Getting my health care feet wet

A little background first. One of the many reasons why we left the United States was the high cost of health care. After my somewhat lucrative career at the bank abruptly ended and with the loss of private medical insurance brought by it, I signed our family up for the Oregon Health Plan (OHP), created under the Affordable Care Act signed by President Barack Obama.

Even after finding full time employment, we still qualified for full coverage, due to loss of income and because my wife was working part time while also going to school, and the insurance provided by my new employer was the equivalent of 1/3 of my monthly pay, which made it unaffordable. This carried us for over a year for which I'm grateful, but the moment I were to receive a 4% raise in pay, we would exceed the OHP income cap and would have to purchase private health insurance. As a diabetic and with the private insurance options available in Oregon, the two types of insulin I take would've totaled $800 each month, or roughly 40% of my income. That's prescriptions only, not counting premiums, doctor's visit copay or deductible. Without any health insurance the monthly out of pocket cost would have exceeded $1400 each month. With the change of federal policy, a legitimate threat of losing health insurance arose and I just couldn't risk jeopardizing the financial future of my family. Thus the need to take advantage of our ability to migrate and leave the country as soon as possible.

The process of finding and moving into an apartment and getting enrolled in the Japanese universal health care system took two weeks and 30 minutes. To be honest that's lightning fast and not how it normally goes for most immigrants. But now that I had my brand new shiny insurance card it was time to go to the doctor to get examined and get my prescriptions filled.

I had done my homework looking online for English speaking doctors before leaving for Japan and decided to take a chance with the Nakamura Clinic. It's centrally located and I felt I could easily access it from anywhere we settled in the city. When I did my research, I learned that the majority of non specialists don't make appointments. It's a first come, first serve system so I got up bright an early and somehow, still arrived at the clinic about an hour after it opened, which put me 10th in line.

In the US, the opponents of universal health care loudly proclaim that the wait times to see doctors in countries with national insurance are endless. Not one of them has produced evidence of their claim, but I was still hesitant. Being 10th in line probably meant that I would not be seen by the doctor until that evening and it was roughly 10:30 AM. My wife had brought snacks and sweets in case the wait was so long that my sugar dropped. But that was not the case. About an hour after arriving, the doctor called my name and we sat down to chat. He apologized profusely for making me wait, but he felt that my case would take longer and decided to finish the easy cases first. We spoke for about 40 minutes, he ordered lab work, which was done at the clinic, and after that he asked me to return to the waiting area until the results were ready. In the meantime, he continued to see other patients, one after the other and very quickly.

After about another hour, he called me back to his office to examine my results. He looked at how much medication I had left from what I brought in the trip and determined I still had enough for a few weeks. He thought this was good and gave him time to come up with a treatment plan. He apologized for the almost three hour doctor visit and asked me to return the following Monday because he wanted to talk about my prescriptions and if they were available in Japan and if not, which ones he considered to be good substitutes.

Back to the waiting room to see what the financial damage would be. Man, I was nervous. Lab work, two talks with him, plus the first time visit fee that doctors charge in Japan. This is the kind of stuff that breaks the bank in the States. The total for my visit? 3750 yen. That, my friends, is less than $35. I looked at my wife in shock. I haven't paid $35 for a doctor's visit since the mid 90s! But wait. Maybe things will change on my visit next Monday. Who knows, this next one may be the "big one".

So next Monday I woke up even earlier, went to the bank and took out a bunch of money to prepare myself for the charges. I arrived at 9:35 and I was still 3rd in line, but by 10:00 AM I was already sitting with doctor Nakamra. He had done his homework and had found out both my insulins were available in Japan as generics. In the States only one of them was available as generic and that was only since January 2017, when the FDA allowed it. He had two pens of my short term insulin ready and he gave them to me because he was worried I may run out. He told me to return in a month and by then he would have made a new treatment for me. He felt the care I was receiving in the US, although good, was only maintaining the status quo (he actually used that phrase) and was not doing enough to get me to reduce my insulin intake. Now that I'm doing more walking and my level of activity is higher he wants to adjust things, but wants to think about it first. I went to pay expecting a ton of money especially because he had insulin for me, but my total bill was 320 yen. Right around $3. Yes, you read it right, three bucks for a follow up visit.

Fast forward one month, to Friday before last to be exact, and once more I returned to the doctor. I arrived at 9:20 AM and the receptionist asked me to sit saying something I couldn't understand. I was 2nd in line this time. A few minutes later, Dr Nakamura came running into the office and exactly at 9:30 he called the gentleman ahead of me. Fifteen minutes later he called my name. He explained how he wanted to treat my diabetes and he started by drastically reducing my total insulin intake. He wants to start me from scratch. He said my sugar will be higher than normal for a time, but he wants to 1. stop the low sugar episodes I've been experiencing several nights a week and, 2. proceed with my treatment "the Japanese way". He told me he had my prescriptions ready to take to the pharmacy next door to his office and that his nurse would go with me to get everything ready.

HA! This is it! Now is when the financial drain will start. "These medications are not cheap" was what I thought. But first a description of the pharmacy. Pharmacies here are not department stores like they are in the US. They are tiny holes in the wall that serve one purpose only, to dispense prescription medications. They don't sell milk, bread, cosmetics or Halloween costumes. Those types are called "drug stores" and they also sell over the counter medications but rarely deal with prescriptions. The pharmacy was staffed by five ladies and the nurse went to one of the technicians, told her I didn't speak Japanese and gave her my prescriptions. Turns out they didn't have enough of of either one, so they called the supplier and told me, through a translation app, that my long term insulin would be there in 30 minutes but my short term insulin would not be there for a few hours. The entire staff apologized and bowed multiple times saying how sorry they were. I can picture this scenario at Walgreens or CVS... "Sir, siiiiiir! yes you! We don't have this one drug. We'll call the supplier but it probably wont get here until Tuesday. Your other one we don't have either but it may not be here until next Friday. You should go home now and come back then. NEXT PERSON!"

I was instructed to return to the doctor's office because he wanted to talk to me some more. After, I paid for my visit to the doctor, a whopping $20. Then returned to the pharmacy where they had part of the long term insulin and part of the short term one. The price came to just over $100. I called my wife and told her but she felt that was too much and that since the Doctor's office had held on to my insurance card when we brought the prescription, maybe they had charged me the price for uninsured. Either way, $100 bucks was nothing compared to what I would pay in the States, right? I let my wife speak with the pharmacy tech and everything was cleared up. The $100 price is for a three month supply of both insulins, another medication I take for my thyroid and two boxes of needles for the pens! So that's less than $33 a month for three prescriptions and hardware to inject.

The same medications that cost uninsured Americans $1400 each month, and up to $800 for insured ones, are less than $15 dollars each for a one month supply under the Japanese National Health Care system. The same exact medication!

I won't get political, but you know what? If there is one thing that reassures me that we did the right thing by moving to Japan, is that one fact. It's tempting to go off on the American health care system, but I'll refrain. The story alone tells the reality.

He who has ears to hear, let him hear...