The eye clinic is part of a larger medical clinic, all housed in what looks to be a renovated bank built in the 1970s. The building gives the entire operation the feel of failed capitalism, a throwing up of hands and an auction of office furniture and original fixtures. Contributing to the despair is an old woman sleeping in one of the lobby chairs, using her coat as a blanket, as if she’d been left there all night. I consider this scene and look over to the walk-up counter where patients are to check in before proceeding on to various clinics and doctors. There is no one at this post. It’s a few minutes before 8:00 in the morning; presumably the wheel of managed care hasn’t started rolling yet.

Eventually, another old woman appears and shuffles to the seat behind the check-in counter. I approach her and she ignores me so she can type something into her computer while murmuring, “I’ll be right with you.” I think of arguing the fact that we are already, technically, with each other. The space between us is two feet. What she really means is, “I’ll pay attention to you when I’m good and ready.”

Suddenly she looks up and gives a wan smile, signaling that she is ready to check me in. I present my insurance card. She takes it and asks, “Do you have a co-pay today?” I’m not sure if an eye exam is considered preventative care. If it is, then there isn’t a co-pay; a little bonus to patients for staying on top of their physical ailments before they spiral out of control and cost the insurance companies thousands of dollars down the road. But perhaps a better question to ask is which one of us, me or the old woman, is sitting in front of a computer, logged into the clinic’s database and drawing a paycheck? Is there no way for her to look up this information? I had no idea that co-pays are so nebulous.

The issue is resolved by having me sign a paper saying that, should a bill for a co-pay or services rendered result as a result of my visit, I am responsible for paying. I am then given clearance to walk up a shadowy set of stairs to my clinic. Above the door to the clinic the words “EYE CLINIC” are fastened to the wall, stark block letters against dreary walls. I walk in and the receptionist promptly ignores me. I sit down and begin to wade through piles of old Newsweek and Time magazines, all of which have chunks missing from their front covers where the address labels has been torn off. This is done so we, the scheming patients who set up “routine eye exams” as an excuse to get into the EYE CLINIC waiting room and copy down the names and addresses of those who receive Time and Newsweek at home are thwarted in our efforts to steal identities.

It isn’t long before another, younger receptionist/nurse/aid appears to talk to the other.

“I need a time card.”

“Get one from Shelly.”

“She’s not my boss. Linda is.”

“She’s not your boss?”

“I don’t answer to her.”

“What about Sue?”

“She’s not my boss either. I have to get my card from Linda.”

This is followed by a lot of sighing. Then the younger one speaks again.

“Oooh, look at you with those pumpkin seeds!”

Of course she pronounces it “pun-kin.” I’ve always wondered how people get off track with this word. It sounds just as it's spelled and yet so many find it challenging.

“I need to eat these all day to calm my stomach. I’m nauseated from my medication.”

“You’re on medication? What do you take?”

Here everyone is silent for a moment: me wondering if I’m going to hear the litany of health problems, the younger receptionist waiting for her answer and the older pondering how to sidestep the issue after she was the one who brought it up.

Finally the older says, “Well…” and laughs in a way that seems to say, “You know how it is with medication.”

“A lot, huh?”

“Yeah. This one is new. Just have to get through the first cycle.”

A stout woman with ruddy skin and wearing a white lab coat comes into the waiting room and calls my name. I gather my belongings and follow her into an exam room.

“Are you here for a routine eye exam?” The stout woman asks.

“As opposed to…?”

“Are we fitting you for contacts?”

“I don’t think I need to be fitted for contacts. I’ve worn contacts for a long time. I just need to see if my prescription has changed.”

“There’s a $70 fitting fee.”

“But I just need an eye exam, a prescription and to maybe order some contacts. Unless I could do that on my own… through the Internet?”

The stout woman fixes me with a look of disdain. “It’s $70 for us to write you a prescription for contacts. If you were a returning patient, it would be $40.” She jiggles her sizeable knee and leans forward. I wouldn’t be surprised if she whispers something about further discounts for returning patients who take care to grease the palm of the commisar throughout the year.

“But I just want to re-order what I already have with the updated prescription. I brought along my current prescription and my glasses.”

She grudgingly takes the information and, while inserts my glasses into a contraption, I venture a question I already know the answer to.

