Health Care Access Disasters, at Home and Abroad

Today’s front page news features a Philippines typhoon victim who died from not getting an antibiotics shot; for five days he lay with a mangled leg, untreated on a hospital gurney, and by the time doctors got to him, the infection was too far advanced.

Here in the U.S., tens of thousands of Americans die each year from our own health care access disaster. Their stories rarely make the front page. Instead, we’re consumed with the political wrestling match over the flawed rollout of Obamacare, and hardly anyone seems to notice the public health scandal that the Affordable Care Act aimed to fix: One in five adult Americans has no health insurance, and as many as 45,000 unnecessary deaths happen every year because of it.

In this week’s New England Journal of Medicine, two Louisville, Ky., doctors at a public clinic tell the story of their patient who ended up with advanced, incurable colon cancer, who had no health insurance despite working full time, and who put off for a year seeing a doctor about his abdominal pain and constipation because he couldn’t afford even the testing he needed. By the time he finally reported in agony to a clinic, and got a $10,000 workup that consumed his life savings, the patient aptly and ruefully called himself “dead man walking.”

Drs. Michael Stillman and Monalisa Tailor tell of other patients at their clinic who suffer pain and indignity every week from lack of access to health care: the man with AIDS who couldn’t get to a dermatologist for treatment of his whole-body rash because he didn’t have the bus fare, the patients who can’t fill prescriptions because they lack the copay, the woman with lung cancer whose surgeon wanted more testing than she could afford before he would operate.

Drs. Stillman and Tailor correctly call this a “public health catastrophe,” and they call out their own professional organizations — the American Medical Association, the American College of Physicians, and others — who have sat on their hands during the political debate about whether and how we as a country will ever meaningfully recognize access to medical care as a fundamental human right.

What’s the option to the Affordable Care Act? Republicans offer as a magic bullet “tort reform,” which by limiting Americans’ ability to sue their doctors for malpractice would allegedly cut all sorts of waste from the health care dollar. It’s a dubious proposition even on its face, and we’ve regularly cited the many reports that show that tort reform would do nothing but give a big birthday cake to the malpractice insurance industry.

Can we come together as a country to fix the scandal of health care access? Part of the problem is figuring out who is this “we.” Many of us with good jobs and regular access to doctors and hospitals find the “dead man walking” stories unimaginable, and we look for ways to blame and isolate the victim. We forget that our system gives reliable access to health care mainly to families with a healthy working bread winner; we’re all one catastrophic illness away from losing a job and losing good health care.

Obamacare means to fix that. It’s an urgent crisis. Let’s never forget that.

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