Tuesday, March 19, 2013

The Uninsured

A.C. is a 60 year old uninsured white female who recently was seen in my clinic.  She was referred for assessment of a new palpable right breast mass which had initially been imaged at an outside institution.  When the institution wanted $2000 to perform a biopsy on this suspicious mass, A.C. was referred to us because we have programs to cover the cost of imaging and biopsies for uninsured women.

M.G. is a 35 year old woman whom I saw this week, one year after her surgery to remove a malignant right breast mass.  She was initially imaged in April, 2011 at an outside institution, but, because she was uninsured and not a legal resident, it took her six months to find us to have her mass biopsied and eventually removed.  By the time she had her surgery, her mass had more than doubled in size and multiple lymph nodes under her right arm had cancer in them.

When I worked at my previous position, a patient had to quit her job in the middle of treatment for her breast cancer because the chemotherapy made her too sick to work.  When she quit her job, she lost her insurance and she stopped her cancer treatment.  When she returned to my clinic a year later after re-gaining her job and her insurance, her cancer had spread.

I recently met a young, white female conservative at a social gathering and, while she said she agreed with my 'liberal' social views, she stated that she 'belonged to the other side.'  When I asked her what she meant, she said that she didn't believe that people should 'be given something for nothing.'  What flashed in my head was the phone call I had made earlier that day to A.C. to tell her that she had breast cancer.  I could only get ahold of her between 3pm and 4pm.  Why?  Because that is the only time she had between her two full-time waitressing jobs, neither of which provided benefits.  She was only able to get the biopsy done because of our assistance programs for uninsured women.

There is something seriously wrong when we, members of the richest country on the planet, allow fellow citizens (and, yes, noncitizens) to suffer the consequences of undiagnosed or untreated disease simply because their situation doesn't allow for the safety net of medical insurance.  The amount of unnecessary suffering is heartbreaking.  All three of the examples above were dedicated, hardworking women who wanted to take care of themselves, who wanted to make the right decisions.  They weren't 'takers' or 'moochers,' just in need.

Although far from perfect, The Affordable Care Act will have the effect of mandating medical insurance for millions of people who currently are uninsured and are at the mercy of an often heartless and inaccessible system.  Although most economists believe that a single payer system is the best (this is also my opinion with Medicare, Medicaid, the military, TRI-CARE, S-CHIP and the Federal Employees Health Benefits system as multiple examples), taking the first wobbly steps towards this with The Affordable Care Act is the right thing to do.  You can read some questions and answers about The ACA here.

Part of the reason I took my current job almost five years ago is that part of the mission of St. Joseph Hospital is to serve the underserved.  This usually means poorer, uninsured patients, many of whom are undocumented.  Every year, we compete for grants and work with state funds to provide these vital services to these patients who would otherwise have no other options.  Politics aside, we as a country must figure out how to ensure coverage for all patients regardless of their ability to pay.  If these means more taxes for those of us who can afford it, then that is the price we pay for a stable, healthy, educated and safe population.  This is the moral, ethical and right thing to do.

We all benefit from a healthy, educated and safe workforce.  Doing what I do at the Breast Care Center at Exempla St. Joseph Hospital helps me keep the Hippocratic Oath I made when I graduated medical school nearly 21 years ago and helps to ensure that I, First, Do No Harm.  

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