I’ve experienced 4 different versions of health care since learning I had Type I back in 1994. I was an active duty soldier then and not one thin dime came out of my pocket. On that day, I saw an LPN in my unit and gave him my symptoms. He sent me next door to see a PA-C, who in turn sent me to a GP, who then forwarded me to see an Endocrinologist who’s been treating George and Barbara Bush. All of that, plus meeting a CDE and nutirtionist within the space of 4 hours. They even had a system (way back then) where my doctor at Walter Reed Medical Center could enter a prescription in a computer and I’d pick it up on my way out of the hospital. I’ve held every instance of care up to that standard.
I was discharged from the Army 9 months later and was put into the Veterans Affairs health care system. More about that later.
A couple of years later I had private health insurance when I worked for the federal government. As a condition for having access to federal employees, insurers were not allowed to prohibit coverage for pre-existing conditions. I was quite happy with it, and the nominal copays for doctor visits and medicine of $20-25 did not seem unreasonable to me.
When I left the government and went to work in the private sector, my new insurance also covered my diabetes. After a few months, my PCP opted out and started a ‘concierge’ practice. He set it up so that patients paid $1,000 per year for unlimited coverage, including a full and very comprehensive annual exam. He limited his practice to 200 patients and guaranteed that each appointment would last not less than 30 minutes. I was completely satisfied not only with his care, but more importantly with the impression that his goal was NOT to get to the next patient as soon as possible. If I had the resources, I’d go back to him in a heartbeat. I left his care when I became too ill to work and lost my job. At that point I went back to the VA system.
In the current health care debate, Veterans Health care is held up as a model of efficiency, particularly with respect to computerized health records. My experience with them has been pretty hit or miss.
On the plus side, some of the physicians (particularly in CT and NC) are affiliated with top shelf medical schools such as Yale and Duke. They have been purely fantastic. Most are interns in training, although they are closely supervised by faculty of both. ON the other hand, some of the nursing staff and administrators are quite poor since they are not as accountable as their peers in the private sector. In addition, prescription refills can be requested online and are mailed for free. Copays are required for meds not required to treat conditions that are not associated with the disabilities identified by the VA as connected with the conditions I was discharged for.
On the negative side, there is no choice in selecting any doctors. You get who they give you. The automated record system is not as seemless as some believe. When I moved from CT to NC I thought that I’d pick up my treatment where I’d left off. Nope. In fact, I had to wait 3 months to get an appointment to review my records with an RN, and another 3 months for a PCP assignment and appointment. PCP appointments typically involve a 2 month wait, and specialist appointments take 3 months.
It is worth noting that I had a continuous glucose monitor when I had private insurance, with the insurer picking up the cost. Under the VA, they will notr cover it, nor provide any formal assistance. If I want to get back on Dexcom, I’ll have to find a private doctor to write the scrip, and pay for everything out of pocket. Given that it is life of death for me due to hypoglycemia unawareness, I have little choice.
I hope this is informative.
