Luis (not his real name) is in his 50’s. He got Hepatitis C and now badly needs a liver transplant. His HMO has been jacking him around, either intentionally or through incompetence. It took a month, and he’s continually weakening, just to see the specialist to try to get on the waiting list for a transplant. Bizarrely, it took them quite a while to determine that he has diabetes and high blood pressure too. Hello? High blood pressure can be diagnosed in three minutes. What IS the problem here?
His former employer (Luis is too weak to work now) wonders why the HMO keeps shuttling him around, doing more tests, when it’s obvious his health is failing. It appears the American health care system is so broken that even those with insurance can’t always get the help they need.
Luis and his wife recently had to sell everything and move in with one of their daughters because they can’t afford rent now that he can’t work. He’s getting forgetful, apparently the toxins from a damaged liver can and do get into the brain. Plus his eyes and various organs may be starting to go.
The US health care system is broken. In a civilized country, Luis would get the health care he needs, and get it quickly. Now, apparently, they’re just letting him die.
Oh yeah, he’s Latino, and thirty five years ago was a gangbanger and still has the tattoos. Maybe that’s why the HMO keeps ignoring him – just another Hispanic gang member, screw him. But he hasn’t been that for decades, and even if he was, it says something despicable about US health care that, even though he has insurance, the HMO fiddles whiles his health disintegrates.
And it’s not just trying to get help from private and group insurers, but if you manage to get help through public assistance because you’ve lost your insurance during a long illness then you’re stuck in another Catch-22.
In my case, I lost my insurance about 6 months before I was diagnosed with ESLD. I needed a transplant and was only approved for public assistance health care about 3 months before I was critical. I received a liver transplant but my meds and care run about $3 to $4K each month. That’s pretty much for the rest of my life. No way can I afford that out of pocket.
Of course, I’m doing great, but I will never get private or group insurance that will cover my meds and my follow-up care. I’m caught between a rock and a hard place. Want to return to working but if I do I lose my insurance and the employer insurance won’t cover me.
Truly, we have a broken system when people who are desperately ill can’t get decent care (as your story points out) and those who managed to get care and can return to the workforce can’t do it because the refusal of HMO’s and PPO’s to cover them would mean they would die from lack of care (while paying for insurance they can’t use).
Excellent story!
[…] This is an excellent short story about the struggles of a man to get evaluated for transplant and the roadblocks thrown up by insurers who are more concerned with their profit margin than human life. Luis (not his real name) is in his 50’s. He got Hepatitis C and now badly needs a liver transplant. His HMO has been jacking him around, either intentionally or through incompetence. It took a month, and he’s continually weakening, just to see the specialist to try to get on the waiting list for a transplant. Luis. Our health care is broken […]
Some people with Hep C got it from blood transfusions. There are also documented cases where people got it from sharing a nose straw (snorting drugs). But the fact is that most people with HCV got it from shooting up. Like HIV, it is a disease of the unwanted. Unlike HIV, HCV has an average onset of 20 years. If we live long enough to get diagnosed, chances are we’ve gotten clean. But the HMO sees a druggie, so why bother? Especially when treament can cost thousands per month!
BTW, I got my treatments through Kaiser Permanente. Not only did they ENCOURAGE me to undergo treatment, all those expensive prescriptions cost me only $125 per month. My doctor (who happened to be black) was awesome (and I generally don’t like doctors). I’m not alone in this experience: several of my friends were treated quite well by Kaiser, considering the cost of treatment and the pariah status of many HCV sufferers. And there were plenty of minorities in the waiting room.
Not everyone has access to Kaiser. I no longer do. And though they’re the ones everyone loves to hate, my experience is that they do a far better job of health care than the open market.
It’s just so sad and so wrong. A 55 year old man who has been gainfully employed for years, with three kids and eight grandkids, who was a valued and trusted employee, has to sell everything and move in with a daughter because our health care system is so broken that help isn’t there when it’s needed.
This is also how many foreclosures happen. Someone gets ill and can no longer work…
We need a rational form of national health care. Every other western democracy has one.
When were any of you told that life would be FAIR?
There aren’t enough organs to go around anyway. Most will die waiting for a liver transplant – 2/3 in fact. You are judged by the transplant team on EVERY aspect of your life. They are the *gods* and our lives are in their hands….. along with the MELD score that isn’t the fairest of systems either. Do you really think socialized medicine will make this better? People in countries with socialized medicine report waiting 3 to 4 years for elective surgeries and months to years for doc appt.s. They are no guarantees for anyone in this life. We are born and then we work our way towards death on God’s time table and through the trials and tribulations that God wants us to endure for whatever reason. I am sorry to read about Luis. That has happened to many of my friends. I am glad to read that Buck was one of the lucky ones. I have lost many friends while waiting for transplants and have many friends that have been sucessful. It is another coin toss in the game of life.
PS – I do have Hep C too and have been turned down at three transplant centers because I also have emphysema. Just didn’t want you to think I wasn’t sympathetic or aware of what the problems are because I AM ! My Hep C came from working in the medical field and YES… we have a horrible stigma placed on us the moment we walk into a doc’s office! So let’s get out there and CHANGE THAT!