekeeping

When I wrote a piece in 2021 about pain in gynecology, it was fueled by a movement in the UK where women brought their experiences to the halls of Parliament. My story gained a little traction in the US and my surgeon shared it with her residents. I’d spent too much money finding a skilled surgeon with answers, so I waited until the end of my recovery to share it with her because if she dropped me as a patient before she finished her work, I had zero options. She thanked me as I handed her a printed copy, and said it was important for medical staff to understand the patient’s perspective.

A few years prior, a professional providing essential services to my farm noted a small detail on my social media that placed us on ideologically opposing ends of the political spectrum. This person almost dropped me as a client, citing their assumptions. We had never spoken about political concerns face to face. Because my interest went one way and his went another, at the whim of ticky boxes, he was ready to ditch years of positive professional interaction.

I am terrified of what assumptions do to our relationships, even more so with the temperature of the political waters in the US right now. And I say all this because today I’m talking about my personal experiences with the American healthcare system and I ask you to hear my words beyond what they mean to you politically. I ask you to hear them as one human speaking to another, traveling in the same ship that is carrying us all.

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In the middle of last week’s Subscriber Gathering, I had to end the call early because it felt like I was having a heart attack. I’ve lost numerous family members to cardiac events so the signals are not lost on me. And yes, I know the difference between a heart event and a panic attack. You’d be amazed at how many people don’t seek treatment because they’re afraid of being told their symptoms are all in their heads and how many times I’ve had legitimate physical concerns overlooked because anxiety is listed on my health record.

What I’m focusing on today is my personal reluctance to seek treatment — and it has nothing to do with being labeled crazy. I own that tag and wear it proudly with my pearls and overalls.

My ankles had been swollen the week before. I’d had mild chest pain for five days, and I had a first available appointment scheduled with my regular doctor in the coming week that I made the moment I noticed puffy ankles.

As I process my decisions leading up to the moment I ended the Zoom call early in a panic and called an ambulance, I can see my reasons as clearly as a script printed on a piece of paper and every single one of them hinges on — I did not want to waste money.

I knew that as soon as I stepped into the pipeline of diagnostics, I would lose control of my bank account. I’m a financial educator. I get off on accounting. I love spreadsheets. Unlike so many people, I’m lucky to have inherited a healthy relationship with money thanks to my grandfather (he’ll be making another appearance in just a bit). But even so, my hesitation to seek earlier treatment came down to my resistance to spending money.

I’m lucky for many reasons.

• I have health insurance.

• I graduated from a private college with zero debt because poetry afforded me scholarships (weird, I know).

• I do not live alone and have access to transportation. And I have a great community of chosen family.

• I have cash in savings so I have the option of choosing the airline points when I hand over a credit card for an emergency room co-pay (and can do the same when the bills for the ambulance and specialists begin slouching their way to me).

• I live in an area of the country with many healthcare options.

• I am immensely privileged to live life on my own terms and to work a job that I love that keeps my body moving while utilizing my creativity and allowing me to daily expand my vision.

Let me qualify number one — I have health insurance.

Before the Affordable Care Act, my work as a horse trainer and previous history of being treated for anxiety made me unable to purchase a normal health insurance policy. I paid $700 a month for speciality insurance underwritten for circus performers and this policy was major medical only, meaning that it would pay a portion of the cost of catastrophic medical events once I had reached an astronomical deductible. It did not pay for doctor’s visits or prescription drugs.

Before universal healthcare insurance coverage without the exclusion of pre-existing conditions was available I would have done anything — and I mean anything — to have the security of coverage. Beg, borrow, steal — I was game. I begged my family to provide coverage on a corporate policy. They said no. I twice chose to get married because it opened up my health insurance options. I have dated people I didn’t care for because they showed the promise of being friends with benefits — actual benefits, like health insurance and disability coverage.

For a short while, I was able to obtain a disability policy that was unwritten by Lloyd’s as unique coverage. I paid my monthly fees for several years and never touched the benefits before it was canceled suddenly with no explanation. Some mysterious insurance guideline changed and I was deemed too risky with the pesky horses to manage.

The decade I spent securing worker’s compensation insurance for my farm in a state that does not require workers comp for agriculture, and therefore no company wants to offer coverage for a high-risk profession, while at the same time, federal guidelines insist on workers comp, is worth its own story.

