THE TRUTH OF THE MATTER: Off to Nogales, Mexico
In the near-term future -- a conversation with my orthopedic surgeon:
Doc: You can get dressed now.
Don: So doc, what's the news? Give it to me straight.
Doc: I have good news, and I have not so good news. Which do you want first?
Don: Let's have the good news.
Doc: It seems like you will need a hip replacement.
Don: That's the good news?
Doc: Yes, but only one hip -- your left one. Your right one is not too bad, at least for the time being.
Don: I hate to have to ask, but what exactly is the bad news?
Doc: Under the new Vermont Universal Health Care System, you will have to wait some time before you can have the hip replaced.
Don: Well, that's not bad. If I have to get a new hip, I wouldn't want it done until next month. I can endure the discomfort a bit longer.
Doc: I'm afraid to say, you might have to wait two years or more.
Don: You're kidding?
Doc: No, I'm serious.
Don: Why's that?
Doc: We've been informed by Vermont's Knee and Hip Joint Replacement Allocation Board, this year's replacement quotas are filled up.
Don: What board?
Doc: A few years ago, when Vermont's Universal Health Care was adopted, the state took control of all aspects of health care. Boards were established to review and determine allocation for all elective and more non-elective medical/surgical procedures.
Don: Why, and who serves on these boards?
Doc: The medical/surgical delivery system is broken down into 354 different procedures -- joint replacements, heart stents, cataracts, tonsils, sinus and on and on. The members of the review board -- some professionals, more lay members -- and are appointed by the governor.
Don: I get it, but what's their role?
Doc: The various boards meet once a month, some weekly, and decide how many procedures can be done the following month, up until the year's end. It is based on the funds allocated by Vermont Health Connect, the overriding board.
Don: I'm still lost.
Doc: The board we must deal with had funds last year, to do 510 replacements. There were requests filed to do 3,220. The patients that were not attended to got placed on a "waitlist" and put into the cycle for this year's review and allocation.
Don: So where do I fit in, and why two years?
Doc: To put it bluntly, you just don't fit -- you are too old, and your age does not make you a priority. You are 74 years old and you are not working in a critical profession or job. Lastly, you are not the main financial supporter of a family with kids under 18.
Don: Why didn't we know this was coming? Why wasn't this allocation -- rationing is a better term for it -- talked about before now?
Doc: Because all the blabbering was about how we would be paying for health care, and that only came after all the chatter on getting the enrollment corrected -- remember the mess that was back in 2013/14?
Don: Yeah, I do, but nothing about getting to see a doctor and being put on a waitlist was ever discussed.
Doc: Well, Vermont was the first state. Many doctors saw the allocation -- rationing, if you will -- of medical/surgical procedures coming and just packed up and left the state.
Don: Can I go where they went?
Doc: No, the way things work now, you have to get your treatments done in the state you reside in -- no state-to-state doctor shopping is allowed.
Don: Is there anything I can do to get my hip replaced?
Doc: Yes, but you will have to go to Nogales, Mexico. The clinic there does about 30 to 40 hip replacements a day. It is all cash, no insurance and for about a tenth of the cost here and it will take two weeks to get an appointment.
Don: What will that mean?
Doc: It means you'll pay about $6,000. But keep in mind your rehab will have to be performed back here. And you can't sue if anything goes wrong."
Don: What have you heard?
Doc: They're not bad, do fairly good work, but they do experience a high rate of infection -- around 1 in 6 last count -- but they're improving -- it used to be 1 in 4 hips became infected.
Don: Last summer I was told by my cardiologist that I might be a candidate for a pacemaker and said nothing about this waitlist.
Doc: When you are in Nogales, get it done. In Vermont you will have an even greater wait for that procedure under Vermont Health Connect. I need one too and I've been told I'm on the schedule 18 months out. And guess what, I'm younger, with three kids and in a critical profession.
Don: How ignorant of me for not seeing health care rationing coming -- and now a lack of doctors and cost being the ultimate driver of the system -- shame on me.
Don Keelan writes a bi-weekly column and lives in Arlington.
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