The elephant in the room: health care's inaccessibility

By Paul Redstone, M.D.
Clinical Psychiatry News, May 14, 2016

As I read the array of articles in medical newspapers and on websites, I am intrigued by various reports about medications, such as the article, “Antidepressants tied to lower dementia mortality.” This and other articles about new therapeutic approaches involving medications are useful and interesting. However, what is lacking in this coverage of health care are articles about the “elephant in the room.” That elephant is the sadly deficient state of health care availability for vast numbers of the population who might, in fact, benefit from these treatments. This problem obviously is not unique to psychiatry; I am sure this could be said for all branches of medicine.

I have been working for many years in the Medicaid/Medicare inner city sector of society and am continually appalled by the lack of support available to the people I serve. I am not talking about the problem of availability and access to doctors – which is another important issue. I am talking about people who “drop out” of treatment for 6 months or more because, as they have said: “I had trouble with my insurance changing!” or “They sent me a letter, and I didn’t know what it was for and discovered by not replying I lost my coverage,” and on and on.

Then there are those who confess that they didn’t fill the prescription “last month” or for several months because they could not afford the copay. Yes, that $3-$7 required copay added to other health medications plus food and shelter needs simply did not exist! And on and on go the stories. I am not talking about Ronald Reagan’s imaginary welfare queens or drug users who are diverting money elsewhere. These are people who might or might not even be on welfare. Contrary to myth, many people on Medicaid actually work but are still unable to earn enough money for food and rent, much less prescription copays.

In addition to this glaring deficiency in medicine as a whole, has anyone noticed the deafening silence regarding dental care? If we think about what we are trying to treat, how does giving an antidepressant serve the person with chronic dental problems, or the person who is reluctant to smile because of being self-conscious about not having dentures? How does the antidepressant help that patient? The field of psychiatry constantly includes discussions about addressing problems in the context of the whole individual. Does that not include the mouth? I am amazed that there is not more public discussion by psychiatrists and other physicians about this unconscionable state of affairs. We keep discovering new drugs and treatments, but so what if it is only for a select few?

Our publications and organizations like the American Psychiatric Association and the American Medical Association need to be producing blazing headlines about this terrible state of affairs. As physicians, we are in the business of helping people by treating and hopefully alleviating suffering. It shouldn’t be our problem to figure out how our patients can pay for this treatment. But if they can’t pay for it, what good is our training, intention, or business?

If our patients cannot reliably afford the treatments we prescribe, it seems our only choice as physicians is to become politically vocal: So when will we all unite to insist on accessible health care (including dental) for all? The article published within the past few days in the American Journal of Public Health from 2,000 doctors supporting a single-payer health care system is a wonderful start. I am sure that more than 2,000 doctors would agree. However, it is only a start! And if you object to the sound of “single payer,” that is fine as long as we create a situation in which there is a health care system that effectively provides truly comprehensive access for all.

Dr. Redstone is a psychiatrist who practices in Springfield, Mass.

PNHP note: This opinion piece was originally published under the title "The elephant in the room: Health care for the working poor."