David E. Gumpert-blogmaster
I am a journalist and writer. I've written a number of books and articles about small business and entrepreneurship. I've also written some history, in the form of a memoir I co-authored with my aunt, about her experiences during the Holocaust.
When I was diagnosed with prostate cancer in Sept. 2001, part of my identity became forever tied up in my medical condition. I also received my first introduction to the business of health care. As a journalist, I am prone to doing research, and my research into prostate cancer indicated that surgery was probably the best approach for me, given my relative youth (54). But my research also indicated that surgical outcomes vary widely, with some patients experiencing both urinary and sexual difficulties post-surgery. Most troubling, my research suggested that surgical outcomes in my home area of Boston were worse than in other areas of the country.
So I went scouring around looking for a top-notch surgeon. At one point, I was considering a highly-recommended New York City surgeon, who wanted $11,000 for the surgery, with half in advance. I went to my HMO to seek permission to have the surgery done outside its network, so the expenses would be covered. I didn’t foresee any problems. I figured they’d appreciate the disparity I had uncovered in surgical results, and would have the same interests as me: that I not subject myself to unnecessary risks and that I receive the best care possible.
I was taken aback when my primary care physician called me back with a response to my request: permission denied. “We feel the care here is equal to what you’d receive elsewhere,” he said.
After I hung up the phone, I realized how naïve I had been. I had assumed they would be primarily focused on the quality of my care, when what they really were most focused on was their costs.
I decided I’d just have to bit the bullet and pay for the surgery myself, since my primary concern was still the quality of my care. As things turned out, I had an opportunity to switch insurance coverage just before my surgery, and I went to a program that paid for out-of-network procedures. (I eventually wrote an article in Boston Magazine about the part of my journey having to do with the complexities of sorting out the research on prostate cancer.)
But the experience has stayed with me, and I’ve become ever more interested in the business of health care. I understand that this is a huge subject, and that one person writing a blog can’t cover it all. I’m going to attempt to explore various facets of the subject, via profiles, investigations, and commentary.
My web site has more information about my identity.