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Luis Lang case sparks wrong questions

Lang has garnered a lot of attention, but his case just points to the need for a better approach to health care in the U.S.

By Jessica Schorr Saxe, M.D.
The Charlotte (N.C.) Observer, June 6, 2015

Have you weighed in on Luis Lang, the diabetic smoker who put off getting health insurance until he was about to go blind from complications of diabetes, only to find it was too late to enroll in an Affordable Care Act policy and that he wasn’t eligible for Medicaid in South Carolina? Since his story was reported in the Observer, it has unleashed a torrent of comments and has been widely disseminated through social media. Lang has raised more than $25,000 for eye surgery through the original story and his GoFundMe site – and is now an advocate for the ACA.

Apparently everyone has a position. Many are punitive, as in “he made his bed, so he must lie in it.” One suggested that he go blind: “Learn to read Braille. Sell pencils on the street.” Some remark on the value of his house, his “immaculate lawn and gardens,” and his “fine furniture.” Some wonder why, if they had the foresight to invest in their own health insurance, they should now pay for his health care. Others note that, if he does not get help and goes blind, he will actually cost the public more in various ways. Many who have contributed to his surgery are self-described liberals, provoking a separate stream of criticism as expressed by Keith Larson in a column titled “Go ahead and gamble: the liberals will rescue you.”

Since there are millions in similar situations, this could prompt other discussions. If he didn’t smoke, would he attract more sympathy? What if we knew his wife really couldn’t work, which he suggests but doesn’t explain?

The problem is that this is the wrong discussion.

What’s the best model?

The questions we should be asking are these:

Who needs health care?

Who benefits if everyone has health care?

Do we really want people to have better health habits? If so, is blaming them and excluding them from health care the way to accomplish that?

Is crowdfunding the way to finance needed medical care, or are there better models?

We all benefit from coverage

And the answers are:

Everyone needs health care. Some need it more than others, but we all need it at some point, and we all need to know it’s available when we do.

We all benefit if everyone has health care. Infectious diseases are an obvious example. If our neighbor or food server has whooping cough, we are better off if they are not deterred by expense and get treated before starting an epidemic. We are better off if our employees or colleagues have their diabetes or asthma treated so their work is not impaired. We are also better served if our neighbors can get needed care and are not beset by anxiety about illness or mounting medical bills.

Many have expressed reservations about Lang’s health habits and decisions. Yet, most of us do not have exemplary lifestyles. Like Lang, 18 percent of U.S. adults smoke. And two-thirds are overweight or obese. A doctor’s words can affect detrimental lifestyle habits. Even brief smoking cessation counseling by a physician boosts success. In medical practice, I helped many patients stop smoking, eat better and be more active. But I could do that only if they were able to see me.

Crowdfunding is interesting because it taps compassion, a quality sorely needed in this discussion. But crowdfunding is an inefficient and arbitrary mechanism for distribution of resources, directing funds to those with savvy and communications skills rather than those with the greatest need.

Much spending is wasted

We must ask the right questions in order to direct our energies toward a compassionate solution to the health care plight of so many and away from the impulse to nitpick our neighbors’ lives and second-guess their decisions.

Asking the right questions will lead to the right solution. The ACA is a step in the right direction in providing more people with insurance, but it will not solve the problem. We must move forward to provide everyone with needed health care. We can look to the example of other developed nations which all provide universal health care at considerably lower costs than ours by administering it through a unified system instead of our fragmented, complex non-system. The Institute of Medicine estimated that 30 percent of our health care spending is wasted, much on administrative complexity and unnecessary care. Harnessing that wasteful spending and putting it to use would provide more than enough resources to provide care for all.

If we have the vision to ask the right questions and exert our political will, we can save costs and move toward a kinder, gentler system in which Luis Lang won’t have to crowdfund his sight.

Jessica Schorr Saxe is a Charlotte family physician and chair of Health Care Justice – N.C.

http://www.charlotteobserver.com/opinion/op-ed/article23220168.html#stor...