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.
Mr. Davis didn’t qualify for Medicaid but they’re saying with Obamacare he would qualify for Medicaid? How messed up is that?
Ping.
The author of the article:
Dr. Michael D. Stillman moved from Boston to Louisville when his partner, Dr. Steve R. Williams, a neurological surgeon, took a position at the University of Louisville School of Medicine. They sold their Boston condominium at 300 Boylston, Suite 609, across from the Public Garden, for $2,150,000.
Did they choose to spend their money on something else? Did they have cable, cell phones, smoke, drink, gamble?
A high deductible, catastrophic policy would have been relatively inexpensive.
Hospitals have charity care to help those who meet income guidelines.
Need a lot more info before believing this.
This steaming pile is purely an emotional justification for wealth redistribution.
He had money to purchase insurance but chose not to.
Yeah, I thought that was strange, too. Ten grand saved but no insurance?
In the past hospitals used to just eat it if someone could not pay ( so with rising prices we all paid) not that bad a deal if you think about it
They did not turn people away at emergency rooms.
Who knows what will happen now?
"Mr. Davis was poor and ineligible for Kentucky Medicaid."
These are the two key phrases of the article. This man is the "working poor".
Something does need to be done to address these issues, but the answer is NOT the British health system- where the results for this man would have been the same.
And from what I've been hearing Obamacare is worse than Britain's NHS, if that's even possible.
Well isn’t that special? Are they going to have a baby soon? Which one will be the mom?
Tax payers spent over a Billion dollars to enrich a Bunch of Michelle Obamas Friends who wrote a web site that doesnt work,The Obamas spent more than a Billion on their travel last year,the IRS said the other day Billions are sent to people who dont deserve earned income tax credit payments every year and they are not going to challenge them because they dont want to discourage people who are qualified for the payments,Obama paid Billions to Solyndra and other Green companies that went bankrupt.Now How many poor and indigent people could have been helped without this Obamacare disaster,surely in the richest and Most compassionate country on the planet we can afford to help all the Mr.Davis individuals to get help without the A-Holes in Washington making a Crap heap out of the Medical system. Dont forget after Obamacare is fully implemented there will still be 30 million Mr. Davis people WITHOUT Health Insurance,This is how you answer the Crap coming from Communists.
In addition I dont know what this person is Talking about because if Mr. Davis is over 40 years old he will not get his care anyway,because the person Ezekiel Emmanuel,author of Obamacare,and also author of The “Complete Lives System”which states that only People between the ages of 15 and 40 will get money spent on them for care,anyone over 40 has already had their ration of Quality of life years,those under 15 will get no care because they have not contributed enough to society to garner any concern. To read more of the Compassion this supposed expert who is trying to garner support for a Monstrous Health system that 95 percent of the American people are not even aware of, Google “Complete Lives System”,Ezekiel Emmanuel and read it for yourself.
THIS IS HOW YOU FIGHT THIS CRAP,WITH THE FACTS,INFORM YOURSELF AND THEN INFORM OTHERS THE TRUTH
<< Well isn’t that special? Are they going to have a baby soon? Which one will be the mom?>>
What interest group has abnormally high health care costs and would therefore want government to fund their health care?
http://www.home60515.com/4.html
Um, the ones who have contracted just about every sexually transmitted disease known resulting in the destruction of their immune systems and the “final solution” of HIV infection? Is that the group you are referring to?
I have a military veteran patient who shall of course remain anonymous.
Three years ago he was diagnosed with rectal carcinoma. The tumor was surgically removed and radiation and chemotherapy were recommended to give him the best chance for survival. All of this would be performed through the VA at no cost to him.
He refused further treatment and has spent the time since his surgery obsessively scouring the Internet for the elusive “natural” cure. His cancer has returned and he is now obstructed just like the man in this fanciful story. He will die soon.
Maybe the man in this story made the same choice and that fact was completely omitted because it didn’t fit the libtard narrative.
Gee, if we can figure that out, why can't everyone?
I've also learned that Stillman has been an active supporter of Obamacare for its inception.
The article is biased political lobbying masquerading as medical scholarship.
They also want fedgov to find a cure for HIV so there are no consequences for their perversions.
This is similar to Steve Jobs' refusal of conventional treatment for his unique form of pancreatic cancer.
Your scenario sounds more plausible: Occam's Razor.
Get back to me when Obama and the rest fore-go their taxpayer provided luxury healthcare and join the rest of us.
Exactly. Moralize to us about health care for all when you accept the same for yourself and your family.
To be fair, my VA doctor wanted to put me on Statins for cholesterol. I argued with her and insisted on using diet and exercise. Later, she told me she never said this before but I made the right choice. My bad levels dropped 50 points and she told me to keep on with what I was doing.
That said, if it were a tumor I'd get it cut out (if possible).
You are blessed if you are healthy enough to exercise your cholesterol away.
The human body’s warranty expires at age 45 and weight-bearing joints are usually the first parts to experience problems. This restricts a lot of people from being able to exercise.
There are others who have genetically elevated lipids who can eat rabbit food and jog 6 miles per day and they still have sky high levels.
These are the people who should be taking statins if needed.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.