Second Verse, Same as the First

I have a patient with hepatitis C. She had some signs of cirrhosis (fibrosis in the liver, which is one of the effects of the virus), and she wanted to get treated, which usually requires a liver biopsy. So I referred to the liver clinic.

They sent her back to me saying that she needed an ultrasound beforehand. The ultrasound showed a possible mass, which could be liver cancer (hepatoma). In my discussions with the liver people we decided that she needed an MRI to rule out the hepatoma before moving forward with her Hep C treatment.

So like a good little monkey, I ordered her an MRI, filling out all the forms and getting all the prior approvals, kissing all the rings on all the HMO fingers.

But since it wasn't an emergency, they gave her an MRI date five months in the future.

One week before she's supposed to get scanned, I am contacted by the MRI techs. Why? Her ultrasound (remember that?) is now TOO OLD, so she needs to get a new ultrasound before she can get her MRI.

So okay. That would be a good end to the story: unnecessary bureaucracy causing the need for multiple imaging, the waste, etc etc.

Except that's not the end of the story. Because of course, it's impossible to get an ultrasound in one week, so she ends up missing the MRI appointment that it took so long to get. Now it'll be God knows how long before she gets scheduled for another MRI. (And by the time it rolls around, the repeat ultrasound i'm getting today will be outdated. Repeatedly. Again.)

All this time, there might be a liver cancer growing in her belly.

Could a thing like this happen under another system of healthcare? Absolutely. Might a single-payer system require non-emergency MRIs to wait a few months? Of course.

So really, this story is for those who live in fear that single-payer healthcare will give us long waiting periods. Let's be clear about it: we've already been given long waiting periods. The HMOs gave them to us.

But what the HMOs giveth, we can taketh away. We just have to decideth to.