The doctor, when he arrives in the examination room, is brisk and professional. He does not waste time on chit-chat. That’s fine with me. These are qualities you want in a guy who’s leaning over your wife’s leg with a scalpel.
We’re in a dermatologist’s office in Kingston, and we’re here about Julia’s mole. It’s changing. The mole itself is only a couple of millimeters across, and the change is subtle: a faint pinkness limning the border, a hint of a new texture. It’s a relief she noticed it at all; I surely never would have.
On the wall, there’s a cheerily macabre poster, showing a few photos of Moles Gone Bad, and listing the things you should be on the alert for in a mole. There’s a helpful acronym, too: ABCDE, which stands for Asymmetry, Borders, Colors, Diameter and Evolution. Hers is tiny and innocuous-looking, but it’s shifting on at least four of the five. Clearly, it’s got to come off.
But before he cuts into her skin, there’s a matter to settle: Money.
Both of us work. We make okay money. Middle-class money. We are shockingly lucky to have financially helpful parents, if the feces should ever truly hit the oscillating whirly device in our lives. I’m a freelance writer, she’s a paralegal — and a local elected official to boot. But it’s been years, more than a decade maybe, since either of us had a job that came with health insurance. Before the ACA passed, we were on expensive private insurance with a huge deductible; now we’re on expensive ACA insurance with a huge deductible. Plus ça change, as they say.
The question at hand: Are we going to send the mole to Albany for pathology? It would be nice to know if it’s precancerous, or, perish the thought, melanoma. But given that the treatment in either case is slicing it off — as this guy is about to do anyway — maybe we can just have him toss it in the bin here. It would certainly be cheaper.
Pathology is going to cost somewhere between $300 and $1000, he tells us, with a distressing lack of precision. And he needs to know now, before he cuts.
“What would be the benefit of knowing?” I ask him. Maybe we don’t need to know. Maybe we could just leave the lid on that particular box of knowledge forever. Maybe we can live with Schrödinger’s Cancer.
It’s not lost on me that if we were truly freaking out about money, we would never have come here in the first place. Already, visiting the dermatologist has set us back a few hundred dollars, and this on top of a massive surprise dental bill last month. Looking at that little brown dot on her leg, barely the size of an apple seed, it’s easy to imagine treating it with daily applications of wishful thinking.
It’s incredibly common for people on high-deductible insurance plans to delay getting medical care, kicking the ball down the road until it simply can’t be ignored. One study conducted by the Commonwealth Fund in 2014 found that 44 percent of “underinsured” adults — a category that includes many, perhaps most, people with high-deductible plans — had declined to seek medical care they needed because of the cost. I do it myself, often. With a $500-a-month family premium after ACA subsidies, there isn’t much room in the budget for surprise medical bills — and even if we manage to meet our $8,000 family deductible for the year, our bronze-level insurance will only cover 50 percent of most bills.
Delaying care can kill. According to a study published this year in the Journal of Clinical Oncology, women on high-deductible insurance plans who were diagnosed with breast cancer delayed starting chemotherapy by an average of seven months. For a disease like breast cancer, where early detection and treatment can mean the difference between life and death, seven months is too long. But if you’re choosing between the mortgage and the medical bills, that choice makes a brutal sort of sense.
After a moment of wavering, we opt to send Julia’s mole to pathology after all. If it’s melanoma, she needs to know. Maybe that knowledge would make her — or her future doctors — more vigilant about future run-ins with the ABCDE checklist. Maybe it wouldn’t matter. All I know is, I don’t feel like playing games with my wife’s health over a few hundred dollars. I’m acutely aware that that attitude is a privilege.
While he wields the needle full of local anesthetic, I hold onto her big toe, and begin telling some long rambling anecdote, hoping to distract her from the looming scalpel. It’s mercifully swift and painless. Off it comes, leaving a pale-pink divot in its place, small enough to cover with a little round Band-Aid.
We could have universal healthcare. We could have had it years ago. Every other nation with a half-decent GDP and a couple of chips on the global poker table has it.
I’ve been upset about the way we handle healthcare as a nation for a long time. It’s maddening to be unable to plan rationally for healthcare costs; it’s infuriating to watch friends and loved ones get sick and not get help. In the wake of last year’s pointless federal tax cuts, which appear to have saved me personally a few hundred dollars a year at the cost of massive collateral damage to the budget and our flimsy social safety nets, I’ve gotten angry enough about it to feel like spitting teeth. I know I’m not alone.
There’s a proposed law, the New York Health Act, that would create a single-payer health program in the state, and make healthcare free at the point of service for all New Yorkers. A study released this week by RAND Corporation, a policy research nonprofit, found that if passed, the New York Health Act would begin to cut health costs in the state around 2022. By 2031, authors claim, the program would be cutting total healthcare costs in the state by $15 billion a year. The prospect of passing the taxes needed to pull it off, which would fall heavily on the state’s wealthiest households, seems radical, but not unimaginable.
My $0.02, for what it’s worth: Get it done already.