Sid's Perspective on Health Care

As part of “homework” for my UCLA certification program, I had to interview someone who has struggled with some aspect of a complex health system. Who better than my 91-year old father? We sat on a bench above the beach this afternoon, watching the surfers. Here’s Sid’s perspective, all in his own words with minimal editing.


Karen: You were born in 1922, when many babies were delivered at home by midwives. Tell me about health care when you were a boy growing up in Brooklyn. How did people get services? How were the services paid for?

Sid: You called the doctor only when near death. People used home remedies; some worked and some didn’t. There were no clinics. The family doctor was only called for emergencies. I was actually delivered by a doctor, it cost $5. My father only made $10/week, he had to borrow the money. All of the childhood diseases were rampant. It was customary to have measles, mumps and scarlet fever. Classrooms were crowded and bathrooms were more like a cubicle in the yard. We all grew up on remedies from Europe. The treatment for a cold was a mustard plaster on the chest. I received primitive health care up through 10 years old. I had bad acne as teenager, the treatment was brewer’s yeast (swallowed) – it didn’t work. There was also low frequency x-ray treatment to dry up lesions. Health care was poor during the depression, there was no money. Diphtheria and polio were very prevalent. There were lotions and herbs, black salve. Some people had their blood drawn out of their bodies with cupping, similar to acupuncture today. Women had as many babies as possible, because children died so often. My mother had two miscarriages before she had five children who lived.

Karen: Health insurance wasn't widely available until the 1960s. How did people react to having insurance? What changed?

Sid: Major employers started providing minimal coverage in the 1950’s. There were pay deductions, then it became part of union contracts, then it broadened. When you and your brother were born, the company paid for the hospital and pediatric bills. Doctors formed corporations and health care became a business. Appointments rarely exceeded 15 minutes.

Karen: You worked for Western Electric for 40 years. How would you rate the coverage provided by your employer?

Sid: Up until the end of my career the coverage was good. When the phone company mergers happened (the breakup of AT&T and the absorption of Western Electric in 1989) and management changed, the executives received golden parachutes. Coverage was cut back for everyone who remained. Death insurance was cancelled first. I had retiree benefits for decades until I went onto a series of Medicare HMO plans. The first time I had traditional Medicare was this year.

Karen: Health care is complex and fragmented. What has been the most challenging part for you and your family?

Sid: Delays in appointments and treatment. Doctors were loaded with patients and had limited time. Specialists never had time to see anybody. Expertise was fragmented, and many doctors didn’t keep up with the latest advances in treatment and research. Doctors tried to give adequate treatment with limited resources. I can’t blame the doctors in managed care plans. Secretaries and administrative clerks were dictating how much care patients could get, based on tables. There was always an appeals process, but I had no occasion to appeal.
 
Karen: How is the health care experience different in your geriatric years?

Sid: I had to change HMOs several times with a loss of services each time, I had to hunt around. At about age 70-75, we (mostly your mother) started to need more care, with more specialists.

Karen: What is most important to you when selecting a doctor? When you ask questions of your doctors, how do they respond?

Sid: Most of my doctors responded well to my questions. My technical background as an engineer was respected. My issues were high blood pressure, diabetes and heart problems (atrial fibrillation). Not all doctors were respectful and some didn’t want to discuss my problems. My current doctor, who you helped me to select, is very good at listening. The doctors were technically the same, personal concern made the difference.

Karen: How would you restructure the health care system if you could advise decision makers?

Sid: Create a single payer, government-sponsored system like Britain, France and Germany. No private corporations, no investors, no highly paid executives. Medicare, as one example of this model, has low overhead and does it well.

Karen: Health care and prescription drug costs keep rising. In your opinion, what is the biggest cost driver?

Sid: More and more people are getting older, with more needs. The costs of medications are going up. For instance, for my insulin pens, my out-of-pocket allowance went from $30 a year ago to $60 now.

Karen: You've lived into your 90s. Think about your lifestyle. What did you do right? In hindsight, what would you have done differently?

Sid: I violated all of the standard rules for diet. I liked meat, although I tried to balance it with vegetables. Some genetic influence must have helped. I was very active, I liked to walk until spine inflammation became a problem. I didn’t smoke or drink – all the people I knew who did are gone. My father was a smoker and he died at age 58. My brother was a heavy smoker who died at age 64.

Karen: Any other comments or insights that you want to share?

Sid: Every effort should be made to have health care available in a minimum amount of time – treat minor ailments before they become major ones. Personal budgets should include the costs of health care, just like planning to pay for rent or food. It should be the same mentality about paying for health care. If people look for minimal cost, they will get minimal care. People have no cash reserves. I was fortunate that I had savings which were invested wisely. Regarding Obamacare, the intent to cover the full population is good. However, insurance programs rely on a huge base of healthy as well as ill people. Younger people need to enroll. They don’t expect to get sick and are resistant, they don’t see the value. I wouldn’t be here today unless my employer-paid pension plan was established when I was young. They tried to cancel the plan later on and weren’t successful. I’m sure they hate my guts that I’m still alive!