There are things I always try to economize on. I will agonize forever before buying a new piece of clothing, and wait months or even years before investing in a new piece of furniture. But last week, when I went to the acupuncturist, the guy told me he was going to specially cook some herbs for me to help me with my hearing loss. It was going to be $450. I was like, Yes, fine. NO PROBLEM.
Seriously, it’s just like a switch goes off in my head. “Oh, it’s for my health? Well, spare no expense!”
This isn’t entirely a bad way to be (although I’m still kicking myself over that cute fuschia dress that I left in the digital shopping cart, only to later find it sold out). But the “spare no expense” idea for health costs has also gotten me in trouble, because it has often made feel pressured to spend money I don’t have, on services that might be nice but perhaps, not that useful. So I’ve been trying to adjust my way of thinking.
I’ve seen a lot of practitioners for my health problems who deal with mostly wealthy clientele. I am not wealthy, but I do have savings to overspend from, and I believe that spending $4,000 a year (at least) to get excellent care for health problems that cost me many times that in lost wages makes sense. Especially because many regular doctors absolutely refuse to fill out disability forms, which means that for lack of $4,000, I could lose my entire disability income. So it’s a brutal and frustrating, but ultimately rational calculation.1
That said, while some of their clientele is in my category — the, “I can’t really afford this, but I guess I’m somehow paying for this, oh shit” — many of them are quite wealthy. And that means that my fancy doctors tend to recommend, not the most practical doctors, but the best doctors by their own lights, which often means concierge-style doctors, and these types of doctors are often wildly, wildly impractical.
For example, when I was looking for somebody to help with my endometriosis issues, they recommended I see {Fancy Doctor Lady} at the {Center for Wealthy Middle-Aged Women}.2 Once I started exploring the practice, however, it started to feel less like a medical clinic, and more like a money grab wrapped in a spa day wrapped in a pseudo-culty, Landmark Forum weekend.
How much does it cost? Who knows! You don’t get that kind of info, instead you need to start with a “quiz” that has questions designed to get you to answer “yes”… an old standby sales technique. Are you committed to taking charge of your health journey? Do you want more vitality in your life?…well yes, of course. And then once you answer “yes” to these obviously manipulative questions, then do you find out how much everything costs? No, then you have a “free call.” And then at the very end of their schpiel, where they tell you about the Special Attention you’ll receive and all the Phone Calls you’ll get over a few month period….only then do they finally mention that you pay up front like $2,500 for a few months, and you see the doctor maybe once or twice during that time, and the rest of your appointments are buffered phone calls of people who are not doctors, but are just…paying attention to you and answering your questions I guess?
But the problem with my endometriosis is not that the endometriosis feels lonely. The endometriosis doesn’t need a spa treatment and the endometriosis doesn’t need me to pay $2,500 to have people suck up to me. I need to know things like: Should I do excision surgery again, or wait it out till menopause? Who’s a good Chinese Medicine person for this stuff in the Bay Area? Hey let’s do an ultrasound and see if my fibroids need urgent treatment. How much iron should I be taking? Any additional nutritional supplements I should be trying? What about hormone creams?
I didn’t want sucking up, I wanted…medicine.
Now, I’m sure the fancy doctor lady did all those things too — she came highly recommended — but at the end of the day, even though she was on this list of the “best” doctors recommended by another “best” doctor, I decided, You know what? Fuck this shit. I’m going to see a regular gynecologist at a regular practice that takes my fucking insurance. And I used to feel hella guilty about this sort of thing, because If I Really Cared about my Health, then I would be Moving Heaven and Earth to see The Best.
But now I realize, often, there are different kinds of ‘best,’ and seeing the more regular provider doesn’t even necessarily mean I’m getting worse quality care. I’m just getting care that fits my personal needs…like not being broke, and not feeling manipulated.
Those are both very important personal needs.
Another personal need I have? Not to be filing endless reimbursement claims with Medicare all the time. I used to think Blue Cross was bad, but Medicare takes abusive paperwork to a new artform. They have designed their entire reimbursement system to get you to have a nervous breakdown at the thought of ever doing it again. Like Pavlov’s dogs, I am now thoroughly trained. It worked. They won.
So yes, I do have severe mental health issues, but oh well. If I hear about a True Genius, who can break through years of trauma and dysfunction with their special insights, for only $500 an hour (no insurance accepted)? Oh well! I guess I’m not going to see The Genius! I guess I’ll never really break through into the rarefied upper echelon of who I could have ultimately been as a person! Because I’m only going to see a provider that takes my insurance. At least for now.
Another example: I was seeing a well-recommended acupuncturist during the fall. He was skilled with my particular problems. I thought he did a pretty good job. But ultimately, I stopped going to him for a simple reason: he doesn’t have a receptionist, and he doesn’t use an online booking system, and trying to get an appointment set up with him takes forever.
I found a different place now. It’s not in a fancy artsy building like his, it’s in a workaday office through the side entrance of the Japantown mall. But they come highly rated on Yelp, and crucially, they answer the goddamn phone. So last week, when I suddenly lost part of my hearing, they squeezed me in the very next day. I’m still waiting to hear back from the other guy.
He’s not “the best” if he doesn’t get back to me when I need him to.
So, TL;DR - even something really important — like healthcare — doesn’t have to be “perfect” just in terms of prestige or what other people think of as quality. It needs to be good enough — for your needs. Which may be very boring things like insurance coverage or being easy to schedule, even with brain fog.
In my case, that means I’m not going to a spa treatment for my endometriosis — I eventually ended up at the UCSF Endometriosis Center, which is still incredibly high quality, and crucially, accepts Medicare and Medi-Cal.
I’m still looking for a therapist, but not having to submit massive paperwork every month is its own kind of therapy right there.
And I’m not seeing the acupuncturist that the fancy people recommended. I’m seeing the one that actually answers the phone and can fit me in when I have an emergency.
It’s ok to have needs. It’s ok for them to be highly practical and pragmatic.
And, also, goddammit, it’s ok to buy the new dress without agonizing over it until it’s gone.
Even invalids deserve pretty dresses.
Similarly, I also spend an eye-watering $315 a month to have my disability law firm on retainer. This is not for their legal help, not really. It’s mostly so that, when the disability insurance company is trying to figure out who to drop that year, what long-suffering patient won’t fight back, they’ll see my lawyer’s masthead at the top of all my correspondence, and know I have an attack dog in my corner, and perhaps they will pass me by.
It’s not so much legal help, as protection money.
I am trying not to get sued.
Post Script: I GOT THE DRESS! Turns out if a clothing store sells out online, you can sometimes call the brick and mortar store and they'll have one available in their returns. :-)