How It Is Done Here

I spent three hours at the opthamologist’s yesterday and left without what I went there to get.   I was screened for glaucoma and every other eye disease, after a very detailed vision test with the nurse.   Unfortunately, the doctor said, he could not give me a prescription for new glasses because nobody would pay him for it.   “I used to get $20, I’d charge $40 sometimes,” the solo practitioner with the crowded waiting room told me, with only a slight complaint in his tone.   In a few months, when I get the EOB from my insurance company, I’ll learn how much he made to spend ten minutes with me yesterday, above the $25 copay I had to make in cash. I’ll bet they pay him less than $100 for all those minutes.

The doctor claimed, at 4:00, seeing me for my 1:30 appointment, that the optometrists’ lobby (who knew, but why wouldn’t they have one?) had made it virtually impossible for an opthamologist to write a prescription for glasses.  Then, twenty minutes later when the drops had fully dilated my pupils, he chided me for my reflex to close my eye when something with a bright light approached to touch my eyeball to measure it’s pressure.  

“It’s not a reflex,” he corrected me, possibly incorrectly, “you just have to control it.”   On the second or third try he was able to touch the sensor down on my right eyeball, move it around.  The left eye wasn’t as cooperative.   Three tries and I was still blinking when he tried to touch the probe to my eyeball.  He snarled at my lack of cooperation.

“I’m not trying to be a difficult patient, doctor,” I told this affable, slightly gruff eye doctor.

“But you are being a difficult patient,” he said, suddenly graduating from gruff to asshole.

Funny, I had no reflex to say “I might have been a less difficult patient after waiting, say, only 90 minutes, or a scant two hours, for this exam you already told me will not result in what I came here to get, namely an updated prescription for these fifteen year old glasses.”

Nor did it occur to me, angry, scrappy, no tolerance for assholes person I have long been, to say “nor is it a reflex to be a dick, particularly after keeping a patient waiting for almost three hours.  You can control it.   I don’t give a fuck about how much you used to be able to charge for a prescription.   Or how important you think you are, or how sincerely you believe your droppings emit no foul odor, nor any of the rest of it.   I’d be tempted to tell you to fuck yourself a little, but I’m trying to be like fucking Gandhi these days, so kiss yourself instead, my brother.”

The doctor also informed me I have something called blepharitis.   I asked him how one gets blepharitis.   “Bad eyelid hygiene,” he said conclusively, making another note in my new file next to the large printed circle that was one of my eyeballs.   He didn’t seem concerned about it, told me to buy eye wipes and gently scour the area between the hairs on my lower eyelid and the eyeball itself.   I asked how often I needed to do this.  Every day, he said, for the rest of your life.

This guy was just a hardworking American doctor running a successful neighborhood practice.  People are used to waiting as long as they need to in order to see a doctor.   This guy had a waiting room full of people the whole time I was there (though the number grew over the course of the hours I was there).   They were all fairly passive, patient, used to waiting as long as it takes to see the great man.  Every one of them using their cellphones, though the office was plastered with NO CELL PHONE use signs.  The doctor, in fact, snapped at me to turn off my cell phone as he escorted me back to his office.   Nobody but me, I suspect, had any second thoughts about why it took more than three hours to see the great wizard. 

My conversation with the nurse who did the actual vision test was a bit more interesting.  She looked at my paperwork and insisted I fill in my social security number, as requested on the form.    I resent this insistence on something that was once very private and is now required by every bloodsucking corporation one deals with.   I described to her how I’d worked for a bloated, amoral leech, a collections attorney, who had taught me the great value, to creditors and their attorney partners, of a social security number.    You can freeze all their bank accounts, for example, take whatever money they owe you by serving a restraining notice on the bank, sitting back and waiting for the panicked debtor’s call.

“People owe the hospitals millions of dollars they never pay,” she said indignantly.  “Millions!”

I, myself, have an unopened stack of bills from hospitals, and collection notices from an attorney for the most aggressive of them.   I said nothing about this, what was the point?   I told her how many corporations now obtain legally enforceable default judgements, obtained fraudulently by not informing the defendants that there is a case against them.   Since they have no notice of any court case, naturally the alleged debtor doesn’t show up, and bingo, Bird Wins!  Default Judgment.  Their unethical attorneys get bundles if judgements on default, worth many, many millions annually, by simply not serving the required legal notice on millions of suckers.  It’s called “sewer service”, create the legally necessary “proof of service” and put the required notice that your proof swears was legally delivered, directly into the shredder, or sewer, whichever is handier.  No harm, no foul, courts are too busy to inquire into cases where only the powerful side shows up.

I told her that American medical care, the most expensive in the wealthy world, also has far from the best health outcomes.   We argued this point for a moment, with her going on about how poor people in America have the best insurance in the world, then I made my next point, about medical insurance.  

A big part of the cost of expensive American health care is the army of private middlemen who take their cuts.  Why are insurance companies involved in health care, again?   It was an interesting talk, after I conceded her the last four digits of my social security number.  She gave me an excellent and thorough vision test, the results of which I, arguably, do not own.    We call this free enterprise, the free market, the right of entrepreneurs, large and small, to be rewarded as handsomely as possible for the risks they take to make a profit.

Dr. McGruff did give me a recommendation to a local glasses store where there is a young optometrist who seems pretty sharp.  I require a prism lens in my glasses, to make my eyes cooperate more smoothly with one another as they get tired from the endless tracking that is reading.  Prisms are tricky, the opthamologist told me, and I should go to a recent optometry school grad to prescribe the exact prism I need, slightly different from the ones I’ve been wearing for more than forty years.

The insurance company offered me “vision” with my health insurance plan.  It was about $10 or $20 extra a month, but did not include glasses.  It would, presumably, pay the $30 to $50 I will pay this young optometrist for the eye exam.  I figure for the $120- $240 it would cost me for the year, I will make out OK on this particular deal, just like I did with the $88,000 I was charged for Rituximab.  

God bless these United States, eh?  Will you do that, God?   Can I get a fucking “amen” here?

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