A friend made a joke about having been treated for a blood clot and a heart condition but decided to give up before finding any definitive answers. “I don’t care. That’s how I do health care. I just don’t care,” he said.

I would hear those same words echoed by my doctor a few days later.

Photo by Owen Beard on Unsplash

My Internal Magic 8-Ball

The funny thing about my recent, short vacation to a bougie ER is that I had actually listened to my intuition a few hours before. I knew I had a visit lined up at my regular doctor the following week, but I’d had my ankles plumping up — they were already deflated — and this weird ache in my chest. I’d also woken up with periods of cold sweats that had nothing to do with the temperate rainforest I live in.

By mid-July in South Carolina, everything is plumped up, or stoved up, as my grandmother called it. Everything is hot and sweaty. But these sweats were different. And they were also different from my long familiar friend the hot flash.

I’d kept my schedule going throughout the day, but I was tired and chose to lie down for a minute in between sessions. As I lay there, I sank down deep into my consciousness and I asked myself: should I go to the hospital?

Yes. The answer came back.

Should I go right now?

No. The answer came back.

I taught more riding lessons and ate a snack in between my last walk around the barn and signing in to Zoom for our monthly Subscriber Gathering. The people joining me were all familiar faces and we immediately dove into topics like religion and permission to think.

I recorded the session but interestingly, the recording never completed. There’s no record that it ever happened. As I sat there, I remember watching the image of myself staring back at me from the computer screen as I pressed my hand against my chest. The mild pain bloomed into larger pain.

And then it was like an explosion of heat across my chest, up my body, through my throat. I couldn’t breathe. I couldn’t swallow.

I signed off fast and found my mother, naked, in the shower. I asked her to drive me to the hospital. She has never finished a shower so quickly.

But as I waited for her, the burst of heat that had dissipated flared up again. It stopped me in my tracks. The pain in my chest seized. We decided to call an ambulance.

This is going to be so expensive, I thought.

The medics hooked me up to machines and studied my heart. As one peered over the shoulder of the other, he tore a printout of my heart rhythms off the machine. “In this moment, you are not having a heart event, but it doesn’t mean that you haven’t had one or that you won’t be having another. We’ll just be giving you a ride if you go with us, so you could also have someone else drive you.” He studied me like we shared a secret.

“I should have someone else drive me,” I said.

“That’s a good answer.” He handed me the printout and told me to give it to the ER.

It was like finding a designer bag at a discount store, the way the system turns patients into consumers, the way the system reminds us that we need to be thrifty, that the choice is ours, that we need to shop around.

I’m grateful to the medic for his honesty, even if he couldn’t say it outright — have someone drive you. It will be cheaper.

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Barn Raising

Before I moved into the farm that I now call home, my grandfather and I were building a farm together. We had a builder lined up and my grandfather and I spent long, delicious afternoons arguing with each other about politics as we drove from listing to listing looking at land for sale. I am so incredibly thankful for the time we were able to spend together because we were both wired to only do things if we had a reason for doing them. Dreaming a farm into existence was a good reason.

My grandfather was an integral part of my ability to access horses and he took immense pride in it. He loved the natural world and was his true self when we were together in the wild. His public image was at odds with his heart. A career politician and entrepreneur who created radio networks that powered our region’s entrance to the digital age, in many ways, he lived his wildness vicariously through my love of horses.

He called me on a Saturday morning before I’d started teaching and we discussed a large tract of land that I could potentially long-term lease. But his details were off. He mixed up names and facts. His astute mind suddenly faltered.

I begged his wife to take him to the hospital.

After a few short, intense months of hospital stays and a brief period of at-home hospice care, he passed away from bone cancer.

His entire life was spent building businesses, saving and investing money, and finding ways to increase his wealth. As the attorney completed the inventory of his estate, the cash reserves were meager.

“Here we have an example of a poor, rich man,” the attorney said. After the hospital bills, there weren’t many liquid assets left.

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Priorities

My grandfather is just one example and he was lucky because he had the cash to spend. But I have stood beside family members who were not at the end of their lives as they lost everything to healthcare bills.

I work in an extraordinarily litigious industry and daily battle pressure from people to allow them to do more and to take more risks with horses while I know that they can potentially sue me if they overface themselves and are harmed.

As the emergency medic gave me options for getting to the hospital, he couldn’t speak his truth because he needed to save his ass.

