Monday, July 28, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Sick and tired of poor health care access

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By
From page A8 | May 04, 2014 |

I’m sick this weekend. Not hacking-up-a-lung or I’ve-got-the-flu sick, but sick nonetheless.

I had a sense of it Wednesday night, to the point that I took an over-the-counter medication before bed. I don’t believe that it worked because I was miserable Thursday morning. I barely made it to a 1:30 p.m. appointment with a pair of Assembly district candidates, then went back home and did the remainder of the day’s work from our dining room table. In the meantime, I called my primary care physician midafternoon to see if I could get in later that day (I figured that was wishful thinking), or possibly Friday.

No dice.

The first available appointment was 3 p.m. Tuesday – a full five days from when I made the call Thursday. They said they would try to squeeze me in Friday, so I took the Tuesday appointment and hoped for the best.

There was no improvement Friday, so I went to a quick meeting in the early afternoon and again worked from home. As I worked, I waited for a call from my doctor’s office. The call never came.

So it was off to the urgent care center Saturday. The doctor prescribed a couple of medications, including a high-power antibiotic, and sent me on my way. Given how the medications are supposed to be taken, I figure I’ll get in two full days of doses of each by the time Monday morning rolls around and I (hopefully) return for in-office work.

This is not the first time since I moved here in September 2009 that I have not been able to see my primary care physician when I felt I needed to. I don’t go to the doctor often, because I tend to be in pretty good health – aside from the occasional cold. So when I make the decision that I need to see a doctor, I need to see a doctor.

This is twice that I’ve ended up in urgent care. Once I actually saw my doctor in a timely manner, and once I felt better by the time the doctor could see me. That’s pretty much it in the past four and a half years. This (as I see it) poor track record of being able to see my doctor when I need to is troubling. I pay good money for the insurance coverage that I have through my work, and my boss pays good money to keep the premiums somewhat in check.

What good is it if you can’t use it when you need it? I know, the insurance covers the urgent care visits, but that’s not the point. The point is that I can’t see my doctor when I need to.

Maybe it’s because I get sick at times when a great many others get sick, and the system is overburdened. Maybe it’s the health care network to which I belong. Maybe it’s my doctor. My wife seems to be able to see her doctor with less of a wait, but a wait nonetheless – far greater for us both than we were accustomed to before moving to Fairfield. Perhaps we were spoiled by Central Valley health care?

This week’s medical trials proved troubling beyond the ramifications at work and the need to do a great deal of work from home. I missed Saturday’s Thunder Over Solano at Travis Air Force Base, and suspect I’ll miss Sunday’s installment as well. I missed the Solano County Library Foundation’s inaugural BrewHaHa on Saturday at the Specialty Event Center. I’m writing this column instead of enjoying select brew samples. Had I been able to see my doctor Thursday afternoon or Friday morning, the medications I ultimately received late Saturday afternoon may have had enough time to work their magic and allow me to participate in some extracurricular community activities.

Alas, that’s not the case.

Friends and coworkers tend to get this shocked look on their faces when I describe a Thursday call that yields a Tuesday appointment. That makes me think my network and my doctor are the root causes, which makes me wonder: If it’s so difficult for me to see my primary care physician now, what’s it going to be like now that the Affordable Care Act has kicked into high gear and literally thousands of Solano County residents are seeking care from what’s apparantly a strained local health care system?

I think it’s time to give serious thought to changing health care networks – and doctors – at open enrollment this fall. Kaiser Permanente can’t be any worse than what I’ve experienced with Western Health Advantage over the past four-plus years.

Reach Managing Editor Glen Faison at 427-6925 or gfaison@dailyrepublic.net. Follow him on Twitter at www.twitter.com/GlenFaison.

Glen Faison

Glen Faison

Glen Faison joined the Daily Republic as managing editor in September 2009. He has worked as a reporter and editor for daily and weekly newspapers in the San Joaquin Valley for 20-plus years. His experience includes time as editor of the Golden Eagle, a military paper serving the Lemoore Naval Air Station. He graduated from Fresno State University with a bachelor's degree in journalism and bleeds Bulldogs red. He is an avid Washington Redskins fan, and attended the 1988 NFC Championship Game against the Minnesota Vikings at RFK Stadium. He married his wife, Jill, in 2005, and has three children: Courtni, Tyler and Hayli.
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Discussion | 29 comments

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  • Mr. SmithMay 04, 2014 - 2:19 am

    Glen: When you finally get to see your doctor, it would be interesting to hear what he/she has to say about the situation with WHA and health care services in general. Sounds like you have experienced the nightmare all of us will eventually face due to the ACA. It has been stated often here that "health coverage" and "health care" are two different things. Your situation is a prime example.

    Reply | Report abusive comment
  • Glen FaisonMay 04, 2014 - 11:31 am

    @Mr. Smith: I'm keeping my Tuesday appointment, and I will ask. He's a good doctor. He came highly recommended, and when I can see him, he's great. It's the "when I can see him" that's the problem: the "health coverage" versus "health care" dynamic you mention.

