A Tale of Two Patients

By Joseph Eichenseher, M.D.
Sonoma County (Calif.) Gazette, April 10, 2015

In previous columns in this newspaper you’ve heard a myriad of reasons why single payer, or Improved Medicare for All, benefits Americans and provides for a better and less expensive solution to the debacle of our current healthcare situation. While Canada and all developed countries have ongoing problems with healthcare, and none pretend to be perfect, the seriousness of our current crisis, in the form of out-of-control costs and unnecessary suffering, has reached epic proportions, casting us in a shameful light. Tens of thousands of Americans die each year due to lack of insurance, and there are millions of other examples of avoidable suffering. I see many of them daily as a primary care physician here in Sonoma County. The following are two examples of how our dysfunctional health system impacts local lives.

Patient #1 - “Bob.”  Robert M. is a 50-year-old carpenter experiencing daily chest pain at work.  He copes by doing less of the activities that cause the pain, but the symptoms are worsening over time. He works three part-time jobs, none of which provide health insurance.  He comes to my community clinic office because we have a sliding scale, and the visit costs him $40, as opposed to a private office that would charge over $200. He states that he can’t afford to spend more, as he is supporting three children and his invalid mother. Upon my exam it is determined that he needs a referral to a cardiologist and a possible heart procedure. The initial visit to the cardiologist will cost $300 (and they won’t see him if he doesn’t pay first), and any procedure will likely cost a minimum of $40,000. He understands he needs care, but refuses to follow my recommendations due to his inability to pay. We try to convince him that if he doesn’t go to the hospital or a specialist soon he will continue to suffer and possibly have a heart attack. He leaves our office downtrodden.

Patient #2 - “Cindy.”  Cynthia R. is a 61-year-old daycare worker with similar symptoms as Bob. When with the children, doing strenuous activities, she has sharp chest pains. She is one of the fortunate Americans to have insurance, but with a $5,000 deductible. This situation of “underinsurance” increasingly affects tens of millions of people. When we recommend that she seek treatment for her heart condition she likewise refuses, stating that she can’t afford to pay the deductible. We plead with her to seek appropriate care, yet she declines, and leaves my office more stressed, adding to her risk of a heart attack.

Both Bob and Cindy’s situations are common in today’s America. They are hardworking people who continue to suffer unnecessarily. Due to untreated medical conditions they are likely to miss many days at work and leave family responsibilities unfulfilled. The knowledge that treatment is available, yet financially challenging to obtain, also causes stress in their lives and worsens health outcomes. They will likely die younger or experience an emergency situation, causing more suffering and costing hundreds of thousands of dollars, potentially creating insurmountable debt. Medical bills are now the number one reason for individual and family bankruptcy in America.

The rest of the world has figured out that healthcare is a right for all people. They don’t tolerate for-profit health insurance companies and they find ways for everybody to be covered less expensively with better health outcomes. Society benefits if all people are treated with dignity. If either Cindy or Bob lived in Canada, Singapore, Australia, Costa Rica, or France they would receive timely specialist treatment and avoid unnecessary suffering. They would be happier, more productive citizens. The United States of America is a great country that offers so much opportunity and possibility. It is time for us to be part of the 21st-century civilized world.  Please consider joining us in Sonoma County to fight for healthcare justice: “Expanded, improved Medicare for All.” 

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Dr. Joseph Eichenseher is a member of the Sonoma County chapter of Physicians for a National Health Program. He resides in Healdsburg.