Friday, September 23, 2011

I Get a Flu-Shot: Another Report on Health Care for the Uninsured in the Greatest Nation on Earth

Two years ago, I wrote about my experiences as I went to get a flu shot.

I had more experiences yesterday.  Here's what happened.

Steve tells me at lunch that the shots are available at his workplace, and all employees have to have them.  He'll be having his today.  He's insured and I'm not.  So he wants me to go to our local Walgreen's pharmacy and get my shot.  They've just begun offering flu shots for this season.

After lunch, we head to Walgreen's.  The store is full of staff members all wearing t-shirts that say on the back, "Get your flu shot today."  They're busily stocking shelves in almost every aisle.  I seem to have arrived at a stocking time.

I head to the pharmacy section of the store where, I remember from last year, the flu shots were offered.  No sign anywhere in the store tells you where to go to find out how to obey that tantalizing instruction to get your flu shot today. 

When I reach the pharmacy section, a quandary: nothing anywhere says flu anything at all.  There's a set of stanchions and aisles with some 8 or 9 people waiting in line.  There are two windows labeled "pick up or drop off."  There's one window labeled "consultations."  As my elderly Polish-Canadian friend about whose death I wrote here some months back was wont to say with self-mocking dramatic overkill on such occasions, Vat to do, vat to do?

I'll take "consultations" for $100, Alex.  I head to that window and stand, noting that, behind all the windows, there are two people serving the some 10 or more customers waiting outside.  One of these, the head pharmacist in a white lab coat, is on the phone laughing and talking.  He continues to be on the phone laughing and talking for 20 minutes as I stand at the consultation window.

His assistant is trying simultaneously to fill orders, wait on customers at the drive-through window, and wait on those in line in the aisles outside the pick-up, drop-off windows.  Of those standing in line, one is in one of those motorized shopping vehicles provided for ailing customers, another has oxygen lines in her nose, and one is so wan and weak I'm concerned he'll topple over any moment.

After about 10 minutes, the assistant passes by me and says, "Be with you in a minute."  She never returns.  In about 10 more minutes, the pharmacist concludes his phone conversation and asks if he can help me.  I say I'm here for a flu shot.  He replies, "You need to go to the windows," gesturing towards the lines waiting for the pick-up, drop-off windows.

I dutifully take my place in the lines, noting as I do so that there are arrows with the words "entrance" → and "exit" → at the start of the lines.  Both arrows point in the same direction, presumably the direction of the exit.

I finally get to the window and tell the assistant who had told me aeons ago she'd be with me in a moment that I'm trying to get a flu shot.  She's wearing one of the t-shirts: "Get your flu shot today."  She asks if I've had a flu shot at Walgreen's before, I say yes, and she looks me up in the computer.

Asks, "Insurance the same as last year?"  I'm baffled.  I didn't have insurance last year.  I haven't had insurance since the spring of 2007.  I'm afraid I'll create more delays and complications if I explain this, so I simply say, "No.  I'm not insured."

She fiddles at the computer several minutes and then says, "Go sit in those chairs" (pointing to the chairs arrayed outside the stanchions and aisles) "and I'll bring you papers to sign in a minute."

I sit.  I wait.  Some fifteen more minutes pass.  The wait is made less tedious because the wan, weak man who was previously in line and who is also now sitting down is a talker.  He talks a while to the woman next to him, who is holding her baby.  The baby is named Jamal, and is cute as a button, but worried-looking.

He then asks me, "How are you doing?"  I reply, "Fine, thank you.  How are you?"  "Not so good," he says.  "My kidneys don't work and I get dehydrated.  When that happens, I get so weak I can barely walk.  I can't breathe and my heart races."  We then talk about his medical problems.  He had a liver transplant six years ago, the steroids he had to take in conjunction with that blew his kidneys out, and so one step forward, two steps backwards, medically speaking.

