I had my annual wellness visit with my doctor yesterday. It was a positive experience. The clinic was running on time. I didn’t have to spend much time waiting. My doctor was not rushed and took time to chat about several important topics. The routine lab tests were ordered and I was able to have the samples for the tests drawn on the same visit. I left the doctor’s office feeling that I had been heard, cared for, and have access to a relationship that will be beneficial should I encounter a health problem or crisis in the future.

It took me a while to find a new doctor when we moved. We were pleased with our family physician in Rapid City. She had cared for our parents, knew us and our family history, and provided excellent care. After living in two different homes in two different towns since we retired, I feel like I’m getting new relationships established and am feeling good about health care.

I know, however, that my experience is not what many people experience when it comes to health care. There are many reasons for that. First of all, I am not sick. I have been blessed with good health and my concerns are relatively minor. When serious illness occurs people usually find themselves being shifted from specialist to specialist and have to meet new doctors and establish new relationships. The more one has to visit doctors, the more time is spend in waiting rooms.

Another factor in my positive experience is that my family doctor is a part of a relatively small, physician owned practice. I know that the practice will have to grow in order to survive in the complex world of American healthcare. I know that there are problems with practices becoming too large. I’m not eager to see more bureaucracy, more policies, more specialists, and less time for patients that comes with large health care organizations. Part of what made my experience positive yesterday is that the pace of the clinic was not hectic. The doctor did not have to rush off to complete mountains of paperwork or attend endless meetings.

Probably the biggest factor in my experience, however, is the simple fact that we have much better than average insurance. Our medicare is administered by a private insurance company that also provides supplemental coverage. There was no co pay for my visit yesterday. I didn’t have to pay any out of pocket costs. The prescription refills ordered by the doctor came to less than $20 for a reasonable supply. The costs of this package, however, are significant. We are eligible for such coverage only because we have worked for the church for all of our lives and have participated in the denominational health care plan for decades. The costs of our premiums are somewhat hidden because they are deducted from our pension payments. The result is that our cash retirement income is much less than we had projected, but because the premiums come out first from our checks, we have adjusted to that expense.

There are a lot of people my age who cannot afford that kind of insurance. There are lots of people my age who could not obtain that kind of insurance even if they are able to pay. We have a health care system that is not at all equal or fair in the distribution of resources. A few of us have this very luxurious level of care while most others struggle to receive minimum care. It doesn’t make me a one percenter, but I am aware that I have incredible privilege when it comes to health care.

Most people cannot afford to establish a relationship with a family practice physician because their out of pocket expenses are so high that they are simply priced out of preventive care. They only see a doctor when there is a health crisis and at that point they see whatever doctor they can find, usually starting with an urgent care or a telemedicine provider. After they recover from whatever it was that took them to the doctor, they are overwhelmed with the bills they receive and cannot fathom why the charges are so high. It seems that the numbers bear no relationship to the services provided. If they are forced to use a Hospital emergency room, the cost is so high that they run the risk of bankruptcy. Needless to say they will avoid contact with the health care system as much as possible simply to reserve enough of their income for rent and groceries.

No other country in the world has a system that extracts so much profit from caring for sick people. No other developed country in the world has worse health outcomes. Infant mortality is rising. Maternal health is falling. The system is not working.

In this broken system are well-educated, experienced health care workers who genuinely care about providing good care to their patients. Physicians have no more control over the costs of health care than patients. They experience the out-of-control system on a continual basis. They may be a bit more aware of the amount of profits that go to insurance providers, pharmaceutical companies, and technology systems than some of us, but they feel powerless to change the system.

I know that if the medical practice that cares for me continues to be successful it will be purchased by a larger health care system. Large hospital corporations are purchasing virtually every type of health care clinic that they can at prices that are dramatically inflated. Growing large seems to be the only path to survival in this system. I hope I have a few more years of good care before the clinic is swallowed up by some larger corporation that is in the business of extracting profit.

For now, however, when I allow myself to lay aside some of my cynicism, I can be grateful for the luxury of a positive experience with a good doctor. I hope I get a few more years before I have to start the search for a new doctor once again.