I tell them if they want to provide free health care to go to Cuba. If they want free health care to go Cuba. That is the end of discussion.
Posted on 10/26/2013 9:28:04 AM PDT by Praxeologue
“Shocked” wouldn't be accurate, since we were accustomed to our uninsured patients' receiving inadequate medical care. “Saddened” wasn't right, either, only pecking at the edge of our response. And “disheartened” just smacked of victimhood. After hearing this story, we were neither shocked nor saddened nor disheartened. We were simply appalled.
We met Tommy Davis in our hospital's clinic for indigent persons in March 2013 (the name and date have been changed to protect the patient's privacy). He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences.
The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening's end he'd been sent home with a diagnosis of metastatic colon cancer.
The year before, he'd had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he'd need insurance to be adequately evaluated, and billed him $200 for the appointment. Since Mr. Davis was poor and ineligible for Kentucky Medicaid, however, he'd simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment.
Mr. Davis had had an inkling that something was awry, but he'd been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we'd found it sooner,” he contended, “it would have made a difference. But now I'm just a dead man walking.”
For many of our patients, poverty alone limits access to care. We recently saw a man with AIDS and a full-body rash who couldn't afford bus fare to a dermatology appointment. We sometimes pay for our patients' medications because they are unable to cover even a $4 copayment. But a fair number of our patients — the medical “have-nots” — are denied basic services simply because they lack insurance, and our country's response to this problem has, at times, seemed toothless.
In our clinic, uninsured patients frequently find necessary care unobtainable. An obese 60-year-old woman with symptoms and signs of congestive heart failure was recently evaluated in the clinic. She couldn't afford the echocardiogram and evaluation for ischemic heart disease that most internists would have ordered, so furosemide treatment was initiated and adjusted to relieve her symptoms. This past spring, our colleagues saw a woman with a newly discovered lung nodule that was highly suspicious for cancer. She was referred to a thoracic surgeon, but he insisted that she first have a PET scan — a test for which she couldn't possibly pay.
However unconscionable we may find the story of Mr. Davis, a U.S. citizen who will die because he was uninsured, the literature suggests that it's a common tale. A 2009 study revealed a direct correlation between lack of insurance and increased mortality and suggested that nearly 45,000 American adults die each year because they have no medical coverage.1 And although we can't confidently argue that Mr. Davis would have survived had he been insured, research suggests that possibility; formerly uninsured adults given access to Oregon Medicaid were more likely than those who remained uninsured to have a usual place of care and a personal physician, to attend outpatient medical visits, and to receive recommended preventive care.2 Had Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer, and his abdominal pain and obstipation would surely have been urgently evaluated.
Elected officials bear a great deal of blame for the appalling vulnerability of the 22% of American adults who currently lack insurance. The Affordable Care Act (ACA) — the only legitimate legislative attempt to provide near-universal health coverage — remains under attack from some members of Congress, and our own two senators argue that enhancing marketplace competition and enacting tort reform will provide security enough for our nation's poor.
In discussing (and grieving over) what has happened to Mr. Davis and our many clinic patients whose health suffers for lack of insurance, we have considered our own obligations. As some congresspeople attempt to defund Obamacare, and as some states' governors and attorneys general deliberate over whether to implement health insurance exchanges and expand Medicaid eligibility, how can we as physicians ensure that the needs of patients like Mr. Davis are met?
First, we can honor our fundamental professional duty to help. Some have argued that the onus for providing access to health care rests on society at large rather than on individual physicians,3 yet the Hippocratic Oath compels us to treat the sick according to our ability and judgment and to keep them from harm and injustice. Even as we continue to hope for and work toward a future in which all Americans have health insurance, we believe it's our individual professional responsibility to treat people in need.
Second, we can familiarize ourselves with legislative details and educate our patients about proposed health care reforms. During our appointment with Mr. Davis, he worried aloud that under the ACA, “the government would tax him for not having insurance.” He was unaware (as many of our poor and uninsured patients may be) that under that law's final rule, he and his family would meet the eligibility criteria for Medicaid and hence have access to comprehensive and affordable care.
