Years ago, I left a violent marriage in Colorado and returned to Iowa to start a new life. My health insurance was good until the end of the August, and coverage at my new job wouldn’t take effect until October. That’s the way things are, I was told. You’ll be fine.

 

My Nicaraguan pediatrician friend astutely summarized her work: First you make the clinical assessment, then you make the financial assessment. In other words, a clinician may know the right treatment, but what good does that do the patient if the treatment is entirely out of reach financially?

 

In the clinic where I work, we don't take insurance. It's not a concierge practice but a church-based one, run on grants and hardscrabble for decades. For a provider, there's something freeing about not having to consider insurance. There's no frantic search through formularies, no restrictive list of specialists, none of the prior authorizations that suck up time and stamina--all things that have nothing to do with patient care but must happen in the insurance world. None of that.