My very first, all’s well prenatal appointment with a nurse midwife came with a $16,000 bill. I was a graduate student. My husband was a graduate student. This meant that we were frugal, but we were also good at research. We had priced getting pregnant beforehand. That one bill, a single cystic fibrosis test (for which I’d been quoted $180 by the lab), cost more than we expected to pay, even under worst-case scenarios, for prenatal care and the birth too. Our new-baby euphoria all but fizzled as we realized we would be playing nine months of Russian roulette with medical bills.
No toys for you, baby!
Of course, I fought. Over the phone, in person, in writing, at every level.
“Would you like me to put you through to our charity services?” customer service reps offered in sympathetic tones.
But the capacity to pay wasn’t the point—or maybe it was precisely the point—my basic student insurance would cover the test, if I submitted the paperwork. Which I didn’t do. I refused to be swindled, even if the swindling was institutionalized, and even if I wasn’t really even part of the equation.
On my due date, I received my first letter from the collection agency. It was a Friday, after 4, and Al, the supervisory dead-end who won my call couldn’t be bothered to stop typing while I talked. From there it went downhill. He accused me of lying. He told me the case had been closed and I had been informed. But I had requested a letter. A letter had been sent. I had not received a letter. The letter was dated—well, that very day.
When my husband got home that night and found me drafting new letters that I hoped would get Al fired, he confiscated my file folder jammed full of phone calls transcriptions, lists of names, copies of letters sent.
“You’re done,” he said.
But there would be a next time, and next time, I vowed, I would not be a pawn in the game hospitals and insurance companies play with one another.
I did not intend, however, to take my grudge against the U.S. health care system so far that our next child would not be born a U.S. citizen—my husband, even keel to my crusader bent, would never be swayed into something so ridiculous. But here we are.
In January, if all goes well, I will deliver my second baby in highland Mexico. While there are some terrifying components to this arrangement—mostly having to do with language barriers and cultural differences—I confess that I am mostly relieved.
The farther I progress in my pregnancy, and the more experiences I have with the medical culture of Mexico, the more relieved I become.
This is not because I imagine for one moment that Mexico is a paragon of modern medicine or that my experiences translate into those of Mexicans across the country, or any of that. And I could very well change my mind entirely before this whole ordeal is through. But for now, I am basking in the simple one-on-one humanity that I have been met with so far.
Imagine, if you will, walking into a bright, sunlit hospital where the waiting area for a given doctor has fewer than a dozen chairs. The receptionist-nurse greets you and apologizes because the doctor will be just a minute. There are no forms.
When the minute is up, the nurse waves you over and you walk down a passageway into the doctor’s office. By office, I don’t mean exam room. I mean a room that is taken up primarily with a large wooden desk. There isn’t clutter, exactly, but the desk isn’t a sterile field either. There’s a computer, files, photographs, and a few anatomical models. It might be a professor’s desk, or a lawyer’s.
Dr. O., a man in his early forties who looks a bit like a chubby Charlie Chaplin but thankfully isn’t funny, stands up and comes around the desk to shake hands with you and your spouse. Then he gestures to the two leather chairs opposite his own.
For half an hour, sitting in chairs, all parties fully dressed and eye level with one another, the doctor asks and answers questions, occasionally fleshing out the database form on his computer. Of course, there are language barriers, Spanish vs. English and metric vs. imperial systems, but these are patiently overcome. Only once you and the doctor are satisfied is there any move towards the exam room.
The doctor shows you the bathroom and hands you a cotton gown to put on. When you come out, the nurse who has come in for this second phase helps you onto the scale (which reports in kilograms, a blissfully meaningless number), but it is the doctor himself who takes your blood pressure and raps on your kneecaps with that little hammer. Then there is an ultrasound: the right number of everything, a strong heartbeat, oh, and it’s a boy.
A few minutes later, you are dressed again and sitting in the leather office chairs. The doctor hands you a DVD of the ultrasound, tells you to schedule your next appointment in four weeks, and shakes hands all around again.
As you leave, you pay the receptionist for the appointment. 500 pesos, or about $40.
Maybe there are doctors in the US who treat patients this way, but I have never met them. I don’t doubt that a majority of doctors would like to treat patients this way, if only the system would allow it.
Of course, as tickled as I am by Dr. O.’s system in terms of how I stand to benefit from it, I can see how aspects might make Dr. O.’s life miserable.
For one, Dr. O. isn’t part of a practice.
“Of course, I will deliver your baby,” he told me during my second appointment. This made my husband and I giggle. Our first child was delivered just after a shift change at our hospital: the midwife and delivery nurses who oversaw our son’s birth had only just arrived. We learned the midwife’s name from the birth certificate.
Furthermore, while Dr. O.’s consultorio is located in a hospital, he operates independently.
“You pick the hospital,” Dr. O. explained. “Then you call me, and I will come there when you are in labor.”
So now we embark on a project to compare birth packages at various hospitals around the city. To this end we are handed glossy brochures with descriptions of rooms and their amenities, birth classes, and a la carte items—like a bed for my husband and extended stays. Our options include private and public hospitals, and we will weigh in details like proximity to our home, but it is thrilling to be able to choose.
I know Mexico is no medical utopia. Not by a long shot. But it is a treat to feel like a consumer, rather than a rat in a maze.
Better still, without inexplicable medical bills to hyperventilate over, or hours lost pushing 1 for English and 3 for billing and then languishing on hold, I sure feel a whole lot healthier.