Tuesday, December 09, 2008

The Price of Health

By Kelly Jean Cogswell

Thursday, I bought a bathrobe and pajamas, packed a bag, and took the metro to the hospital where I handed over both my credit card and a check so they would accept my 59.2 kilos of flesh to be depilated, disinfected, knocked unconscious, pierced with holes, de-cysted, and released.

Even paying full price, it was a bargain by American standards. In Paris, doctors will make a house call for about $85. A visit to a gynecological clinic costs $40. A sonogram is about $100. And a prescription of Xanax runs three bucks. Laparoscopic surgery with three nights in the hospital is a mere $5,800, surgeons' fees and morphine included. In New York, that'd barely cover a bed pan.

For most French folks, the government covers two-thirds of health care costs, and they often have a supplementary insurance that gets the rest. For the poor and unemployed, the state picks up the whole tab. The best thing is, French doctors are competent. Even in the public sphere. The hospital I was going to was more highly rated than the private clinic a friend of mine used that cost an extra 600 bucks a day.

I checked it out, did price comparisons. That's the American way. To focus on dollars and cysts. When the radiologist said I had a big clump in an ovary and needed an MRI, I freaked out more about the cost and whether my insurance would reimburse me than that my body was growing strange fruit. After all, it's medical bills that metastasize into crippling debt. And money that shapes our experience of medicine, even health.

Health for the rich means well-being, every part of the body on track, clear skin, good feet, all systems go. The poor are often grateful just for mobility and generally being intact. You can have rotten teeth, and a bad back, and still proclaim when you lose your job, "At least I have my health."

We don't have the time or money for more. In the New York public health system, you wait months for appointments, then wait for hours and days in waiting rooms with all the other marginal folks, new immigrants, working poor, the crazies who apparently don't deserve better. And rarely get it.

The doctors seem to hate us, and secretaries sneer behind our backs. Bring a list of questions to an appointment, you'll be dismissed as a hypochondriac. Admit a pelvic exam was painful, maybe the nurse practitioner will suggest early childhood abuse and abuse you verbally if you dissent. Wake in the middle of a colonoscopy, they'll continue without anesthesia because they're too incompetent to deal with dropping blood pressure, can't give you more drugs, and pleas to stop, stop, stop from a Medicaid patient are like whispers in deaf ears.

Good luck with that universal health care thing. Access isn't enough for anything resembling care. For that, the enormous gap between the salaries of Madison Avenue doctors and the ones at public clinics has to end, along with segregation of patients. In fact, class and race themselves would probably have to go, along with the culture of scorn as deeply rooted in American medicine as shame and fury are buried in people like me.

Inequality's in the very nature of the medical beast. On the one side, there's the patient as supplicant, asking for help. On the other, some white-coated god free to give or withhold. And charge you for it either way. When money or race or sex or sexual identity is added to the picture, the balance is increasingly skewed.

I'm wary, even in Paris, where the care is good and cost is less a factor. Handing over my body still feels like a kind of fourth dimension prostitution in which I lose both my money and my flesh. All I own is a computer, the clothes on my back, and everything under them until you arrive at my beating heart. Now, even that's yours.

And laying there, a day later, with my dragon breath and scars and IV drip, I was tempted to tell her so. Explain to the young surgeon smiling shyly at the American patient all the effort I've put into protecting this shell. All the male hands on my female ass in high school that I had to shove away. The bottles dodged from cars because I was a dyke and on the street. These sudden waves of hate in the media that sweep you off your feet. The walls I've built against what homophobes do to you in their brains. What doctors have done in the flesh.

How I defend what I want to relinquish. How I want to be saved. And though she had done this thing, cut a miraculous door into a world I kept for myself, and pulled out death, I needed more.

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