The proposed healthcare reforms and the resultant debates are the rage nowadays. Proponents and opponents are getting in each others’ face in ways not perhaps imagined by the administration. The head butting is so intense at times that to a casual bystander, it might appear that people have forgotten why they were arguing in the first place. No one is ready to give an inch as they stand nose to nose, screaming and sending spittle flying, the viewers’ eyes riveted to their jugulars which appear dangerously close to burst point.
In this milieu, hospitals and doctors’ offices continue to go about their business as usual. As a matter of principle, we tend to keep our views to ourselves, as surely a majority of doctors do. Sometimes a patient would attempt to get us sucked into the current national argument but they don’t get very far, running into our carefully crafted stone wall of non-committal answers. But there are other times, when one encounters a situation that tends to precipitate musings. I found myself in such a situation on a busy office day recently. A situation which can be frustrating and is probably played out almost every day in physicians’ office all over the country.
On a busy office day, in walks a man for his scheduled appointment. He is in his mid-50s and accompanied by his wife. After a little prodding, he reveals a rather concerning history of chest pain. He has several risk factors for coronary artery disease and has had quite a few episodes of chest pain in the last few months. Each time however, he decided to “tough it out” and never once came to the ER. This visit, he frankly admits, is occurring only because his wife nagged him into it. Well, you need things done, sir! Surprisingly, this is met with a firm refusal, “can’t do it”. Well, why the heck not?
The man and his wife didn’t have medical insurance, you see. To be precise, they no longer had medical insurance. Both had worked all their life until recently when he was laid off. She still had her job at the time and they were able to keep the dwindling shadow of insurance coverage over their heads. But not too long ago, she lost her job too and with it, their remaining insurance coverage. Now in their mid-50s and with known health issues, they perhaps aren’t perceived as very desirable employees despite their impressive work experience.
And therein lies the rub. They have been told they don’t qualify for Medicare or Medicaid. They’re not poor but they cannot be called particularly wealthy either – just a normal, middle class family. ‘Medical expenses’ is not something they can pay out of their pocket without going bankrupt. And if they did go bankrupt, the man said with a rueful smile, they might qualify!
I had just seen a rather too self-confident (dare I say, cocky) young man who is in good physical condition but still receives disability assistance and Medicaid, and who claims (with some pride) to not having worked in years. The contrast between these two patients and their situations forced me to wonder. Why is it that a person can work and be productive contributors to society all their life but then when it’s “their turn”, are forced to consider bankruptcy in order to qualify for health insurance? Why is a reasonably healthy young man receiving positive reinforcement to be a negative contributor to society?
There is perhaps some logic in all of this, but so far it has eluded me completely.
As I watch the raging healthcare reform debate, I cannot help thinking of that middle aged couple. What do they think of all of this? Which side are they on, in this debate? Do they support universal health care? Would they have liked their health insurance to be portable? Would they have worried about the often touted proposed cuts in Medicare, or would they have believed what AARP or factcheck.org have to say?
I would like to ask them, but my principles wag an admonishing finger at me.
