My left hip announced its early retirement last month. I'd been favoring it for months to prolong its years of service. But transplanting a hydrangea and foolishly obeying the words of the hokey pokey at the Yuma Norwegian Fest sealed its fate. When, as ordered, I "put my left hip out," it never quite returned.

Whatever the cause, the worsening of the pain gave me a chronic limp, curtailing my daily walks and regular visits to the gym. That led me to consider hip replacement surgery. The love of my life encouraged me to have it done. After consulting my HMO's website to find out as much as I could about the operation, its risks and recuperation time, I asked my doctor to refer me to an orthopedic surgeon.

My wife and I are a team when it comes to important health issues. So when we arrived at the San Marcos Kaiser Permanente medical office of Dr. Amy Steinhoff we were prepared with notes and hopes for scheduling surgery within a month or two.

But after examining my hip's range of motion and showing me the x-ray of my hip, Dr. Steinhoff suggested another course of action. She explained my osteoarthritis had not yet created bone-on-bone contact, and that surgery wasn't the only way to relieve the pain. When she suggested pills and a cortisone injection, I pushed back. Since the arthritis in my hip was progressive and could never be reversed, I reasoned, surgery was the only ultimate solution. She pointed out artificial hips often need replacing in 10 years.

As we neared a stalemate, Dr. Steinhoff played the trump card. Kaiser Permanente, and federal law (an oblique reference to the Affordable Care Act) require a conservative, step-by-step approach to medical care, rather than moving ahead too quickly to more costly, and riskier treatment.

That ended the argument for me. I'm a strong supporter of the Affordable Care Act, with its emphasis on the quality, rather than the quantity of care. Dr. Steinhoff assured me that surgery will be considered, but only after we pursue other avenues to control the pain and restore my quality of life. She offered prescription strength ibuprofen and referral for a cortisone injection. If they don't do the job, surgery would be the next step.

The extra strength ibuprofen has done the job so far. My hip has been pain-free for two weeks. I've been able to return to my daily walks and regular gym workouts. I don't know how long it will last, but I'll be prepared for an injection if it comes to that, and surgery as a last resort.

According to a 2012 report by the California Public Interest Research Group (CALPIRG), "Your Price May Vary," the median price of hip replacement surgery last year in San Diego County was $64,480.

The price of a cortisone injection done under fluoroscopy, according to Wiki Answers, ranges from $1,500 to $2,000.

A February report by the Congressional Budget Office says federal healthcare spending is now expected to be 15 percent less than what had been initially budgeted for 2012. Douglas Elmendorf, Director of the CBO, noted a ‘significant part’ of the savings are the result of structural change in how healthcare is now being delivered. (Forbes, 2/12/2013)

My small encounter with Obamacare is a practical example of how this federal program has the potential to improve the quality of healthcare while controlling costs.

Richard Riehl writes from LaCosta. Contact him at [email protected]


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