I haven’t had employer-provided health care in over ten years, which means I’ve been paying for individual or small group insurance for myself and now my family every month. Every year my premiums increase by 30%, so I’ve changed providers going from crappier to crappier policies until now we’ve got the cheapest I can find. This “cheap” policy is costing over $1300 a month and is an HMO, so it only covers in-network providers. Because it’s not a very good insurance company, very few providers take it. For my OB/GYN I just pay out-of-pocket for my appointments.

Two things now: my pediatrician referred my son to an ear-nose-throat specialist to check his hearing. None of his referrals take our insurance, so I called the company, used their website to pick a random doctor, called the doctor and was told they didn’t take it, was transferred to another doctor, was transferred again and finally ended up with a fax line picking up my call after fifteen minutes on the phone. After two hours calling various people, I gave up and am now going to pay out-of-pocket for the referred doctor for Ollie tomorrow.

Some time last week I think I stepped on a piece of glass. There’s something in my heel and I’ve soaked it and squeezed and tweezed but whatever it is, I can’t get it. It’s been throbbing for a week. My primary care physician can’t see me for two weeks. Their urgent care center takes my insurance but I have to make them my PCP to have the visit covered. Another local urgent care facility doesn’t take my insurance. So basically if I want to address this before May 24 and not pay out-of-pocket, I need to go to the ER and it’s a $50 copay.

I wouldn’t even mind going to the ER except my local hospital closed and the ERs are across or uptown. Why did my local hospital, a level 1 trauma center serving an area with over 800,000 people, close? It went bankrupt. There was a New York Times article around the time of its closing stating that its ER was a dumping ground for people with no insurance because they wouldn’t turn anyone away. I don’t know if this is true. I don’t know why they went bankrupt and suddenly closed. But it’s insane that an area as dense as the lower west side of Manhattan has no hospital and that politics and money are keeping residents from critical health care services.

I probably won’t go to the ER because it’s not an emergency, and I don’t think it’s an appropriate use of those services. But my insurance and the system are conspiring to send me there. I’m not sure how that keeps health care costs down, to pay for an ER visit over less extreme types of care. I guess ultimately the insurance company saves money because I’ll just walk around with glass in my foot for two more weeks. And pay out-of-pocket for care in addition to paying thousands of dollars a year for insurance.

I’d hoped health care reform would somehow solve this, but it’s clear to me that it won’t. The system is broken and even people who talk about fixing it don’t seem to realize just how broken it is.