Delving into Health Care: What I've Been Doing and Thinking on My Sabbatical

Many years ago, I worked with a fellow UXer who was studying at nights to get his massage certification. I asked him why, a little puzzled why he'd be exploring this, when he was clearly great at his job and making loads of money at it.

"I figured I needed to learn a trade," he said, "And I enjoy helping people."

Many years later, I'm also getting my massage certification. I get it now. My initial draw to UX was that I could ultimately feel that my work was helping others. With massage, there is no question as to whether my existence and efforts are actually helping someone. The work is meaningful, direct, and immediate. It's wonderful.

As part of the massage training, I've also been volunteering in the field, working with patients, and I've had the opportunity to interview different health practitioners about the ups and downs of their professions.

Today, after a volunteer shift at Services for Brain Injury, a few insights absolutely hit me like a hammer:

1. Even when the patient's insurance covers services, not enough of it gets covered.

Patients are already forking over a huge sum of money every month for their now-obligatory coverage. When you add in the extra payments they must make for routine visits to doctors, the cost of getting there, and the cost of maintenance medications, they are paying a huge portion of their income every month to a machine that frankly shows little benefit. Why are they paying 300-800 per month when they need to pay more on top of that?

2. Insurance doesn't cover what people actually need.

I am especially seeing this problem with patients with acquired or traumatic brain injuries, and it breaks my heart. More or less, when you have a brain injury, you are given a mere 12 therapeutic visits per calendar year, following your incident. That means, three months after your injury, no more proverbial soup for you. Nada, nothing, zip.

So God/Allah/Buddha/Entropy help you if you have your head injury in January. God et. al help you if you have a slow recovery. By the time your full coverage is re-engaged the following year, you may feel so bitter and defeated by your setbacks that you may not wish to re-engage, and yet you NEED to keep your brain active THROUGHOUT your recovery period in order to better activate different parts of your brain to take over for your deficits.

Added to this (and I know I'm biased here, but bear with me), massage is not covered. Granted, as a profession, it's still bearing the stigma of adult entertainment, but I am convinced that in order to correct, rehabilitate, and strengthen musculature and the motions that they perform, the muscles must first be relaxed and able to achieve their full length, so as to execute motion smoothly and comfortably. If the person has had a stroke, head injury, or any injury, changes and shortening of muscles can occur within days of the incident. If the joint remains immobilized, soft tissue shortening can occur in as few as four weeks. 50% of stroke and head injury patients will develop at least 1 contracture within 6 months of the incident. Contractures are shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.

Massage can release this. Massage can prevent contractures. Massage can help the muscle remain supple so that it's available to function as the body and brain recover.

You've seen contractures in your friends, relatives, and war veterans. You may have some soft tissue shortening because of a break, fracture, strain, or sprain in various places of your body. It's common, yet because it's not a covered treatment by insurance, nobody gets treated for it.

Here's Rick, one of the patients we see at Services for Brain Injury. This photo was taken in 2012, and his right arm is looking relatively relaxed here, but without proper treatment, contracture is something he struggles with. He was injured in 1991, while serving as a Marine during Operation Desert Storm. He was in a coma for six months, and when he woke, his entire right side was weakened.

As a man who lived life through his tall and able body, this was devastating. And yet, there are limited services for this guy, who has an immense will and determination to serve. Rick is getting ongoing services through the VA, but the belief as to what constitutes care per his programs is limiting. His story is one of the few I can speak of, since his story was featured in the San Jose Mercury.

Rick Peralta, Lance Cpl., U.S. Marines

3. Your insurance coverage dictates your course of care

Health care practitioners didn't take courses in school regarding insurance and reimbursement payments. No, there they learned how to actually take care of you. When these young professionals entered the market to heal the sick and repair the wounded, many--or most/all of them were plunged into the craziness of premiums, copays, insurance formularies, and their own compensation models, and they had to add this layer of bureaucratic nonsense on top of their actual care knowledge.

Your health insurance determines who gets served first in the emergency room and hospital. Your insurance coverage determines whether you get treatment A or B. Health care providers most of the time don't even tell you that another option is available, if you wanted to pay for it. They assume (probably rightly) the majority of the people won't pay for it.

4. Health care practitioners don't get paid jack, compared to what insurance companies charge.

This one gets me especially angry. It's the classic worker-vs.-administration problem, but with an extra layer of BS. I know there's the prevailing belief that doctors get paid tons of money, but compared to dot-com money, it's nothing. And when you consider what your nurse and physical therapist get paid, it's even less, and that's appalling.

Yet more loathsome still, when I compare the significance of the work that health care providers do (saving a life; healing the sick; helping little kids live a full and vibrant life) versus what we do in dot-com on a daily basis (Farmville; foosball; political catfights over prestige, image, or button placement on the Marketing home page; music on a video game), it gets me stirred up.

If these practictioners aren't being fairly paid, why the hell are we paying so much for our services, then? My last ER visit was worth at least the full monthly salary of one of the nurses who visited me for ten minutes. Heck, when I think of my last blood tests, that could have paid for three days of the phlebotomist's pay.

What the hell is going on?

We are paying for the insurance tennis match between the health care provider and insurance. We are paying for Marketing folks at the health care provider level and the insurance level. We are (sigh) paying for the dot-commies who are making the Marketing websites :(

Observations to Actions

I want to be part of the solution. I want to help people in ways that are immediate, meaningful, and when possible, direct. Our health system has evolved with some sincere intentions, but the health system needs the Care put back into it. As I consider my return, this is a critical value that must be answered in my next job. I want to be part of creating a solution for the future, not perpetuating the problems.

#HealthInsurance #HealthCare