“Are contacts covered by insurance?”

“No. They’re considered cosmetic.”

Oh, yes, the old “cosmetic” ploy. If you have eyesight so poor you can’t leave the house without corrective lenses but think that glasses are a pain if you want to, say, exercise, you are being vain. You simply want to look good. And even though we live in a society that is forever telling us that we don’t look good enough and should try harder to look our best, if you want contacts, be prepared to pay out-of-pocket. This may even sound logical but there’s a kicker – glasses aren’t covered either! Why? Because glasses cost too much. In other words, your health care provider can tell you that your vision sucks, that without glasses or contacts you aren’t fit to operate a motor vehicle, but they won’t do anything to help pay to remedy the situation. After all, vision isn’t a big-time problem. You’re still breathing. It’s not cancer. But if you do get cancer, well, you’ll want to cross that bridge when you come to it because cancer is really fucking expensive.

“What’s the co-pay for glasses?” I ask the stout woman, smiling sweetly.

“Glasses aren’t covered.” She looks at me, breathing hard from the exertion of taping my current prescription into my file. “What’s it going to be?”

“Well, I need to order more contacts, so I guess…”

“Since you have the information for your old prescription, I’ll treat you as a returning patient and charge you $40.”

“Thank you.” Thank you, stout woman, for taking pity on me and only ripping me off for $40 instead of $70.

I am shuffled off to the official exam room to wait for the doctor, who comes in and clasps my hand in his doughy one while introducing himself. I promptly forget his name because I am too busy thinking about how he looked like a stock “child molester” character from TV. Or maybe the guy on <I>CSI with a locked room in his basement filled with S&M porn. He is pasty, mild, slightly nervous and has a comb-over; he seems to be tinged with regret that he’d wanted to become an optometrist in the first place and is now condemned to work at EYE CLINIC, possibly for bad behavior elsewhere. He performs the eye exam half-heartedly, barely rising above monotone to say, “Which is better? Lens one…or two? Lens three…or four?”

It is determined that my right eye has changed ever-so-slightly but my contact prescription will remain exactly the same.

“When you get into the high power lenses where you are, there are less incremental changes that can be made without going up another full step. I think we’ll keep it where it is.”

Translation: “Your prescription is the same and here’s a lighter so you can torch your $40.” Why am I so bent out of shape over $40? It has more to do with the style and method of care delivered. The extra fees tell me that I’m captive in a system that will charge whatever it can get away with and not offer much of value in return. Certainly not employees to greet me when I arrive and who won’t talk about their stomach problems in front of me. Certainly not a pleasant atmosphere with good magazines that aren’t ripped and crinkled as if Child Molester Optometrist masturbated over them.

As someone who lost her health insurance and then became ill, I have been on the other side of the equation. My treatment involved two rounds of radiation, which I then paid off myself over the course of a year. At various points in the process of diagnosis, treatment and bill-paying was made to feel as if I were a hobo, standing at various reception desks with my bundle on a stick, daring to want and expect decent medical care without insurance. Now that I have my own health insurance, I find myself expecting better treatment and am disappointed to find that the care is still the same because, with the system currently in place, there is no incentive for places like EYE CLINIC to change.

My eyes are dilated and I am sent back to the waiting room for fifteen minutes. While there, I listen to two employees complain about the lack of space for workers to stow their coats, purses and other personal belongings. Indeed, I’ve been dragging my own coat and bag around to all four of my location changes. It is all too depressing, with the lights from the displays of Soviet-style frames one can purchase creating a white-out at the edges of my vision , and I close my eyes. After Child Molester calls me back to the exam room and determines that my eye health is sound, I am sent out to the receptionist with a ream of paperwork.

“That’s $120 with the contacts. Do you want to pay for the whole shebang today?”

“Sure.”

She takes my money, gives me a receipt and goes back to her phone call. I stumble out into the first sunny day in two weeks and have to keep my eyes on the ground, struggling to get the enormous, wrap-around sunglasses in place so I can drive. The sunglasses make the light only slightly more tolerable but I proceed to get on the highway anyway. I guess I’m feeling reckless. Cataclysmic accidents are when health insurance really starts to pay off: $50 co-pay for an emergency room visit, waived if you’re admitted to the hospital. Hello, easy street.