Op-Ed by Bob LeBow, MD, Medical Director at Terry Reilly Health Services in Nampa, Idaho
People without health insurance suffer many indignities--long waits in overcrowded emergency rooms, the inability to pay for a needed prescription, and the scorn of those who think they are just looking for a handout. But they should not have to suffer untimely deaths. And, families should not be split by the lack of health insurance.
Unfortunately, I've seen that happen far too often. At our clinics, we see many families where health insurance is the dividing line between those who get care and those who go without. More than half of the people we treat -- about 17,000 patients a year at our four community and migrant health centers in and around Nampa, Idaho -- have no insurance at all. They either can't get it through their employers, can't afford it because of low pay, or they don't qualify for Medicare or Medicaid.
Our clinics -- known collectively as Terry Reilly Health Services - - offer medical, dental, and mental health care to anyone in the community, regardless of their ability to pay. But for some, the shame of being without insurance and lacking the money to pay for care outweighs the fear of disease and death.
A few years ago, a woman in her late 20s came to our clinic in Homedale, seeking prenatal care. She was two-to-three months pregnant and had no health insurance. Her husband had a green card, and both her children were eligible for Medicaid since they had been born in the U.S. But she was undocumented and ineligible for Medicaid pregnancy coverage.
We charge $500 for prenatal care and delivery, and we try to collect as much of that as possible. We explained to this woman that we would expect $50 a month from her. Maybe that was too much, because she did not come back. That is, until she came to our affiliated hospital, worried because her baby had not moved in two days. She was two weeks past her due date. We determined that her baby, weighing 12 pounds, was dead. The mother also had untreated gestational diabetes, which probably contributed to her infant's death. An obstetrician performed an emergency Caesarean section to remove the dead child. During the operation, fluid from the amniotic sac traveled to the mother's lungs and she died on the operating table.
Two untimely and tragic deaths could have been avoided if the mother only would have had gotten appropriate care. Another woman I treated died too young, as well. She was a single mother in her late 20s. She came to our walk-in clinic with the hallmark symptoms of bacterial endocarditis, an infection that can send clots from a heart valve and quickly kill someone. We hospitalized her immediately, but a clot broke off and caused a stroke. Although we did all we could, sadly, she died. Her mother came in three weeks later for care, and mentioned that her daughter -- whom I recognized as our patient -- had recently died. When I asked if her daughter had delayed care, the mother conceded that she had put off seeing a physician because of her lack of health insurance. Ironically, the young woman had recently been promoted to assistant manager at the convenience store where she worked, and was awaiting approval of her health insurance application.
Now, her mother will have to care for her two young grandchildren. Other patients put off getting the medications they need to survive, and get sicker. Some people with chronic illnesses such as diabetes or asthma go for months without absolutely crucial therapies because they can't afford them. Once, I had to call a woman and convince her to bring her 17-year- old son back for his asthma prescriptions. She told me that they had left the clinic humiliated when our desk clerk had inadvertently asked for our token $8 fee for the office visit. It had been a hurdle for them to come in because they knew they did not have the money to pay for the visit, much less the additional cost for the medications.
This young man eventually got his medication. But some of my patients have not been so fortunate. Many Americans, including local and national leaders are unaware that so many people are going without necessary medical care because they don't have health coverage. The uninsured as a group may be invisible but their problems are not. Let's start working toward resolving the problems of delayed care and lost dignity?