• If you’re a horse person reading this, I get you. I think most of us have sacrificed our personal health to make sure our businesses and horses are covered.

• If you’re a friend from another country, I want to hear about your experiences with your healthcare system.

• And if you’re in the US I don’t think there is anyone who hasn’t had to navigate the system in some way. I don’t have answers. I just know that we need to do better.

Because the first question someone asks when they’re choosing to receive healthcare shouldn’t be — how am I going to afford this?

And I know I have the luxury of options. Very few do.

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Like a Drug Deal Gone Wrong

After my doctor commiserated with me in a misery of shared confusion with the health system he rapid-fire ordered three tests, all in different locations around the city. I had one hour to get to the first.

I sat in the parking lot before I entered the hospital and clicked through check-ins and co-pays on my phone. I noticed the hospital had made it super convenient for me to pay by saving the details of my airline credit card that I’d used to complete my purchase at the ER a few days before.

$170 - $170 - $170

It reminded me of when I was in college and I rented a massive, historic house with two great guys. We each had a floor to ourselves. Thrilled at the possibility of living off campus, we counted and re-counted our money in the front seat of my friend’s old diesel Mercedes. Throwing the money around, we looked like drug dealers.

I watched my airline points racking up.

I have super sexy veins. Baby medics in training like to use my arms for practice. They had forgotten to start an IV when I was in the ER and that caused its own comedy of errors, but the nurse checking me in for this procedure kept apologizing before the needle was out of the wrapper.

“Just stick me,” I said. “I don’t care.”

Late last night, feeling heavy and gross and out of sorts, I clicked on my emails and found that the procedure I’d had earlier was denied by my insurance company because my doctor didn’t get pre-authorization. That made sense. I’d barely had time to get to the appointment.

I have a new insurance policy this year — one with better hospital coverage — and I realized as I read the fine print in a panic-stricken daze that it does not cover CT scans or MRIs without prior authorization.

And I had another procedure lined up for this morning.

I almost canceled but instead, arrived for check-in with my writer fires blazing.

I asked a hospital liaison if my procedure had been approved. She complimented my hair and didn’t answer the question. When she realized I wasn’t moving from the lobby until she searched the computer, she ushered me to a room far away from other humans.

She continued with the compliments and was a textbook example of de-escalation, but did not answer my question.

“If your doctor ordered the procedure he knew the value was greater than insurance concerns,” she said.

“I’m a writer working on a story about the healthcare system,” I said.

Her tone changed and she immediately searched for — and found — authorization for the procedure I was about to have. I asked her to print a copy. She said she didn’t have access to a printer. I encouraged her to find one in another office. She, eventually, did.

As the technician later prepped me for the procedure she asked why I was there. “I don’t know anymore,” I said. And it was true. I was lost in the system.

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Stories Are Important — Share Yours

I know every single one of you living in the US has battled the medical system — if not for yourself, then for someone you love. I don’t think my experience is unique and that’s why I need to share mine with you.

Stories are immensely powerful. Telling our stories can be life-changing. As long as we sit back and quietly take the system as it is, nothing will change.

I’m joking when I say I don’t care. I do care. I care horrifically. I’m going to keep navigating the system and advocating for myself. I have advocated for strangers in hospitals as I’ve sat uselessly beside the beds of people I love.

But for everyone whose stories have been swallowed by conglomerates, we owe it to each other to tell ours. We owe it to the world to tell our stories without the politics, without the presumptions, and assumptions, and slants.

Think about where you go when you have a health question. We laugh about Dr. Google, but humans need to share experiences. Reddit and Quora exist because we navigate uncertainty through intertwined narratives.

Our words can literally move metaphorical mountains.

Use them.

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I’m processing the events of this week slowly as I go. If you’re a part of my daily life, I don’t have words to express what I’m feeling right now so don’t take it personally if I can’t talk. I will, eventually.

They’ve ruled out most of the big, scary problems but I still have tests and new doctors to see for the next couple of months. I’ll update you all as I have more information, but for now, I’m just trying to find words.

My in-person journaling workshop will meet on the porch this Friday evening. We’re going to be free-writing and letting the spirit lead us. But I’m postponing this month’s online workshop that was scheduled for Sunday.

For now, I’m going to tally my co-pays and sleep.

Love,
Kim

Kehena Beach, Puna District, Hawaii