Taking the Care out of Healthcare

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A reason not to stay: Healthcare. (Effie, recognise the shirt? It’s the only one that fits over this darn cast!)

I will try and keep this one from being a rant. I already wrote on the subject of healthcare back in September 2014. But this time we thought everything was finally covered after eight months of phoning and faxing and posting bits of paperwork to our health insurers and the people at Obamacare who are like ravenous document-eating monsters. We thought we were prepared. Obviously not. Last Sunday playing an impromptu game of volleyball (anyone over forty take heed) with some friends after a gorgeous day wandering a bird sanctuary spotting bald-headed eagles, kingfishers, and the likes, I caught the ball and heard a ‘crack’. I pretended nothing untoward had happened and carried on with the game so as not to put a damper on the evening.

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A reason for staying: The freedom of riding your bike around the block with no adults hovering…

When I got home, my finger was swollen and purple and I knew something was wrong. So, the next day my husband, J, took the morning off work (which ended up being a day and a half) to ring our health insurance company to find a doctor covered by our health plan. So far, so good. He found a walk-in clinic and we got there just as it opened. I was seen quickly, x-rayed, and told by the doctor there that I would need to see a specialist as it was a bad break. She put my finger in a little splint and after I had given my insurance details and filled out reams of paperwork, they sent us to see a specialist who I was under the impression would be covered by our health plan. This is where we went wrong. At every step of the way, you need to ring up your insurers and check that the doctor you are being sent to, is covered by your plan. Even of you are told he or she is, he or she probably isn’t. But then again, even when you ring your insurer to ask, you are, more often than not, given the wrong information.

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A reason not to stay: The Testicle Festival in nearby Clinton

So we went to see this specialist, who was a lovely, older chap who did more x-rays and said the splint I had been given was not sufficient and I would need my hand in a cast in order to keep my finger absolutely still. If I moved it at all, I might need an operation and the insertion of pins (at which point more dollar signs flashed behind my eyelids). So a cast was put on. I liked this doctor a lot and it turned out he had put money into a film made by a friend of ours. “I got my first cheque from it today,” he told J and I.

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A reason to stay: the golden light.

I was told I needed a follow-up appointment in two weeks in order to make sure everything was healing properly. While making the second appointment, we realised that this doctor was not in what our insurers call “The Ring” (yup, just like the horror movie). “Are there any other doctors at that practice who are in the ring?” J kindly asked our insurers. “Yes,” they replied and gave him the name of a doctor who turned out not to be in the ring. Another few phone calls, and J was given the name of another doctor who was in the ring. It turned out this guy doesn’t have anything to do with bones. Another phone call. This went on from 7:30 am to 5:00 pm with J on the phone being given the wrong information and being told slightly insane things, like, “There are no doctors in Missoula who treat bones and who are covered on your plan.” Then, on the next phone call, he would be told something else. I guess the insurance companies hope to simply wear people down until they eventually give up. I now understand people pulling their own teeth and doing basic surgery in their kitchens. It is awfully tempting.

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A reason to stay: the best signage in the US

After a morning of making more phone calls, J finally found me a doctor who will check my cast in two weeks, and who is part of the ring, and who is in Missoula. We will get stung financially for seeing the first doctor whom we assumed was in our plan, but hopefully from now on, we won’t have to pay. When I say, “we won’t have to pay,” I mean “we won’t have to pay any more than we already do every month for our non-existent healthcare and apart from the amount of money we still have to pay for every visit (35 bucks) and every x-ray (another 120). Apart from that it’s totally free!” Work that one out. But we have learned an important lesson: at every step in the process of seeking healthcare, you need to be on the phone to your insurers for several hours. You need to speak to as many people as possible and sort of deduce what exactly the truth might be based on the number of similar answers you get to your questions. Imagine having to do this if you were in chronic pain, or were very elderly, or had a very sick child you had to watch fading away on your sofa while being dicked around by these idiots? Nope, me neither.

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A reason to stay: the best signage in the US part 2.

