Columns 2006

Health care system in need of help

I recently got sick while visiting the East Coast. I was in Center City Philadelphia and could find no walk in clinic so I ended up at the emergency room of the Jefferson Hospital.  Since my cousin Joe has a large portrait of himself in their lobby because of his pioneering work as a doc in their ER, I figured I was golden.  I’d drop his name a few times and get the red carpet treatment.

Well, I dropped his name as loudly and as frequently as I could and it got me nowhere. One nurse did admit that she’d been there long enough to remember him but no one else was the slightest bit impressed. In the end, dropping his name got me a cot in the hallway after waiting five hours to be treated.

As I sat there thinking I’d surely die of whatever bug had gotten hold of me on my plane flight East, I became vaguely aware of the people and problems around me.  It didn’t take long to figure out that for many people there, this was their health care system.  They had no other.  Seeing the same health care provider twice for their problem was just a distant dream. Being seen in an office not even that.

We talk a lot about health care in this country. For those of us lucky enough to have coverage, the conversation is just that – conversation.  We may groan and complain about how long we have to wait to get an appointment or how long we have to sit once we get to the doctor’s office, but the bottom line is that we have access to that office and a means of paying for it.  Too many people in this country are not so lucky.

So I sat there on that bed in a hallway and wondered how much I would access care if this was the only care I could reach.  How often would I bother to hang around for five hours to be seen by someone for whom I was just the next set of symptom amidst a crowded field of people with symptoms? Most likely I’d wait until it was a crisis and I had no choice.

That decision is costly not only to the person who makes it but to the society that ultimately bears the price of treating a condition that has been left too long untreated. As a diabetic, I know that it is easier to treat my diabetes now than it would be to treat the complications that can arise if I don’t. Insulin is cheaper both for society and me than amputations or blindness.

So the question is why this country is having such a difficult time figuring out how to make sure that no one in our society falls through the cracks of the health care system. Poor people have Medicaid. It may not be much, but it’s something.  Older Americans have Medicare. Again, not the ideal but at least a safety net of sorts. Some workers are lucky enough to have employers who provide health care in some form or another. 

But there is a whole world of people in America who make too much to quality for government programs but too little to be able to afford health insurance and their employers offer them no options for coverage either.  For them, the world is a harsh place if they even so much as have a toothache.

The sign in the Jefferson ER made it clear that they would treat you if you needed help regardless of your ability to pay.  Which is a fine and noble sentiment except that in the end, someone has to pay. And that someone is all of us. We pay with higher premiums for our health insurance. We pay every time the hospital charges us $225 for the plastic bedpan they provide.  We pay because the working poor end up not working when they get so ill they need to go to the ER for care and, voila, they are then eligible for Medicaid. 

We pay because people who have to wait until they are so sick they can no longer function, end up becoming dependent on society to care for them.  If they had been able to afford care from the beginning, they might have been able to remain contributing members of the workforce.

I don’t know what the answer is but I do know that what I saw at the ER that long afternoon was not the way a country as rich as America should be handling the health care of its citizens.