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Please begin with an informative title:

For the last six weeks, I've been struggling with health issues.  And I have no insurance. So here's my story.  I set it down to give a firsthand account of an encounter with the US health care system. Some of the choices I made may have been good, some may not have been, but here they all are.

Intro

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First off, why do I not have insurance?  From 2002 to 2009, I worked for a local eyeglass-lens manufacturing company, in a division that made prescription lenses for scuba diving masks. My pay was $8.50 an hour, I got no benefits of any sort. Health insurance was an impossibility for me. Luckily, I have only rarely gotten sick ever since I was a teen--the last time I had to see a doctor was in 1988 for medical troubles related to a visit to Nicaragua. Since then, lack of insurance wasn't a problem because I didn't really need medical care anyway.

In 2007, I formed a little publishing company called Red and black Publishers, to reprint some books that were out of copyright and also to print some manuscripts of my own that I could not find a mainstream publisher for. I assumed it would merely bring me some extra spending money each month.  Instead, it did lots better than I expected--my income doubled and then tripled. By 2009 I was able to quit my day job and live on just my publishing income.  In 2010, approaching the age of 50, I began having annual checkups at the local care clinic, paying for them out of my pocket.  

Early this year, I looked into getting health insurance. After looking at plans and prices, I decided my best option was probably to get a high-deductible plan that would protect me in the case of something major, but would leave me to pay myself for routine things. Because of my age, though, the insurance companies would not even quote me a price until I had submitted a new physical to them. So I decided to wait until later this year to see if I could get anything better under the much-vaunted health insurance exchanges (which don't exist yet in Florida).

Hence, I was without insurance in April. When I developed a few instances of diarrhea, I didn't really think about it--I just presumed I had eaten something I shouldn't have. Looking back now, I can also see that I had a few instances of troublesome heartburn for the few weeks prior to that, which I didn't really think about at the time. But during the second week of April, I had four days in a row of diarrhea coupled with occasional vomiting. I went to the care clinic, was told to take Immodium for the diarrhea, and was given a prescription for an anti-nausea drug. It didn't really help me, and within a week I was severely sick, with regular diarrhea, vomiting, a feeling of being wrung out and listless. I seemed to be sick for 5-6 days, then feel better (never completely well though) for a day or two, only to have all the symptoms come back again. I was sleeping up to 15-16 hours a day. Finally after another two weeks of that, I couldn't take anymore, and early on a Saturday night I walked to the emergency room of the nearby hospital. I didn't know where else to go.

They took some blood and urine, did some tests, and told me they couldn't find what was wrong. They suspected it was GERD, possibly with an ulcer, and gave me some acid blockers and some stronger anti-nausea tablets, rehydrated me with an IV, told me to keep taking Immodium, and then sent me home. When I told them I had no insurance, they explained that the billing department had a sliding scale that would adjust my cost depending on my income.

They told me to follow up with a primary care doctor in 5-6 days, and the next Monday I went to a local primary care clinic and signed up with Dr Scutaru, making an appointment for that Friday.

The acid blockers seemed to work very well. Within four days the symptoms had been noticeably reduced. The diarrhea pretty much went away, the constant gurgling in my guts settled down. When I went to see Dr Scutaru on Friday, I told her I was feeling better, didn't have the worn-out feeling and was able to get up and walk around outside, but that I still had no appetite and some vomiting (usually in the morning when I woke up) and had to make myself eat things like jello, crackers and apple juice just to get some calories into me. All in all, I thought things were improving. She decided that there probably was no ulcer (I didn't have any pain anywhere during the whole time), but that it was likely GERD, and I would have to make lifestyle and diet changes to minimize the frequency and severity of the symptoms.  I left feeling pretty OK.

But that very evening things got worse for me.  I had a bout of very violent vomiting that lasted almost two hours. Not knowing what else to do or where else to go, I walked myself back to the emergency room.

I fully expected that they would do an endoscopy on me (a procedure where they put you under anesthesia and insert a small camera down your throat). I was surprised when they told me they COULDN'T do that: as an emergency room, the only things they could do were "emergency" things--their job was just to stabilize me, and if I need anything more than that, they would discharge me so I could go elsewhere for it. So they did more blood testing (because I had told them I had been to Africa recently, they added a malaria test), and once again couldn't find anything. They then explained that they had pretty much done all they could for me, and if the symptoms persisted, I would need to see a GI specialist for anything further. An endoscopy there, I was told, would cost around $3,000.  

When I got the bill for the two emergency room visits, the total was over $5000, but because I was uninsured, they had reduced it to roughly $2500. They told me I had 90 days to pay it, or it would go to Collections--but if I could not pay it in 90 days, I could arrange with an outside agent called MedMax to set up a payment plan. So I was able to make arrangements to pay it off over time.  (And if I had actually purchased the insurance I was looking at back in February, I would have ended up paying all that cost anyway as a deductible.)

This was on a Friday night. By Monday morning (this past Monday), I was feeling better again, and decided to put off seeing the specialist until and unless the symptoms got bad again.  Partially this was simply because of economics-----if the emergency room had been able to do an endoscopy, I could at least--being uninsured--have paid on a sliding scale and have arranged for payments over time to cover that cost. It was unlikely I could do that with a specialist. Also, as I learned more about GERD, I began to realize that there really is no effective cure for it anyway, and that an endoscopy would really not help any with the treatment--the only real treatment being dietary and lifestyle changes. So I decided not to see a specialist unless it became an absolute necessity.

Over the past four days, I began to feel better again. The morning vomiting mostly stopped, on Wednesday I felt well enough to eat an actual solid dinner, and yesterday I actually had a real lunch and a real dinner (turkey sandwiches) for the first time in weeks.

Today, though, it feels as if I am slipping backwards. While I felt pretty OK this morning and had another sandwich for lunch, by late afternoon I was beginning to feel nausea again, and had a bit of diarrhea for the first time in over a week. So here I am, hoping that my symptoms are not going to get worse again over the next few days. . .

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