Finally, we can pressure our professional organizations to demand health care for all. The American College of Physicians, the American Medical Association, and the Society of General Internal Medicine have endorsed the principle of universal health care coverage yet have generally remained silent during years of political debate. Lack of insurance can be lethal, and we believe our professional community should treat inaccessible coverage as a public health catastrophe and stand behind people who are at risk.
Seventy percent of our clinic patients have no health insurance, and they are all frighteningly vulnerable; their care is erratic, they are disqualified from receiving certain preventive and screening measures, and their lack of resources prevents them from participating in the medical system. And this is not a community- or state-specific problem. A recent study showed that underinsured patients have higher mortality rates after myocardial infarction,4 and it is well documented that our country's uninsured present with later-stage cancers and more poorly controlled chronic diseases than do patients with insurance.5 We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance.
Something about this just doesn’t ring true - Kentucky sounds like it’s still in the 1950s — where exactly did this happen? Rural area,city? For the primary care physician to just drop the ball because the patient lacked insurance, that sounds really bizarre. Are there simply no resources in Kentucky? Mitch McConnell should be ashamed.
I live in a smallish city in SW Michigan where there is a massive federally-funded clinic, which is currently doubling its capacity, due to all the poor & uninsured people that live in this area. It is staffed by doctors and physician extenders, who for the most part are here for a 3-4 years to pay back their education loans. They serve both the Medicaid population and the uninsured. The idea is to provide primary care so that problems are identified early & TAKEN CARE OF IMMEDIATELY. If someone shows up at the ER with the problems described for this poor man, and diagnostic tests were performed to identify the problem, he should have been taken care of by the surgeon on call, if for no other reason than to relieve pain. If he were kicked out without any treatment because he doesn’t have insurance, that hospital should be liable, IMHO. Most hospitals are non-profits, and get huge tax benefits because they supposedly take care of everyone, including those who have no way of paying for the care (charity). Doctors and surgeons have on-call rotation with the full knowledge that they could end up with a patient that has no insurance, but they are obliged to provide that care. They can write it off come tax time, but of course, need enough paying patients to stay in business.
I believe that the major problem with the “system” is what to do with the chronically ill, including cancer patients who don’t have insurance for whatever reason. That is a problem that needs solving, and the so-called Medical Home concept could work if there are enough primary care doctors left after Obamacare decimates the whole shebang. The rest of us need to avoid the “system” as much as possible - ever notice the number of people dead or maimed for medical errors & over-medication? If you have an acute problem that doesn’t go away in a week, get it checked out. Very little of the care that goes on in hospitals is for life threatening conditions. The sicker you are, the worse the care seems to be - at least that is what I have noticed after working more than 30 years inside the Beast.
In Socialist countries, there aren’t many private charities. I once had an LATimes columnist, on a radio program, tell me that I shouldn’t have control of my own charitable giving because ‘I might not donate to the right charities’. Yep, that’s how they think. They KNOW BETTER than we peons (maybe that should be pee-ons), where ALL the money should go.
I liked that movie, but the message was scary: the Brits don’t like their old people, but we Indians do.
Thanks to all your comments, when someone now Googles this article, they will see this FR thread and each of your comments. Thank you. You have performed a public service.
I am glad the British are able to travel to India to get good medical care. My point was that they cannot get it in Britain in a timely manner.
I tell them if they want to provide free health care to go to Cuba. If they want free health care to go Cuba. That is the end of discussion.
That evil heartless government! Was he too white to get medicaid?
I got your point & agree. In the US, Blue Cross has paid for people to go to India for heart surgery - not sure where that happened but read about it. I would be surprised if it was only 2-3 months in Britain...
re: “Let me also suggest that there is no obstacle to this doctor starting a charity that targets medical professions and the rest of the healthcare industry for VOLUNTARY donations to support care for the indigent.”
I totally agree with you on this. Christian missionary organizations build hospitals, fund and provide medical personnel and medicine to villages and people groups worldwide (when allowed to by local governments).
Why cannot this be done in our own nation? Now that I think about it, this probably IS already being done here.