Since typing the previous sentence (one-handed), there has been another development. We have just been informed that the one doctor our insurance will cover, and to whom we have just arranged to have my medical notes sent, may not after all accept me as a patient. He is away and won’t be back until next week, which is when I am supposed to have my hand checked again. We have also arranged for J to pick up my x-rays tomorrow and take them to this non-existent doctor. So they are sitting in the waiting room of Doctor Expensive to be taken to the office of Doctor Not-Available-Right-Now. As it stands I am not with any doctor and if the one we have been told to go with by our insurers doesn’t accept me (which apparently is not uncommon) then my choices are to pay through the nose and have everything sent back to Doctor Expensive (at our expense) and pay huge amounts of money for treatment or to literally rip my cast off my arm with my teeth. The latter seems like the most sensible solution at the moment. We were not told any of this when the receptionist at Doctor Not-Availble advised us to move over to them. At every step of the way we have been met with obstruction, lack of professionalism and a total lack of transparency. Oh yeah, and huge bills. The first visit was $369 dollars. Why is any of this significant? Well, for those of you who have read my latest blog post, I had been lulled into thinking about staying here another year. The landscape, the people, my friends, my daughter’s friends, the sunshine, the signage, the incredible literary scene, the thriving film community, the independence we see growing daily in E, the debates about freedom and individuality that rage around us here in Montana. It is all wonderfully seductive. But humming away in the background is this idea that we can’t get sick. If we do, we can’t access the most basic healthcare without being stung financially, giving over our life to making phone calls, and being sent in circles that are making me feel I am the crazy one. And I find this simply too hard.

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A reason to stay: shop windows like these.

After this experience, I just want to get back to the UK. I know it is changing there, too. Cameron and Osborne are doing their best to sell off the NHS, and UKIP is gaining ground. The country sounds like it is becoming less of a kind and gentle island (albeit with its own set of growing and very disturbing problems to do mainly with privatisation) and more of a capitalist’s wet dream.

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A reason to stay: freedom for E

J says I just need another road trip to make me want to stay. Next week his mother and a friend of hers are coming to stay. We’ll be hopping in the car and taking them to Butte and Livingston and some smaller places in between. Maybe once I am back on the road and indulging in all this space that seems to encourage serious thinking, my broken finger will seem terribly small and unimportant. But right now, that doesn’t feel very likely.

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To stay or to go: Places like this make me very curious…

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Fun Things Coming Soon

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Fun Things Coming Soon — a storefront in Butte, Montana

Since my mother’s death almost three months ago, I seem to have a new vigour. Perhaps this renewed energy is down to the act of wringing out as much writing time as possible before it’s my turn to pass on to the next life or nothingness or wherever it is you believe we go to after we die. Or maybe it is simply down to the longer, sunnier evenings and the warm March air.

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That big sky from the empty road

I have been writing alot and really focusing on work—mine and that of other writers—and yet in the very back of my brain it is as if I am tuned to static. On this frequency I can hear the hum of indecision about whether to stay in Missoula one more year or whether to stick to our original plan and head back to London this summer.

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Clinton, Montana — the wrong side of the tracks

It has been interesting watching and listening to J and E and I, and our different ways of framing this adventure. J wants to stay in the US forever. He has no doubt about this. His only problem about staying here is that there is no work for him. He would need to be in Los Angeles or New York to make the sort of TV docs he made back in London. We are noticing the lack of his salary. A lot.

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The crisp Montana light in Butte.

My relationship to whether we stay or go is more complex. When we first arrived, I felt an odd sense of unease. I recognised the aesthetic of Missoula as that of my home town in Canada. This threw me. Yet the US is not Canada, and this also threw me. I didn’t understand where I was in a profound way. And in a more obvious way, I was missing London: my routines, my support network of neighbours and friends who had bailed me out over the years when E was sick or needed picking up from playgroup when I was stuck on a bus. At the half-way mark of our year-long stay, E suddenly started talking about missing the friends she has made here after months of saying she wanted to be back ‘home’.

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Artwork in a gas station in Sheridan, Montana

When my mother died just before Christmas, all thoughts about Missoula or London were subsumed in grief and the insistent practicalities that surface around death. Now, months later I am back on the teeter-totter (or ‘seesaw’ to my UK friends) of whether to go or stay. I don’t want to say it is consuming me, because it isn’t. But I do find myself thinking about it several times a day.

