Valley News: A 60-year-old man, who I’ll call C.C., recently walked into my family medical practice. The nurse handed me a thin chart record. His last visit was five years before for a skin infection. Written across the top in large block letters were the words, “NO INSURANCE.”
C.C. and I started talking. Over the past month, he’d experienced darkening and diminishing urine, clay-colored stools, fatigue, nausea, abdominal pain, parched mouth and windedness. His vitals weren’t good. He had a rapidly irregular heart rate of 130 beats per minute, and a low blood pressure of 98/52. With the aid of a urine test, ECG and chest X-ray, I knew C.C. was severely ill with kidney disease, jaundice and atrial fibrillation. I could only broadly diagnose, however. He clearly needed more in-depth evaluation: immediate blood work, an abdominal CAT scan and urgent measures to replenish his dehydrated body. But, as C.C. reminded me, he didn’t have insurance. He and his wife own a store, and he earns extra income doing carpentry on the side. Costly health insurance premiums, deductibles and co-payments were not things that he could afford. He asked me whether he could delay treatment, and potentially emergency hospitalization, until he was able to get insurance.
How absurd is this system? Those who defend out-of-pocket costs claim that they discourage the overuse of care, but as a doctor, I see that they make my professional medical opinions irrelevant and deny my patients care. The market-based insurance system, in effect, was denying C.C. the urgent care he needed, leaving both him and me powerless to do anything.
C.C. was stuck in what people in the business world call “churn.” In business, churn describes customer turnover; in medicine, where people with real medical needs are treated like consumers, its effect is to disrupt care. Over the last 20 years, I have seen this business phenomenon recklessly infect medicine. People like C.C. churn in and out of health insurance plans as their age, employment, health and income changes. Health care providers churn patients in and out of offices with “eight-minute” appointments. And an endless churn of reforms — paperwork, electronic medical records, accountable care organizations — do little to free patient-doctor decision-making from interference by middlepersons, and nothing to move us away from the market-based insurance system that puts financial interests ahead of people’s needs.
As a doctor, I am fortunate to have a good degree of financial security, but as a patient, I am affected by this broken system too. My son and I both deal with chronic conditions each day, and this year, getting the treatment we need has meant paying an $11,500 deductible above and beyond the $7,000 annual premium for my Bronze Blue Cross/Blue Shield insurance plan. What about my patients, neighbors and friends with less financial security? I urge all of us to focus our hearts and consciences on human dignity, and to recognize that our dignity depends upon universal, publicly financed health care. We need to step beyond the gimmicks of private health insurance schemes that stratify us into multitiered divisions and produce inequity among people.
I urge the Vermont Legislature to move beyond destructive co-pays, deductibles, premiums and inequitable tiers of access to health care. Let us do the right thing and create a universal, publicly financed Green Mountain health care system that includes everyone in Vermont from cradle to grave. If you agree, join us on Jan. 29 for a human rights vigil at the Vermont Statehouse cafeteria, details at workerscenter.org<http://workerscenter.org>.
Dr. Anna Carey lives in Burlington and works at a family practice in Cambridge, Vt.