|
The
Case for HMO Reform
by Nathan Treadwell '01, Framingham, Massachusetts
 |
| Nathan Treadwell '01 saw the dark
side of the health care system. |
South Side Clinic is nestled into an alley by the Salvation Army
Thrift Store, in a neighborhood that I've been told to avoid past sundown.
It's perhaps a quarter-mile from the clean-looking MetroWest Medical Center,
its grudging parent, but it lives amongst liquor stores instead of lawn
gnomes. Actually, it's a nice, sleek-looking building. It's just that all
the lights are off. I bang on the window.
Eventually, Dave, wearing the only black lab coat I've ever seen, pokes
his shaved head from the entrance. "Sorry about the door, the insurance
Nazis make me keep it locked after business hours. Not much to loot here,
though." He's not kidding. No wall clock or soothing art, bare light bulbs
on the ceiling. The waiting room magazines are very obviously his: American
Biker, The Journal of the American Medical Association, some outdoor
sporting stuff. And the unstaffed reception desk lacks a computer; it is
covered instead with more empty coffee cups than I generate in a term.
He leads me into his office. Papers cover his exam bed. "I pretty much have
to do all the paperwork out of here. No central database, no records storage,
no secretary." Tenet, the corporation that owns MetroWest Medical Center
and the South Side Clinic, has come under new management that is somewhat
less charitably inclined. "The healthcare market's been scrambling lately,
with all the attempts at reform. They don't see caring for homeless ex-junkies
as a real gold mine." He laughs.
We head out to his truck and begin driving to the homeless shelter he works
nights at, a few blocks down. When we arrive, a few guys in sweatshirts
and jeans are standing around the front door, smoking and talking in the
dim light. The building could pass for one of the small private residences
in the area, except for a parking lot full of derelict American-made cars
that looked like they had just survived a Blitzkrieg. As we head for the
door, the men look up and smile. "What's up, Doc?" one asks.
"Where the hell have you been, Paul? I thought you left town."
"No, I got discharged yesterday. Pumped the stomach, and I was in detox
for a week."
"They're shipping you guys out after a week now? God." He pats him on the
back and, looking disdainfully at the cigarette, says, "How the hell do
you move furniture and still do that to your lungs? You complain to me about
shortness of breath, and you can find another doctor, all right?"
When we leave the main office, four or five people from the shelter are
standing around. They promptly assault Dave with greetings and concerns;
he starts moving the group down the hall into a tiny room with peeling paint
and a big-screen TV. One by one he sits people down on the beat-up couches,
asks questions, checks blood pressure. His friendliness surprises me; he
goes through the motions like he's at a friend's house for the game. Maybe
it's just that he's doing the "appointments" in front of 10 other people.
"So I hear you relapsed, Paul?" His question is met with a grim nod from
a big, red-haired Irish guy. "That's a shame. And a lesson, too: No booze
when you're on medication." He points to Paul. "I told you, you don't mix
that stuff - What was it, Wellbutrin? Well, you don't mix it with alcohol.
You'll ruin your liver. How's that working, by the way? Feeling any better?"
"Yeah, better. That shrink, what's her name? On Post Road? The fat one?
She upped my dosage. Said it'll help me stop smoking." He laughs.
A kid, maybe 18, leans forward and takes off his Pats hat. "Whassat? Wellbutrin?
That a painkiller?"
"Antidepressant," Paul answers. "And it makes you not want to smoke. Something
with the nicotine."
"Aw, Paul, you're not depressed. Why the hell are you depressed? You got
a good room, you didn't get fired, get good money, got a girlfriend. Hell,
I should be depressed." A few of them begin to laugh and poke fun at each
other, and Dave leans over and whispers: "Dual diagnosis. You can't get
government money just for being an addict anymore; you have to fake mental
illness. Only way these guys get medical."
The arguing subsides a bit, and Dave asks if everyone's had their Hepatitis
vaccination. "You know Freddie Beckette? Big black guy? That's what he died
of, hepatitis, the year before they developed the vaccine. It screws up
your liver, and most of you don't have much liver to lose. So you guys give
me a call if you want one, during the day."
"Can I get one now?" the anxious woman asks eagerly. "Do you have it here?"
"Not on me, no. I can give out flu shots, though." He grins, pulling out
his black bag. "Anyone want one? Flu shot?"
He takes out a syringe and starts prepping it, but there aren't any takers.
He turns to a big guy in a green sweatshirt. "Jerry, come on. You shot smack
for what, 10 years? And you won't get a flu shot?" Jerry shakes his head.
"Then don't you complain to me when you get the flu, okay? Anyone else?"
I need a flu shot, so I interject. "Yeah, sure."
Dave smirks. "Jerry, you're gonna be shown up by a scrawny little kid? Jesus,
what's this world coming to?" Jerry pushes up his sleeve and swaggers over,
and Dave injects him and gets out another needle. "There, that wasn't so
bad," he says, sarcastically. It's getting competitive now, and just about
everyone in the room volunteers, rolling up their flannels, taking off their
Pats jackets. When he gets to the last one, a wiry 60-year-old man wearing
red suspenders and grinning into space, it takes him three minutes to find
a vein in his arms.
We head back to South Side.
"I got started with this in med school, in Utah. They had a clinic, I had
spare time, I needed experience. So when I came out here and no one wanted
to run this thing, I got ordained. Apparently a third-year resident has
enough experience to start his own practice."
"So how many homeless are there here?"
"What, in Framingham? Thirty. Want to know their names? More are in the
shelters, and lots of people come to South Side during the day. From Hollistion,
Natick, Worcester even."
I head into his office to get my bag, composing questions in my head. What
do you like most? Ever seen a dead guy? What's the hardest part? But when
I come out he's asleep on his desk, stethoscope snaked beside him.
|