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Inside the Silver Dollar Bar, Butte, Montana on Garage Sale Day. (Thank you to Brian for taking the time to show us around)

About a month ago I decided that returning to London was the only choice we had. This was partially prompted by an email from British Airways telling me that I had enough air miles to fly home for free. I never believed you could actually do this. The only catch was that I needed to book by March 8. The free flights were selling out, so I panic-bought a ticket for myself and E back to London on July 26th. Like everything in life, these weren’t free, exactly. But the total of £300 in taxes was not a patch on the £2,000 each these tickets would be normally for this time of year. I was all set to return and felt a sense of calm that the decision had been made. J will be joining E and I in London in the autumn once he has finished a few projects here. This decision isn’t ideal in many ways—primarily because we decided to come here as a unit and there is something unsettling about leaving as disparate entities. But sometimes one can read too much into the symbolism of things.

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Butte, Montana

Then last weekend my old friend Y from Toronto showed up and we headed out on a road trip around western Montana. The huge skies, the empty roads, the bars full of characters and very cold beer, and the constant sunlight flooding the fields and mountains with a golden glow. It was all too much. I suddenly felt a huge ache at the thought of leaving. Of returning to London’s glowering skies which always look as if Josef Beuys has risen from the dead to stretch a slab of grey felt over everything. Even on cloudy days there are no clouds, just an unmodulated whitish-grey, low-lying entity, its only resemblance to sky being the fact that it is above your head. But having grown up in Canada, I think I am hardwired to feel happiest under a big blue dome. I have always struggled with the near constant greyness of London. It affects my moods and behaviour in a way that isn’t good.

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My friend Y and I met a guy called Chuck in Clinton, Montana. This is his son’s old car. The little stone angel on the grass is where his beloved German Shepherd, Angel, is buried.

And then there is the noise, and the dirt and chaos of the big city. Which of course I love. Always have loved. But a new respect for quiet, clean landscapes and the look of ordered hay bales piled next to unbelievably photogenic barns is beginning to take hold of me. I feel incredibly sad at the thought of leaving Montana. Torn, is the word that keeps coming up. I hadn’t thought of any of these conflicts when we first decided to come here. It all seemed so easy. When we told our friends and neighbours that we were going to live in Montana for a year, the general response was one of excitement, sometimes envy, and at other times plain confusion over leaving one of the greatest cities on earth to live in the middle of nowhere. I have never been very good at thinking about the consequences of my actions. I often jump before I look and this is just one more example. But I am not sure how to be any other way. Even when you think you know what the outcome of your actions will be, life surprises you.

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The orderly and photogenic landscapes of Montana

Gone is that simplicity of ‘moving to Montana for a year’. We are seven months into our adventure and any clarity I once had is nowhere to be seen. I have noticed huge changes in E. And so have our visitors. The once painfully shy little girl is now much more open. She is more independent and confident. I think some of this is her age: 7 going on 8. But some of it I think is a result of the freedom she feels here. She can walk home from school with her friends. She can roam the neighbourhood on her own and does so, enjoying the fact that she doesn’t need an adult with her. Seeing her blossom this past year has been like watching an incredible metamorphosis from cocoon to taking flight. And here’s another thing: she talks with an American accent. I didn’t know this would happen so fast. She has adapted to life here and only now and then does she say she misses things from ‘back home’. Today she said she missed the BBC. Yesterday it was our tiny doll’s house in East London. When she says she misses these things, I am not sure she really does or if she is simply remembering them fondly. There is a difference. Can a seven-year-old feel nostalgia?

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E (in the middle) with two friends and their Bassett Hound Leo at Flathead Lake

My friends in London, some of whom I have known for twenty years are irreplaceable. Some days I long to be able to pick up the phone or invite some of them over for dinner. We speak in shorthand and have shared some of the most wonderful and difficult years of our lives. My friends in London are my adopted family. I am who I am partly because of them. But the people we are meeting here in Missoula are kind and open and generous. Would staying an extra year simply make it harder to leave them? Or would an extra year here be a stepping stone to staying forever? Or would we get some of this enchantment out of our systems and feel more willing to embrace the grey skies of dirty old London.

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Alder, Montana, next to Chick’s Steakhouse is Marv’s Rock Shop.

Tonight as I watch another sunset turn the mountains that impossible pink, I still feel torn. I keep waiting for a Eureka moment, for a flash of insight, for an answer to come to me unbidden from inside somewhere deep. But I know that these things won’t happen. I need to make a decision and right now this feels impossible.

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Saying goodbye to this will be hard.