Lack of primary care can be deadly

March 31, 2015

Rutland Herald: Although the governor put single payer on hold, this does not mean Vermont cannot move toward this goal in other ways. The misnamed Affordable Care Act cannot, and will not, do this job.

Perhaps a more appropriate nomenclature for the ACA (or Obamacare, as it is known) would be the analogy given to it by Mr. Wendell Potter, former vice president of Cigna health insurance company. It is, as he said, “The Insurance Industry Profit Protection and Enhancement Act.” As Mr. Potter noted, the ACA’s main beneficiary is the private sector.

There are two bills currently winding their way through our Legislature, however, which will go a long way toward correcting this problem and attaining the goals called for in Act 48. These are H.207 and S.88. They propose to create a system of publicly funded access to primary care for all Vermonters, cutting back on the excessive expense of people utilizing emergency rooms as their doctors because barriers like lack of health insurance or insanely high deductibles shut them out of primary care. Unimpeded access to primary care is ethically, financially, morally, and absolutely essential.

I am an example of this. Several years ago I nearly died from liver disease caused by bad luck and natural causes. I was employed by a Vermont employer at the time. The employer was a large company, owned by an out-of-state parent company. Though I was fortunate enough to have health insurance through this employer, this did little good when the parent company switched insurers on us. The new insurer was also an out-of-state company. This was thrust upon us without our consent or input. This is not an unusual situation in our culture of private insurance.

The change threw my primary care provider into what, in insurance jargon, is called “out-of-network.” This happened just as my disease was coming on. “Out-of-network” means that if I wanted to visit my old primary care physician, I would not be covered by my new insurance. I would have to pay the non-insured prices, which were substantially higher.

Back then I did not know why the uninsured and the insured pay vastly different rates, with the uninsured being the highest charge. I now know the reason. My liver disease had plenty of time to grow from one which could have been easily cured at vastly less expense into a life or death situation as I scrambled around to find another primary care physician in the new insurer’s provider network. It was almost too late when I finally located one. I am sure that the operations I needed to stay alive were twice as expensive or larger because the disease was not caught and diagnosed in its early stages due to this needless situation.

Anyone who has been in this or a similar position knows how primary care is so vastly important. Without it, we die unnecessary deaths. With it, we can prevent these unnecessary mortalities. We could save money in the long term on insurance premiums and hospital costs, which we now throw away on more expensive procedures which could have been avoided, like what happened to me for want of a primary care provider.

 

Walter Carpenter is a resident of Montpelier.