It’s easy to identify the inefficiencies and ineffectiveness in our health care system. Working in a community health clinic, I see daily the dramatic effects of having more than 35 million uninsured Americans (plus 9 million unin-sured foreign nationals).
But you don’t have to work in the medical field to experience the scope of this problem. Chances are, your local church fields prayer requests regarding financial hardship due to medical bills. You may receive e-mails at the office asking you to assist your co-workers in times of need.
Many Americans are flocking to free clinics and are opting for only catastrophic coverage health care plans because this is their only option. You might be surprised by how many of these are people you know.
In an economic downturn such as the one we are now experiencing, even more Americans lose their insurance coverage. The uninsured masses, like an 800-pound gorilla in the room, simply cannot be ignored.
Let me tell you a true story that represents just a single hair from that gorilla. Out of work for over a year and unable to pay his COBRA premiums, John unavoidably joined the ranks of the uninsured. Unfortunately, because John is a diabetic, the cost of doctors’ visits, lab tests, test strips, lancets, syringes and insulin were overwhelming, and he quickly burned through his meager savings.
One day, he was denied the bottle of insulin he needed at the pharmacy because he didn’t have the $20 to pay for it. While he was attempting to scrape together the cash, his blood sugar rose, causing him to urinate more frequently, to the point of dehydration.
Without his insulin, acids built up in his system as his body converted fats to ketones. This made him fatigued and confused. Later, he was found by one of his friends lying on the floor of his apartment, nonresponsive and nearly dead.
Thankfully, his friend called 911, and John was rushed to the hospital where he was admitted to the ICU because of his severe diabetic ketoacidosis. After more than a week in the hospital, John’s condition stabilized, and he was released to go home with a bill for more than $30,000 that he would never be able to pay.
Subsequently, he became my patient at Community Health Care and was able to get his doctors’ visits, labs, diabetic supplies and insulin more affordably on a sliding scale. Even though John was able to receive the care that he needed from our clinic, the number of uninsured patients in America vastly exceeds the capacity that can be served by community health clinics.
This story is just another classic example of how we can have such an expensive health care system, yet so many Americans are unhealthy because they fall through the cracks.
John’s story illustrates the following:
• Lack of insurance leads to poorer health.
This is a fairly obvious fact, but it’s often overlooked or underappreciated since we have not yet made any meaningful strides in reducing the number of uninsured patients.
Uninsured families are nine to 10 times more likely to forego health care. This lack of preventive care results in diseases that are more advanced and difficult to treat when they finally do seek medical treatment.
• Treating uninsured Americans is expensive for all of us.
It is not only expensive for uninsured families, but also for hospitals and taxpayers. Even if patients go to the emergency room for their care and cannot pay for it, someone has to absorb those costs.
Let’s think about my patient, John. Surely a man who cannot afford a $20 bottle of insulin will not be paying off a $30,000 hospital bill.
Many of our uninsured patients generate hospital bills large enough that they qualify for Medicaid, which will then pay their medical expenses. Although there is concern that health care reform will be expensive for taxpayers, we must remember that the current system is already rapidly depleting taxpayer dollars.
Chances are, you, the taxpayer, will be paying for John’s $30,000 bottle of insulin.
The best way to cut costs for taxpayers and individuals is to offer access to a primary care provider to those who are currently uninsured. This is true for two reasons:
• Coverage for preventive care and basic medical needs keeps costs down.
How did the cost of a $20 insulin bottle turn into a $30,000 hospital bill? Because a patient was denied inexpensive primary care. Coverage for preventive care and basic medical needs would radically improve the health of Americans. Health concerns would be addressed in a more timely and cost-effective manner.
Providing coverage for preventive care and even the very basic medical needs such as a few clinic visits a year, coverage for X-rays, lab tests and a limited medication formulary would significantly reduce costly ER visits and hospitalizations. Patients could get access to care before the illness has progressed to the point of being more difficult and expensive to treat.
• Patients need a patient-centered medical home.
This is the place where one primary care provider coordinates the patient’s overall health care. That provider follows-up on abnormal lab tests or diagnostic reports. Patients have open access to their clinic and can see their regular medical provider instead of having to go to the ER to be seen for their cough or urinary tract infection.
With a patient-centered medical home, there is an emphasis on health information technology and best medical practices to promote quality while curbing costs. Medications prescribed from multiple doctors are reviewed by each patient’s personal doctor in order to prevent drug interactions.
Just like in a good kitchen, it is best to avoid having eight cooks trying to spice the chili at one time.
The 800-pound gorilla is looking us straight in the eye. The one thing we can’t do is to ignore the problem. As a nation, each day we do nothing costs us dearly – in taxpayer dollars and, ultimately, in the needless suffering and shortened lives of our fellow citizens.
David Cameron, M.D., is a family physician at Community Health Care in Lakewood and clinical faculty for the University of Washington. He is co-author with his wife Sonya, a marriage and family counselor, of “The Rest of Health.” They have two children and live in University Place.
