As a child, I was taught that it is wrong to covet, that wanting what others have is a deadly sin. I have tried to abide by that admonition all of my adult life. So, with a twinge of guilt, I here and now make this public confession: Despite strenuous efforts to resist longing for that which is not mine, there are moments when I am overcome with a desire to change places with my dog.
Just how much became clear recently when I read the mail sent to my home from the Kenhaven Animal Hospital in Rockville for Toby, my 11-year-old English springer spaniel. The postcard reminded him that it was time for his "Intra-trac bordatella boost, DHP-Parvo Annual Booster, Leptospirosis vaccination, and Heartworm antigen Snap test."
It hit me then and there: In more than 40 years of uninterrupted participation in America's health care system -- a period during which I never missed a premium payment, always paid my deductibles and co-payments on time, unfailingly presented myself for examination in clean underwear and with all teeth brushed, always received whatever treatment was dispensed with gratitude bordering on obsequiousness -- no doctor's office has ever initiated contact with me about anything remotely related to the maintenance of my health and general well-being.
To be sure, there have been a couple of occasions on which the doctor summoned me to retake a lab test because the first result was inconclusive or marred. In those cases, the doctor's office had no choice but to contact me. Usually, I'm the one who does the calling.
In fact, were I summoned home to Glory tomorrow, I doubt my doctor would be any the wiser five years from now.
Not so with Toby. Like clockwork, he hears from his doctor every six months and in writing. Toby is told what he needs, when he needs it and where to come get it.
My envy doesn't stop with Toby's correspondence.
He usually lands an appointment with his doctor within one day, two days max. I'm lucky if I can get on my doctor's calendar within two weeks for a non-emergency visit. Make it two months, if it's an annual physical. But more on scheduling disparities a little later.
I drool with envy at how well Toby's received when he walks through the door.
The receptionist at Kenhaven smiles, greets him by name, asks how's he feeling. She actually seems glad to see him.
Mine, on the other hand, appears to take offense that I'm there. She never fails to make me feel as if I'm interrupting something important and therefore have it coming if she's put out with me. Before shunting me off to a seat, however, she always remembers to demand my $5.
But it is on the matter of actually scheduling a doctor's visit that my comparison with Toby's treatment becomes most invidious.
In visits for physical examinations during the past two years, my doctor -- who answers to the official designation "primary care physician" -- was not to be found. Don't get me wrong. He wasn't hiding. It's just that he's always booked up. To be seen by him means waiting until the seasons change. To get a physical examination within a month, on the last two occasions, I had to accept doctors-lite.
One bore the title "physician's assistant"; the other, "nurse practitioner." (Ask me not what's the difference.) Both "health care providers" touched and probed my aging form, asked pretty much the same questions and promised to convey to the physician what they found. He in turn, they promised, would be in touch should they find cause for alarm. The bells have not yet tolled.
But then again, my phone number may have been lost in the doctor's office, what with all the personnel changes and unexplained switches in primary care physicians I've endured over time.
Contrast that with Toby's experience. He's had the same doctor for 11 years. No peer review committee, health care provider network or regulatory rigamarole stands between him and his doctor. The decision as to whether Toby needs outpatient treatment, requires surgery or prescription drugs, should have shots, diagnostic tests or a short stay in the hospital is left to his doctor and, of course, his owner, who pays the freight.
Moreover, his doctor gives him all the time he needs. My "providers" are clocked by the system -- more than 15 or 20 minutes with a patient and they must explain themselves.
You may have guessed it by now: I'm in a managed care plan; Toby gets service for a fee.
The quality of his care depends upon the quality of his doctor and his owner's ability to pay. My health care, on the other hand, depends upon a vast network of faceless people who know me only by my medical record number and the schedule of benefits to which I am entitled. They, not my doctor, ultimately determine how much care I get for what ails me.
It fell to my saintly sister, Lucretia, who's in town visiting our seriously ill mom, to help put this health care business in perspective. "We should consider ourselves blessed that we can even get some kind of medical care," she said.
And so began a train of thought. In this richly endowed country where, according to the American Veterinary Medical Association, pet owners spend an estimated $11 billion annually on pet health care services, there are more than 44 million Americans (80,000 in the District alone) who, like Toby, lack the means to pay a doctor. We're talking about people for whom the family physician is the hospital emergency room or a neighborhood health clinic -- if they're lucky.
Many of them, as uninsured as most of America's pets, confront their illnesses alone. Faced with a choice between paying to get screened for cancer or treated for an illness and feeding the family, the moms and dads in jobs without health benefits elect to put food on the table.
We're told: "Thou shalt not covet." Fine. But who can blame America's uninsured -- as they eye the billions shelled out each year to keep dogs, cats and birds healthy -- for wishing from a health care standpoint that they, too, could lead a pet's life? In a land as wealthy as America, life-giving health care for people still depends upon an ability to pay. No self-respecting, prosperous nation should tolerate that distinction.