A Look Inside Our Two-Tier Health System

When strep throat hit our family this week, I had the eye-opening opportunity to compare the two worlds of health care in a single day.

MediCal

Under the new health exchange, my children were put on Medi-Cal, our state’s new and expanded program of free health care for low income families, (Medicaid in other states). My husband and I, on the other hand, were offered a subsidy to buy private insurance if we chose. So when strep throat hit our family this week, I had the eye-opening opportunity to compare the two worlds of health care in one day. Until this week, I was blissfully unaware of the disparity in health care access between those with private health insurance and those on Medi-Cal. This story needs to be told.

In one day, I spent a total of 8 hours trying to get my son the care he needed. I spent only 20 minutes on myself. How did that happen? What challenges do Medi-Cal patients face?

Ludicrous Difficulty in Getting Paperwork Processed

Under the health care bill, Medi-Cal was expanded, and our local county Medi-Cal office received 30,000 new applications, according to an agent I spoke to. But they did not hire any additional staff to process them! How could this happen? The people affected by the resulting paperwork nightmare are the least likely to voice a complaint.

So it should come as no surprise, then, that although my paperwork was filed on time in December, and my children were approved to receive coverage starting on January 1st, as of March 25, we still had no official cards that would allow me to take a sick child to see a doctor. The office advised me to use the emergency room for any illness, however minor, and to call them if a child actually got sick so they could rush the paperwork through. Even “rushing” it through took several phone calls and five days, but by a true miracle, someone was finally able to give me the ID number over the phone by the day I really needed it.

I should add that, anecdotally, wait times for paperwork were not that great even before the flood of new applicants this year. One acquaintance with chronic and urgent health problems still had to wait 45 days to get her application reviewed. Rich or poor, everyone should have access to basic health care. This kind of delay is simply unacceptable. We are asking those with the least resources to somehow find the time and energy to fight their way through the system, spending hours on the phone, usually on hold, week after week, just to get someone to review their documents and mail them a piece of paper. Since we moved here years ago and I began following the local news, it seems that whenever California has a budget crisis, (which is always,) we cut funding to Medi-Cal and programs like it. The people affected by our callousness are real human beings, many of them my friends.

Challenges in Finding a Doctor

Our next challenge was in finding a doctor who would accept Medi-Cal insurance. I had foolishly assumed that most doctors would accept our insurance, or at least all the doctors who were affiliated with the various hospitals that we were approved for, including Stanford. It was going to be simple, right? Unfortunately not.

First, the Medi-Cal website which would refer us to a list of doctors in our area was– big surprise– not working. So I used one hospital’s hotline to refer us to a doctor. I hope that, with lots of diligence on my part, I will find additional doctors, (***See my new note about finding doctors at the conclusion,) but the hotline operator told me that she only had information for two– yes that is TWO– doctors in the area who would accept Medi-Cal. We tracked down one of them at the Fair Oaks Health Center in Redwood City. They told me that we could go in to see the nurse without an appointment, so we made it over there by late morning.

Segregated Medical Facilities?

The Fair Oaks Clinic was in a poor section of town, but behind their old building, which now appeared condemned, I saw with relief that they had built an attractive new building. The Mercury News reported on this new building that it would serve 20,000 “low-income residents in the southern part of the county, a group that is mostly Latino but also includes Tongans, African-Americans and Vietnamese, according to the county. The next closest county clinic is in San Mateo.”As we parked and wheeled my feverish child inside in his stroller, I was naively hopeful that we could get the simple strep test and be back home by lunchtime.

The clinic turned out to be a one-stop shop for all kinds of medical needs– from optometry to dentistry to pediatrics, and including a pharmacy. The atmosphere inside was very different from anything I had experienced in the many various clinics I’ve visited in my life. There were people everywhere, waiting in line in different areas, but most everyone was friendly and seemed completely unhurried.

The decor was new and clean, but absolutely bare bones. There was none of that forgettable artwork that you expect in a doctor’s office. There were no tables or magazines or toys or TVs. Our area upstairs had been filled with perhaps 30 chairs in rows. Children climbed over and under the chairs and amused themselves as best they could.

After waiting for a half hour to add our names to the list, the man managing the waiting room informed us (in the kindest possible way) that they would be closing for lunch, and we should come back in about an hour.

After lunch, this man processed our new patient paperwork and told me all about the clinic. In the future, we should try to come as close to 8 am as possible if we wanted to be seen that day. Apparently they have only one nurse on any given day, and there is a rush every morning when they open their doors. Furthermore, I should call ahead to check whether they would be open at all that day. Because they are so short-staffed, they often have to close their doors when the nurse can’t make it or when they need to hold a staff meeting.

We were lucky, though, there were only two people ahead of us in line, so we would get in today. Only two people, I thought, That shouldn’t take long! An hour and a half later, we were finally admitted. The nurse brought us back to a room and interviewed us thoroughly before finally taking the strep test. I was impressed by her patience and kindness and her real interest in our family. Here, we were not numbers to be shuffled through, as I sometimes feel at Kaiser. We were human beings. But the price of getting such personal attention was waiting a very long time to be seen.

Shortly after that, she reported that the strep test was positive, so he would need an antibiotic. But as a nurse, she could not prescribe it. We would have to wait until a doctor was available. Again, we were lucky to be seen at all, since they had a limited number of doctors. But another hour later, the doctor admitted us. Once again, I was impressed by the doctor’s friendliness coupled with a complete lack of hurry. She considered all my son’s symptoms thoroughly before agreeing with the positive test result that he most certainly had strep throat.

Next they sent us downstairs to the pharmacy, where, again, we waited in line for a long time. The pharmacist, like the nurse and the doctor, was really cheerful and thorough in making sure that I understood the directions.

It had been 8 hours since I made the initial phone call that morning, but my son had been seen and gotten the medicine he needed. The visit was completely free, and everyone was friendly and kind. But it was a grueling ordeal to manage with two small children, one of them sick. I cannot imagine how this system must affect those who get hourly wages. How could a working single mother, for instance, afford to take an entire day off work every time her child needed medical attention? But everyone at the clinic seemed to expect it would be this way. They knew the system; they were used to it, and were making the best of it.

***

By way of contrast, when I went to get my own strep test that evening, I simply dropped by Kaiser’s evening clinic, brought in my card (which I had received promptly by mail with no hassle at all), and was in and out in 15 minutes flat. During our breezy 7 minutes in the waiting room, we sat on padded and comfortable chairs, and looked at a magazine while the kids investigated the fancy water dispenser. When the test results came in, I received an automated email. What a radically different experience from the morning!

***New note: It’s been a week, and here is some new information and good news! There was yet another level of processing that I was unaware of. Now that my children have jumped through that extra (and final, I hope!) hoop, we have been referred to a different website which works and which shows many more options for doctors who will take Medi-Cal patients. Hallelujah! As it was, we did go to the best place for us under the circumstances. Fair Oaks was one of the few clinics that would see new patients without an initial healthy-visit appointment.

Also, I see on this new website that our county has 100,000 Medi-Cal patients. So adding those 30,000 new members without extra staff is no trivial project!

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