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  • BaseballmomMay 04, 2014 - 7:44 am

    Where I live (not in CA) no one even expects to see their own doc when they are sick. When folks get sick here they automatically go to Urgent Care. Docs are only seen at regularly scheduled appointment times.... Weird, hah?

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  • Glen FaisonMay 04, 2014 - 11:32 am

    @Baseballmom: Yes, that seems weird to me. You're in Nevada?

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  • CD BrooksMay 04, 2014 - 7:51 am

    Kaiser is great, we've been members since '1972 and highly recommend them! :)

    Reply | Report abusive comment
  • Mr. PracticalMay 04, 2014 - 9:29 am

    I had a premium plan with Kaiser for the past 15 years and was forced out this year due to a 28% increase, primarily due to the "essential benefits" mandate for coverage that I either already had or don't need. I had to go with a PPO that has a 20% copay. As someone who purchases in the individual market, I actually got off easy. Unfortunately, we now have a law that for most, is reducing access either by shrinking doctor networks and/or increasing premiums and out-of-pocket costs.

    Reply | Report abusive comment
  • Glen FaisonMay 04, 2014 - 11:53 am

    @Mr. Practical: A 20-pecent copay now? I miss those days! (kind of kidding) I hear you, though, about rising costs and rising patient cost. I alluded to that in a previous response here and more than a decade of double-digit health care premium hikes.

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  • Mr. PracticalMay 04, 2014 - 5:17 pm

    The plan I was priced out of had $10 to $20 copays depending on the benefit.

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  • Glen FaisonMay 04, 2014 - 5:25 pm

    @Mr. Practical: $40 copays here, on a high-deductible plan, but I'm happy to have the coverage. My monthly premiums are still not so bad, especially since my boss kicks in so much to keep employee costs in check – to the greatest extent possible.

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  • Glen FaisonMay 04, 2014 - 11:35 am

    @CD Brooks: Kaiser was not viewed very positively in the Central Valley, which was a determining factor when we moved here and had the option of either Kaiser or Western Health Advantage. From what I have seen since moving here, Kaiser is much better in Northern California, and particularly here in Solano County. We'll certainly give them a look this fall at open enrollment, and hope for the best.

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  • Teach5thMay 04, 2014 - 8:01 am

    As I've pointed out so many times --- health INSURANCE isn't health CARE. The American public was lied to so many times by the President, Sebelius, Pelosi, and others, and now that the truth is beginning to dawn on the public, the folks are suffering - many while having to pay higher deductibles and monthly premiums. As even more people are forced to get insurance so they don't have pay the fine, the situation can't help but get worse.

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  • Glen FaisonMay 04, 2014 - 11:46 am

    @Teach5th: I'm not really up for a full-on political discussion at the moment. I will say that I've worked in a management role for well more than a decade, for three different companies, and double-digit annual health care premium increases has been the norm, not the exception. Company responses to help keep premiums in check have included higher deductibles and higher co-pays. This goes back to before the Affordable Care Act. Which brings me to the name: Who doesn't want affordable health care? The trick is in the details, and the implementation. For many who had no access to health insurance, and are barely getting by, the insurance is affordable because of the government subsidies. I know people who now have comparable insurance under the federal program to what I have through my company, who pay less than what I pay -- and that's not counting what my boss pays. So, it's affordable for them.

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  • JeanMay 04, 2014 - 8:37 am

    Solano County has a hit and miss of good PCP's. Sometimes I can not see my PCP the same day but they always offer me a same day appointment around my schedule. I am happy as long as I get in the same day. I too do not run to the doctor very often. When your sick your sick. I do not have an HMO. I have a PPO. We pay a good fortune for it and my husbands employer pays a pretty penny on their end. Your right about the central valley. They do have better healthcare. I know a few nurses who went from Solano County to the Central Valley for better jobs. They love it! So your stuck with Solano County. When open enroll comes around and you only get to choose an HMO, go for Kaiser and find a PCP at the Vacaville Kaiser. If you are able to choose a PPO, do it! Your going to pay more out of your pocket but you will have more doctors and hospitals to choose from. You will be able to travel around to a better health care area, (Napa, Contra Costa or Sacramento County) "IF" you choose to do so. Unfortunately this is one of many unappealing issues living in this county has to offer. Hope you feel better soon!

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  • Glen FaisonMay 04, 2014 - 11:52 am

    @Jean: I have had a PPO in the past and I agree, they are worth the extra cost. Unfortunately, I only have access to HMOs. As I mentioned in another response here, I think my doctor is great, when I can see him. Your comment makes me think we may have been spoiled in the Central Valley in terms of access to health care. I can tell you from having lived and worked there that a staggering number of people did not have health insurance and that emergency rooms were flooded, to the point where some of the hospitals in the region (mostly at smaller facilities) closed their ERs and converted them to urgent care-type centers because they were providing services to so many uninsured people who could not pay for those services.

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  • mescMay 04, 2014 - 8:25 pm

    Please look into Sutter Medical Foundation across from the old Walmart. I made the move and love love love it. The access is terrific, I can contact the PCP via appt or online. M PCP referred me to 3 specialists, 2 of them called before I made it out of the building. I am handed a printed 'visit summery' each time I see a doctor. I am extremely happy with Sutter.

