taken care of

A couple months ago I started to notice sensitivity on one side of my mouth to hot, cold and crunchy things. After pretending for several weeks that nothing was going on, I couldn't ignore it anymore. And I found myself in a situation I'd never been in before. I had to decide whether or not to get medical care based not on whether or not I needed it, but if I could afford it.

Growing up, this scenario would never have crossed my mind. As the child of a doctor and a nurse, my every pain and complaint was looked up in the Merck Manual and sent to a local specialist. The resulting diagnosis was then run by various medical acquaintances around the globe, just to be sure nothing was missed. Occasional sharp pains in my right knee? X-rays, orthopedists, and physical therapy. A day of vertigo? CT scan, MRI, and a visit to a neurologist and an ENT specialist. A nasty but routine case of a tropical illness? Med-evacc'ed to Singapore accompanied by an American EMT within hours of diagnosis. No potential problem was every left unaddressed, and cost was never an issue.

But here I am in the real world, with an annoying-but-not-debilitating sensitivity in my teeth that might (or might not) be an indicator of a cavity (or something even more unpleasant), which will almost certainly get worse (in terms of both pain and cost of treatment) the longer I let it go. And as for paying for it? I'm on my own.

And here again I'm getting just a little taste of the uncertainties and ugly trade-offs my clients face. It is absurd that dental and vision care are not included in regular medical insurance (as if the ability to eat and see were somehow non-essential). It is sick that people with incomes over $707 per month are expected to be able to pay for their own healthcare in New York City. (For a point of reference, that's a little bit less than what I pay for rent, utilities, and a monthly subway pass each month, and I'm not exactly living large).

As strange as it feels to consider forgoing a needed dental examination because of the cost, my situation is pretty tame. A few months ago one of my clients told me he had a growth on his neck that was getting bigger, but he couldn't find out if it was malignant or benign because while his unemployment benefits put him above the income range for Medicaid, they also didn't come close to covering the cost of a consultation or insurance.

My story doesn't turn out too badly. I figured out how to afford a dental check-up the same way I afford to get my hair cut in the city (letting a student do it). Turns out there was no cavity, so I'm probably off the hook.

But I wonder what happens to everyone else.