The assistant comes at last with the papers to sign.  I read through them and find our address in Florida from 2006-2007 is given as my mailing address.  Not sure how that temporary address ever got registered as our address in the Walgreen's computer system.  And I had corrected this last year when I got a flu shot.

I cross the misinformation out again and write in the correct information.  Again.  I correct my doctor's name, since Steve and I switched to a new doctor several months ago.  I tick boxes, write in explanations, and sign.  I'm ready.

Ready, that is, to get back into the line and go back to the windows.  Another 10 minutes, and I'm back at a window to turn in the papers.  The pharmacist takes the paperwork.  I explain that I have a new doctor, whose name I've written on the form, but I don't know his address.  Pharmacist looks the doctor up in the computer, seeming puzzled and unable to find him, but finally locating his address.

Then he tells me to go and wait in the chairs again.  He'll be with me when he's free to give the shot.  I go and sit again.  After about 5 minutes, I hear the pharmacist calling me back to the window: "I thought she had rung you up.  I see she didn't.  The shot's $31."   I hand him my credit card.  I pay.  He tells me to go and sit and wait again.

I go and sit and wait.  Again.  The pharmacist finally emerges from behind the screens and directs me into a room where he gives the shots.  I'm quickly given a shot, some papers to take with me, and a little red heart to plaster on my shirt, informing the public that I've had a flu shot.  The whole process has taken around an hour.

I leave, passing several employees whose t-shirts say, "Get your flu shot today."

And so this is how health care is delivered in the greatest nation on earth, the one with the most advanced system of health care provision in the world.  This is one experience of health care delivery in the greatest nation on earth, that is.

I'm fortunate to live in a city that has quite a few health care facilities.  I'm also fortunate to live in a part of that city that is relatively affluent, where waits at clinics or waits in pharmacy lines can be somewhat shorter and less harrying, I suspect, than in less affluent parts of my city.  Not everyone in this country, by any means, lives in places in which it's so relatively easy to access health care delivery systems.

I'm not fortunate in that I do not have health care insurance, and so I'm one of the many relegated to the wobbly, antiquated, malfunctioning structures that try their best to provide elementary, unsophisticated care for the masses, without the resources to provide such care adequately.  And so, even though a large banner outside the local pharmacy giving flu shots this season advertises the shots, once a person seeking the shots walks through the pharmacy doors, s/he has gone down the rabbit hole with Alice, as the preceding narrative indicates.  S/he is likely to find it very difficult to figure out how to obtain that tantalizing flu shot advertised by the big banner and t-shirts.

And s/he is likely to be expected to invest a significant chunk of the workday in waiting for the shot and dealing with red tape--no small consideration for people with jobs, whose workplace is not likely to let them leave work for unspecified lengths of time for such waiting games.

It could, of course, be different.  We could have a health care system that provides basic health care for everyone, funded by the taxes we all pay.  (In our city, we have just passed a tax initiative that raises the amount of sales tax we all pay on all items we purchase.  That initiative had heavy support in the affluent sections of the city.  It was rejected in the poor and working-class areas of the city, since funding public services through sales taxes places a disproportionate burden on the shoulders of the poor.)

We could, in the most advanced and greatest nation on earth, have a system of basic, state-funded health care that makes something like preventive flu shots for the elderly or the health-impaired available in a streamlined, no-fuss way through a system of local clinics set up at certain times of the year, administered by nurses or other health professionals qualified to give such care.  I've seen such clinics at work in far less advanced nations that are not the greatest nations in the world.  They work just fine, and they perform a valuable service for public health.

But we seem unable to get anywhere near these benchmarks in the greatest nation on earth, the one with the most advanced health care system in the world.  And so maybe what we think about ourselves as great and advanced is as wildly off the mark as we are wildly off the mark in meeting the goal of providing basic, no-frills, no-nonsense health care for all citizens.

I'm certainly inclined to think this might be the case, every time I try to get a flu shot in recent years, as one of those aging (but uninsured) citizens who is advised to take this precautionary measure as flu season nears.

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