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  • PornacMay 04, 2014 - 8:57 am

    With the new Obamacare folks, healthcare will be unattainable to everyone except the rich. Stop Obamacare before the masses destroy our health system!

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  • smwieserMay 04, 2014 - 10:06 am

    Why would going to the doctor turn into political bashing? Sir I don't know why your sickness was such a terrible time for you but but as a member of Kaiser since I was a teen I like the fact that they have fixed part of what is wrong with the healthcare system in this country, no matter which Kaiser I go to, they have access to my medical records in the computer system. I take full responsibility for my healthcare. I pay for their educated opinion but my body is mine and I decide what to do No matter which place you go if you are not happy don't take NO for an answer ask to see another doctor. Free will people either have some or play the victim part and blame the government.

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  • Glen FaisonMay 04, 2014 - 12:01 pm

    @smwieser: The rules of my HMO require me to visit my primary care physician, which has proven an elusive thing for me in four-plus years here. I can see any doctor who will see me, but my insurance won't cover the cost of doing so unless I follow the rules of the HMO. Those rules allow me to go to specified urgent care centers (there are two nearby, one in Fairfield and one in Vacaville) when I need to see a doctor after hours. As for not taking "no" for an answer, I guess I could have gone and camped out at my doctor's office Thursday afternoon and all day Friday, but I could not have forced the doctor to see me. I used my free will to decide that I was better off staying and working from home those days, and then getting to the urgent care Saturday.

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  • LilMay 04, 2014 - 10:07 am

    Been with Kaiser for years and I can never get an appointment when I am sick. I always just go to Urgent Care. I am lucky that I don't need it very often. However, when my mom was alive, she had numerous serious health problems and if I called for her, Kaiser would get her into the doctor that day or at the very least the next morning. I think she may have been tagged in the system because this would hold true with all of her doctors, even the specialists. So maybe they give a bit of special treatment to those who they feel really need it.

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  • Glen FaisonMay 04, 2014 - 12:05 pm

    @Lil: I suspect there are those who love and hate Western Health Advantage, and those who love and hate Kaiser Permanente, depending on their individual experiences. I don't hate WHA: I'm simply disillusioned. I realize that if we switch to Kaiser this fall, that things may not improve. I may just end up changing doctors, even though I think I have a good doctor and I like him. But if I can only see him one out of four times, is it worth it to stick with him?

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  • JagMay 04, 2014 - 10:16 am

    For everyone who has health care thru your employer just wait it is about to get worse, when the current contract expires let’s see if you to get pushed off to ACA I am under my company plan and we have about 500 employees but I was told it would be much cheaper for them come September to pay the penalty and drop the plan,

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  • Glen FaisonMay 04, 2014 - 12:11 pm

    @Jag: That's been a talking point since the Affordable Care Act became the law of the land. The notion that employers would drop coverage and pay the fines was downplayed by the law's proponents early on, but the possibility became too significant to ignore when the president unilaterally delayed implementation of the employer mandate. Why do that, if the employer mandate is such a good thing? If employers drop private coverage and send employees to the exchanges -- even if those employers pay the fines -- the private insurance market will lose a large chunk of market share and the government will have a much larger piece of the health insurance pie than it's taken with the Affordable Care Act and already had with Medicare. I am curious to see whether the employer mandate is again delayed come fall. That will be telling.

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  • JagMay 04, 2014 - 2:09 pm

    Yes it was a talking point but I work for a private company so I was able to sit with our CFO and he said to me directly when asked for our company of 500 people it would be cheaper for our owner to drop all of us,

    Reply | Report abusive comment
  • Mr. PracticalMay 04, 2014 - 5:26 pm

    Jag and Glen, one of the requirements to comply with the employer mandate is that to be deemed "affordable" under the act, the employees contribution cannot be more than 9.5% of their income. It's fairly common for the employer to currently pay approximately 50% of the cost. In many cases, to comply with the mandate, the employers contribution will have to increase to 75, 80 or even 90 percent. In some scenarios, it would be cheaper for those employers to cancel the plan and pay the $2,000 per employee, per year fine. They would also save staff hours not having to comply with the monthly accounting to IRS.

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  • Glen FaisonMay 04, 2014 - 5:27 pm

    @Jag: It will be interesting to see if things play out that way once the employer mandate is in place.

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  • CindyMay 04, 2014 - 12:05 pm

    Made me think of an old Hank Williams Jr. song...It's called The Doctor Song...look it up on youtube...so true...lol

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  • Glen FaisonMay 04, 2014 - 12:17 pm

    @Cindy: I just did so. Hilarious! Thanks for that.

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  • Stu ReidMay 04, 2014 - 12:55 pm

    Glen, Kaiser is great, we have been members since we moved to California in 1980. We were pleased initially and they have just gotten better over the years. They are good on the day to day, routine things and nothing short of phenomenal on the big things, ie: major illness or surgery. Try it, you'll like it. Stu Reid

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  • Glen FaisonMay 04, 2014 - 5:23 pm

    @Stu Reid: Thanks for the recommendation. I've heard far more good than bad about Kaiser, in the past couple of years particularly.

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