Treating the Medically Uninsured

Extending a hand to a patient in need is a privilege.

I believe that health care is a human right. This does not mean that every person must have precisely the same level of health care coverage. That is not how our society works.

Wealthy individuals can afford higher-level medical care, just as they enjoy higher-level housing, vacations, legal and financial advice, education, automobiles, and clothing. This list of advantages could be longer, of course. But every American, in my view, is entitled to decent medical care.

We also have millions of individuals in the country who are not citizens, many of whom have no medical insurance. In a perfect world, I would like them to have access to care, along with all other members of the human family. I recognize, however, that this situation in the U.S. has thorny political, social, and economic dimensions. Alas, the world is not perfect.

Our imperfect world.

When I was in private practice, we saw patients who were underinsured and uninsured. We were happy to see these patients, many of whom were working hard at their jobs but simply could not afford coverage. These folks had to make difficult life decisions as they balanced their priorities against their available resources. Many of us have not had to face such vexing choices.

Our staff would work with these patients to devise a payment plan that they were comfortable with. No patient was ever turned away. We were gratified by the generous measure of appreciation they gave us. This was truly such a small sacrifice on our part and was a huge gain for them.

Now, as an employed physician, I am no longer in a position to personally discount fees to accommodate patients in financial need. I miss this experience. When a patient with insurance issues seeks care at my institution, the process is handled upstream, long before I ever see the patient. I never know if such a patient who wishes to see me is unable to do so.

As readers know, I love my current position as a part-time outpatient gastroenterologist. But there are advantages that a private physician enjoys that are simply not present in an employed model. Extending a personal hand to a patient in financial need is one of them.

While we provide amazing health care in this country, quality and access are unevenly distributed. We will not have a truly great health care system until everyone can participate in it.

My own experiences with the uninsured and the underinsured illustrate our health care system writ large. The system is broken and will remain so until every person in our country enjoys basic health care to treat and prevent disease. Clearly, this aspiration should be extended globally since a human right knows no borders.

Although I am not an economist and can’t read a budget, I strongly suspect that funds are there, or could be made available, to extend coverage to uninsured Americans. We simply lack the will. My guess is that most Americans are ahead of our politicians on this issue.

Are all of the programs and projects that our government funds the best use of our resources? Is the greater good being served by these allocations? I know this is enormously complex and makes sausage-making seem neat and tidy by comparison. Every government-funded project is important to some constituency that may wield outsized influence to advance its interests. And every example of government waste represents someone’s income who might have a different view on the value of eliminating his or her department.

If dollars are limited, do you think a well-funded special interest might have the edge over competing projects that are more worthy but lack funds or connections? No need to answer this rhetorical inquiry!

The medical profession can teach by example here. Consider the medical resources that would be available if the profession could finally dismantle two very stubborn and entrenched adversaries: overdiagnosis and overtreatment.

Indeed, I have been thinking and writing on medical excess for decades. If we succeeded, even partially, the cost savings would be huge and could be devoted to extending health care coverage to those who need it. But my primary argument for targeting these twin pillars of excessive care is that they lower the quality of our medical care. More medical care often lowers medical quality. (Don’t get me started on the total body scan, which overpromises and underdelivers! Maybe a future post topic?) Of course, every doctor, including me, believes that every action we take is fully appropriate. If extra stuff is being done, then some other doctor is doing it!

If limiting a service improves quality and reduces cost, then shouldn’t we demand it? I wonder how close we could come to closing the coverage gap by just wringing out the excessive care that the medical profession is already providing. And do you think that our federal and state governments might also have a smattering of excess that could be targeted?

What is stopping us from moving forward?