Monday, February 27, 2017

Looking forward or looking back?

Today I had my, now semi-annual, visit with my oncologist. He ordered the usual surveillance labs and other tests. I have learned that some of these go through easily, some mean phone calls to my insurance. These phone calls are a nuisance for me. But, as a physician myself, I know how to phrase the reason so that things are approved. I know this is far easier for me than for an average patient. Yet, I worry that things will be harder in the future.

Every cancer patient has a pre-existing condition, as does every premature child, mental health patient, and many others. Before the Affordable Care Act (ACA), that meant that every person with a pre-existing condition could be denied coverage, forced to spend down their savings, and finally fall on the mercy of Medicaid, which differs some in the various states. They might then be limited in choices of providers. They finally would need to go to those facilities that are termed "safety net" hospitals.

I have spent most of my career working in safety net hospitals, teaching the next generation of physicians. I know we help a huge number of patients. And, we provide quality care. But, we sometimes lack in some technologies because we try to function on a shoestring budget. With the ACA, things eased a bit, since more of our patients had funding. But, still, not all technologies are available. In my case, my hospital did not have the ability to provide care had my disease turned out to be slightly more advanced. Yet, we often see patients with more advanced disease since they have tended to wait for care, if only because they might have to take a day off work due to travel time and waiting time, and so wouldn't be paid for that day. Even now, many patients miss appointments just to avoid taking time off work.

Waiting to see the doctor or have a test allows disease to advance. That makes it more costly to treat, and treatment less likely to be effective. Yet, plans are being made to force patients to have "more skin in the game" by forcing them to have higher costs when they seek care. Poor patients currently have relatively higher costs. So increasing their costs will force further delays in needed care, and so make US health outcomes worse. Last year, when life expectancy fell for Americans, poor Americans already had a life expectancy 14 years less than richer Americans ( So, poor people have been putting their lives on the line with their health decisions.

Fortunately, I am able to have insurance and to argue for the care that I need. But, as a physician, I also have sworn to care for my patients, and will are for their care. And, I feel all people deserve quality health care. It is not a luxury, but a necessity.

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