Election anxiety has America on the edge of its seat. I anticipated long lines and a lot of drama, so I voted early to avoid the rush. That left me with nothing election-related to do today, so I decided to head over to my local pharmacy and get a flu shot instead.
Last year the flu vaccine was only 50% effective because experts did not correctly predict which viral strains would victimize Americans. This year I have my fingers crossed that the Brisbane and Florida strains included in the vaccine will do the trick. After all, Influenza is the single leading cause of vaccine-preventable disease in the U.S., with estimates between 15 million and 60 million cases in the US a year among all age groups. Influenza leads to 200,000 hospitalizations and about 36,000 deaths a year in the U.S., mostly in infants and the elderly. I’ll never forget the touching story of how one family lost their three and-a-half year-old daughter to the flu.
So I arrived at the pharmacy only to find a disorderly group of flu-shot seekers, pacing near the entrance to the retail clinic. About 20 minutes later a young woman with a clipboard and sign up sheets came out and started asking people what kind of insurance they had. When my turn came she informed me that my insurance plan was not participating, and suggested that I leave. I asked if I could pay out-of-pocket for the shot and she said that I could and gave me a consent form. More people arrived without any movement in the line, and I overheard one person commenting that the nearby polling booth wasn’t moving as slowly. Another customer decided to leave to go vote and then come back later for the shot.
Forty minutes later my name was called and I entered a small room littered with papers and syringe caps. I rolled up my right sleeve and asked the technician about his injection technique. I watched him carefully draw up half a cc of vaccine from a multiple-use bottle.
He then asked me how I was going to pay. I presented my credit card and he said that he only accepted cash or check. I said that I had no idea that credit cards weren’t accepted and he seemed surprised that I wasn’t aware of the retail clinic policy. A large envelope was leaning against his chair leg, full of $30 cash deposits for the shot.
Not eager to go back out to wander the pharmacy aisles and wait for my turn again, I asked him if he could give me the shot and then I’d nip out to the ATM and return with the fee.
He looked at me narrow-eyed, perhaps assessing my “flight risk,” and then replied in a thick African accent,
“Since I left my country and came to America, I learned that you have to trust people.”
So I received my flu shot and found an in-store ATM and brought him back the cash. He didn’t look up from his injecting. I thanked him and went on my way.
There was something about this experience that brought home some of the issues that my fellow bloggers have been discussing with great passion over the last few years:
1. Primary care is slowly being taken over by non-physicians. Politicians don’t seem to be giving much thought to the dwindling PCP base (focused instead on universal coverage), while lower level providers are stepping in to fill the gap. In addition, foreign medical graduates will probably make up the bulk of our primary care workforce in the future.
2. Insurance is a strong gatekeeper to care, but can be overcome with personal cash.
3. The quality of healthcare is decreasing, as procedure-focused specialist fragmentation continues to replace long term healthcare professional relationships with patients. Dirty offices and patient processing mills are fairly common.
4. Long lines, increasing wait times, and disorganized processes and procedures are the norm.
5. We do have access to public health basics like vaccines, but it’s up to the individual consumers to go get them.
6. America is still more trustworthy as a culture than some others. There is reason for encouragement in the fact that Americans are generally honest and trustworthy. That’s nice to hear.
Overall I guess I was a little bit saddened by what I saw today – mostly because it was so emblematic of a system-wide degeneration in healthcare that seems inevitable as needs increase, supplies are limited, and the economy strains to get out of the red.
I got more than I bargained for on this election day. My flu shot gave me a snapshot of American healthcare.