Equal Healthcare Access for All

How fair is it to ask families making 30 to 50,000 dollars to buy healthcare for 15,000 dollars?

“Equal healthcare access for all is against the laws of nature,” my patient stated in a very matter of fact way. A middle aged African American single mother was answering my question as to why she had not seen a doctor before, despite being diabetic for 5 years. I could not tell if she was kidding, being sarcastic or making a factual statement. “Really?” was all I could say. I would have accepted this profound provocateur, had I had not experienced the contrary in Ireland, England and Canada; and also had I not read about the healthcare set up in Japan. The problem with writing about the same subject again and again is the repeating of the same mantra, boring the readers and losing the audience. But the stakes are so high that I am willing to take this risk.

What is heartening is to see the topic raised in the New England Journal of Medicine, national newspapers, weekly editorials and most importantly, in the national election debates. Perhaps there is a chance for a positive change. What shadows this optimism is that we have been there before as well. We have seen the same fervor and debate in national election before when the going was tough, the stock market was down and purchasing healthcare was proving beyond peoples’ means. How fair is it to ask families making 30 to 50,000 dollars to buy healthcare for 15,000 dollars? When, after paying for the healthcare, mortgage and gas, there is hardly anything left to buy food, no wonder so many opt out of purchasing health insurance.

While the problem is complex and involves powerful players and lobbies, it does not require a genius to see some fundamental wrongs. A recent Pricewaterhouse analysis concluded that almost half of 2.2 trillion healthcare dollars are wasted. Yes, you read it correctly; we waste upwards of 1 trillion dollars every year in healthcare dollars. The sources of waste are numerous: avoidable laboratory tests, administrative costs incurred by payers, lagging behind the advances in information technology and medical errors, to name a few. It is beyond the scope of this blog to list all of these factors, or to describe even one of them in detail; I just want to draw your attention to the fact that there is 1 trillion dollars on the table which could be saved from going down the waste drain and diverted to make healthcare cost cheaper and more affordable. Remember, IHI has recently shown us that using simple no cost techniques can save more than a million lives every year.

Does blogging about this issue even have a chance of bringing about the change we have been screaming for? Maybe, maybe not. But it sure helps to bring it to the forefront of national consciousness and awareness. Talking, discussing, writing, singing, shouting; whatever it takes to bring this to the attention of policy makers. You only need to see a couple of helpless uninsured patients, or perhaps to meet elderly Medicare recipients choosing between food and medications to feel the depravity of our situation.