The first time I met Mr. Akhtar he covered his left eye and muttered in Afghani an incomprehensible phrase which my daughter guessed at as, “He is saying he is blind in one eye and was told that in the U.S. he could  get his sight restored.  Actually ever since his family moved in about a week ago, he has been obsessed with this. He has told us that in Afghanistan he heard that in the U.S. you can get a new eye.”

Mr. Akhtar is a refugee from Afghanistan, who with his wife and two girls, age three and six, moved to the Washington area about a year ago after spending five years in internment camps in Turkey. They had just moved into the basement apartment in our daughter’s house. The story of our search to get his sight restored tells much about health care in the U.S. today.

Akhtar (not his real name) was injured when a friend accidentally pierced his eye with a sharp instrument when he was age 10, about 25 years ago. He is also a welder. A one-eyed welder is just a notch above a one-armed paperhanger. The man clearly needed a new eye. I volunteered to get him one.

“Well,” Embry said, “He has come to the right place. The Wilmer Eye Clinic  at Johns Hopkins is the best in the world. If they can’t fix it, nobody can. But I am sure you will need a referral to get to Wilmer.”

So the first stop would be his primary care physician. Akhtar had Medicaid, which was his ticket to getting essentially free health care, so score one for the U.S. –free health care for the poor. The doctor examined the eye and  cheerfully wrote out a referral to an eye doctor in the Medstar system, one of the major health care networks in Washington. I told him that we really wanted a referral to the Wilmer Eye Clinic at Johns Hopkins. As an employee of Medstar, he apologized that he could only refer to one of their eye doctors. Okay, I thought, we will start there and then get a referral to Hopkins. I knew that restoring eye sight from total blindness was going to be a real challenge and that eventually Hopkins is where we would probably end up anyway. But you had to start somewhere. So on to the next step.

A week later when we arrived at the Medstar ophthalmologist’s office and checked in, here is how the conversation went with the person at the front desk:

“I am sorry we can not help you. We do not take Medicaid.”

“But we just got a referral from one of your doctors, and he takes Medicaid.”

“That is his problem. Not ours.”

“Is there any ophthalmologist in the Medstar system who will take Medicaid?”

“Not to my knowledge, but you can try.”

“How do I get a list of Medstar ophthalmologists?”

“No idea.”

Okay, I thought. We will just go private pay. I told her I would pay cash for the visit out of my own pocket. Cash on the barrel head. How could she refuse? I figured it could not be too much, just to get a referral  from the Medstar eye doctor to the Wilmer Eye Clinic. She said that would not be possible.

“Wait a minute! You mean to tell me that the eye doctor won’t  see Mr. Akhtar even if I pay for the visit in advance with all cash or a credit card?”

“That is exactly what I am telling you. He has insurance. We are not allowed to take cash if a patient has insurance.”

“Yes. But you won’t take his insurance.”

“Correct. We don’t take Medicaid.”

The conversation continued along these lines for another few minutes at the end of which I admitted defeat. I complained that all we wanted anyway was a referral to Hopkins, which from the scowl on her face, I realized was not the way to win friends at Medstar.

“Well,” she said sarcastically, “Good luck on getting to the Wilmer Eye Clinic without a referral.”

Out of curiosity, I could not help asking how much the initial eye visit would have cost me if I were allowed to pay for it out-of-pocket. She replied that for someone with insurance it would be about $250. For someone with no insurance who was paying privately, it would be about $700.

“Oh.”

That disclosure eased the pain.

But what to do next? How to get to the Wilmer Eye Clinic? How to get this half-blind welder from Afghanistan a new eye? Follow the story on the next blog post.