Last week the US Census Bureau estimated that 50 million people in the US are uninsured. Here's a story of three of them. (Names and identifying details have been altered to protect the patients' identities)
“I can't afford to pay $600 a month for health care and feed my kids,” said Jeffrey, a patient I was seeing at a Los Angeles community clinic, which provides free care for most uninsured patients. “I hurt my leg and I can barely walk on it,” as this 40 year old with a boyish face explained his reasoning for coming in. However, I was more concerned about his blood pressure. It was 170/110 (normal is less than 140/90). “Has anyone ever told you that you had high blood pressure?” He had been diagnosed with high blood pressure and took medications until, “I couldn't afford them anymore.” He has his own business, thus no insurance plan. He had been off medications for a year. I just cringed as I thought of the amount of damage a blood pressure of 170/110 every day for 365 days had done on his heart, brain and kidneys. Luckily he found us and because of the Affordable Care Act, he will get medical insurance (MediCaid) in 2014. Until then, the community clinics of Los Angeles promise to provide primary care to all patients who can't afford medical care (and even to those who won't qualify for MediCaid). I started him on medications which cost the clinic a few dollars and is free to the patient.
That same day I saw Richard. “I lost my insurance in 2005. I had a stroke in 2007. I'm still weak on one side. The place where I'm staying referred me here to get checked out.” Blood pressure...194/130! Off his medications for 3 years. Often we'll hospitalize people with this number. I started him on 2 medications and brought him back in a few days. 122/74! Two generic medications...again a few dollars. On the third visit I got his blood work back. The kidneys are somewhat damaged, so I added a medication that protects the kidneys. His cholesterol was high, so I added a cholesterol medicine, which will help prevent another stroke. So all in all, four generic medications and aspirin. Still not too expensive compared to the price of not controlling his blood pressure and cholesterol.
Last week, I saw Maria for the first time. She's from Guatemala, who came to the U.S. 2 ½ years ago. Two years ago she went to a county Emergency Room for chest pain. She was told she had high blood pressure and told to find a primary care doctor. She didn't know where to go, so she hasn't seen a clinician since then. A friend told her about our clinic. I don't remember the exact number, but her blood pressure was high.
Last week, the US Census Bureau announced that almost 50 million people living in the US are uninsured.
The American Heart Association and the American Stroke Association put out a joint fact sheet this year regarding the uninsured with Heart Disease. They report that about 6.5 million Americans who have cardiovascular disease are uninsured. These patients are reported to have “dire health consequences.” They are far less likely than their insured counterparts to receive appropriate and timely medical care, and as a result, suffer worse medical outcomes. And most importantly they are dying sooner!
The number one cause of death in the U.S. is due to cardiovascular causes, such as a heart attack, heart failure or a stroke. The most common cause of cardiovascular disease is hypertension and diabetes, both extremely prevalent in the U.S. and on the rise. The cost to care for those with hypertension and/or diabetes is not very expensive at all, if the patient hasn't developed end organ damage yet. Routine blood work every few months, an eye check once a year, an EKG, their medications and routine follow up visits.
However, the cost of going to the ER for chest pain? $5,000. The cost for being admitted for stroke, which usually includes a couple days in the ICU? $25,000. The cost for being admitted for a heart attack which usually includes invasive procedures and several days in the ICU? $50,000. Cost of dialysis (for people whose kidneys have completely failed)? $72,000 per person per year! (www.marketwatch.com)
Maria, Richard and Jeffrey most likely have caused significant damage to their hearts, brains and kidneys by not getting proper care possibly causing future heart attacks, strokes and/or kidney disease. These end sequelae, if don't shorten their length of life, have very detrimental effects costing more money in health care in caring for these issues. Furthermore, if they do suffer these detrimental effects, they may be disabled and their quality of life most likely will diminish significantly. They're just ticking time bombs waiting to blow. Now imagine Maria is your sister; Jeffrey is your brother; Richard is your father. I see several Marias/Jeffreys/Richards weekly.
For me, the “American Dream” is not about making more money than my father made, buying a house or taking several vacations a year. For me, it being part of a society that cares for my neighbors as if they were my brothers and sisters. It's seeing people in need and embracing them back to financial, emotional and physical health. But even if you don't believe in my morality, at least you can admit, that promptly caring for patients with chronic diseases would end up saving tax payers millions if not billions of dollars in emergency care and hospitalization, not to mention the millions of dollars that are lost as a result of someone becoming physically and/or mentally disabled as a consequence of the detrimental effects of their untreated chronic disease. Economically and morally, its a win win.