I agree that the story tore my heart out, but the author’s answer is “universal healthcare”?? Is there no other option? I just do not believe so. I do not want government control over our healthcare nor do I want people who cannot afford it to be left to die in the streets - these two options seem to be how the question is framed.
But, I do not accept that framing of the question.
____________________________________________________________
We afford what we want to afford. What kind of cars did they drive, did they have a big screen TV, boat, other luxury items that may have been unwise purchases.
People who are truly poor qualify for Medicaid, people who make enough to pay for insurance but would rather spend it enjoying life do not qualify for Medicaid. I have nothing against enjoying life but if you roll the dice and lose it shouldn't be somebody else’s problem.
“Don’t doctors take Econ classes as undergraduates, or are all those now taught by Paul Krugman types?”
Not a doctor, but both my micro and macro econ classes used textbooks WRITTEN by that lying sack of **** Krugman.
This poor fellow fell through the cracks in the system. I suspect that there is a lot of embellishment and hearsay in this article being reported as fact.
I have been in medical practice for 37 years and I know of many ways that this man could have received care. The trouble is that none of his providers took the time to point him in the direction he needed to go to get that care. This isn’t the system’s fault - it is the fault of some selfish medical provider who wouldn’t take the time to help.
This article is from one of the most liberal medical organizations in the country so I would expect this kind of misleading story.
“Since he was poor and ineligible for Medicaid...”
This statement doesn’t make sense.
I think so too
Excellent post. Thank you.
Amen.
Insurance is a scam. The guy in the article couldn’t afford the treatment, he couldn’t afford the monthly insurance payments, and putting money in the bank “for a rainy day” was the smartest thing he could do.
Insurance companies never lose. There is profit to be made. And in the fundamental principle of Insurance - they are to hold your funds for you, and then provide the up-front if something should happen. They expect you to continue to make payments into their system after the issue is resolved and you’re feeling better.
So it’s like walking into a bank with an agreement for “An open loan, whenever I need it” and “I’ll just start paying you now. I may need it a month down the road, a year or possibly never.”
With such a statement loss is assumed. A company doesn’t want “loss” so they do whatever is necessary to keep you paying and not taking. I mean, duh.
Real problems occur when the service vendor (Doctors, supply companies, medical technical companies, etc) find this sort of thing to be a cash-cow. An MRI is certainly a fine piece of equipment, but to charge $10,000 for a scan regimen is a bit ... steep. But the insurance “will pay for it”. When the insurance companies refused to pay such high prices (That’s far beyond the contribution of the Insured customer) the courts and the government stepped in and required them to pay it.
So as usual - the root of ALL this problem is government. Were it insurance, they would keep prices far, far down to keep their losses at a minimum. Insurance adjusters and price-setters are onhand to negotiate with these companies that want to charge $100 for an aspirin (These are real numbers, btw)
The government created the problem, and now they want to sell us a solution. That is how government works, and it needs to be simply taken out.
Stop paying taxes, resist this government, give them nothing. No more. No compromises. Whatever it is they want you to do : Do the opposite. They are not out for your best interests.. .They are out for your money.
I hate to say it: VAT. Makes him pay all along since he was 16. Then he gets the care because he paid in.
A 30s man, wife, and 3 1/2 children (wife is pregnant) was told this week that his health insurance policy was being canceled because it did not meet the new Obamacare standards (e.g., the policy did not include abortion or drug rehab or pregnancy insurance — they are devoutly religious so no drugs, no abortions, and the wife goes to a midwife). He makes a modest income, she stays at home. The current insurance premium is $275 per month for a $3000 per year deductible policy. The new Obamaized policy was quoted at $1500 per month.
Why so high?
* paying for birth control and abortions for others
* paying for drug rehab for others
* paying for hospital births for others
* paying for “free” checkups for others
* paying for health care for 50 and 60 yr olds, most of which have more assets than he does, and do not have the expenses of raising small children.
That's not insurance ... that is a socialized medicine subsidy payment system.
The Democrats are telling young men to make "bricks without straw".
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