Navigating the maze

To say I’d been excited about spending Halloween in the United States would be a gross understatement. From my childhood days of last minute but enthusiastic costume production (the witch-inspired bin liner springs to mind) to those awkward teenage years occupied by an unhealthy obsession with Buffy the Vampire slayer; it would be fair to say I had expectations of the American holiday and they were high.

As a busy week of patient interviews drew to a close and the end of October approached, I was enticed onto a plane bound for the sunny climes and palm-tree clad streets of Orange County with the promise of yet more pumpkins, costumed trick-or treaters by the dozens and the attraction I was most excitedly anticipating…the infamous corn maze.

I think my lovely hosts in Chico would agree that we hadn’t had a huge amount of luck thus far in tapping into the true spirit of the season. Spurred on by my foreign enthusiasm we had embarked on a search for an authentic pumpkin patch only the week before. Encouraged and delighted to find details of ‘Miracle Ranch’ Halloween attractions online, we’d made the journey out to the country, expecting the best, only to find three very sad looking pumpkins and not a huge amount else.

My hopes were high, therefore, that Southern California would deliver and it really did.

Finding support wherever I go...

I learnt a few things about myself that day at the pumpkin patch; I’m not too old to get a thrill from petting goats, I am quite partial to a root beer float and lastly and perhaps most disappointingly I am willing to pay over $5 to shake hands with a monkey.

The highlight of the day was, undoubtedly, the maze though I’m not sure Hannah would agree (pictured). The corn sides were tall, the turns many and the ends for the most part dead. Although the sun was shining and there didn’t seem to be any immediate danger, our failure to find the final clue and exit the maze did bring about a sort of pleasant panic. Needless to say, neither of us would be volunteering for the ‘After hours’ haunted encore; that is unless we didn’t make it out alive before nightfall…

The story serves as a useful parallel to the other subject on my mind over the weekend (a bit of a clumsy parallel but bear with me): the convoluted maze that can be the American healthcare system.

I am trying my hardest to navigate it and with expert help I am getting there but the fact that I am by no means alone in my confusion is becoming increasingly apparent the more people I speak to.

I’m here to immerse myself in the community whilst exploring peoples’ experiences of healthcare and I’m learning, in this place at least, these two things very often go hand in hand. Our health is something that connects us all, an aspect of life we will all have to consider at some point. In the UK, we will likely consider it when we have to but here in the States the thought and system navigation required not only when you become ill but in the preparation of such an event can be arduous and for some, overwhelming.

Perhaps for that reason, the topic of healthcare is often at the forefront of peoples’ minds and conversation and it is through casual chats over the last few weeks as much as formal interviews that I’ve come to hear about this confusion felt by so many.

For those who aren't familiar with it, below is a very brief summary of the American healthcare options kindly explained to me by my supervising GP here:

(1)MedicAid (Medi-Cal in California) - free, for those of lower income.

(2) Veterans Administration – provides healthcare for military veterans who qualify

(3) Private Insurance- Can be obtained:

(a) Individually

(b) From your Employer

(4) Medicare- Government program for the over 65s and chronic disabled who qualify

(5) Cash

In list form it appears quite straightforward, however I am yet to meet a patient who is not baffled by at least one aspect of the care they receive. I have in my possession, in fact, multiple medical bills donated to me as examples of just how complicated the process is; not one of the bill-holders could fully explain their contents or where each figure came from. These are not unintelligent people. Indeed along with the explanation above, I was informed that despite everyone in theory having access to healthcare in some form, in practice the system is too complex and so many go without.

A weekend away gave me a chance to explore the subject not only with strangers but also with friends who were kind enough to voice their opinions on the subject and, as I’d experienced before, everyone had a tale to share.

These stories highlighted again not only the confusion felt by many but the huge divide in experience depending on the type of insurance people had. Some friends spoke of the responsibility they felt for making their own decisions as their very adequate insurance provided the opportunity to see many different specialists for a particular problem, an opportunity likely not readily available in the NHS.

However, for others the confusion took on a much more distressing nature as in the case of one couple I have befriended. Diagnosed with throat cancer ten years ago, the gentleman in question had lost his insurance plan as he became sick and unable to work. By terrible coincidence his wife was in a car accident at the same time, leaving her also unable to work for some time. They described the following months of desperate paperwork and phone calls as they tried to find a way for his treatment to be paid for. As seems often the case, this meant using all of their savings, many credit cards and the selling of their house. Whilst this in itself is heart-breaking, it was the gentleman’s comment that he didn’t think he would have survived without his wife advocating for him that really hit home, “ I was too sick to find my way through the system, without her I wouldn’t have made it. Not everyone is that lucky”.

In the case of his throat cancer, it is likely that there would be treatments available in the US that are not on the market for NHS users; there are obvious benefits to being in a private and competitive system. However, it’s a sobering thought that at a time of such vulnerability one might have to endure the extreme stress of working out how they were going to pay for it.

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