My Nicaraguan pediatrician friend astutely summarized her work: First you make the clinical assessment, then you make the financial assessment. In other words, a clinician may know the right treatment, but what good does that do the patient if the treatment is entirely out of reach financially?
In the clinic where I work, we don't take insurance. It's not a concierge practice but a church-based one, run on grants and hardscrabble for decades. For a provider, there's something freeing about not having to consider insurance. There's no frantic search through formularies, no restrictive list of specialists, none of the prior authorizations that suck up time and stamina--all things that have nothing to do with patient care but must happen in the insurance world. None of that.
When I retired from teaching in a suburban school district north of Detroit in June 2003, I left Michigan for my hometown of Pittsburgh with boxes of belongings, twenty-nine years of memories, and health insurance tied to my state pension. That insurance has served me well--except when it has not.