Public Policy

Get Well Now


 

Jeff Glasheen, MD, FHM

Four eyes staring, boring through me, unblinking. Locked in a pose holding a hand-scrawled sign commanding their father to ♥♥GET WELL NOW♥♥, the photo of the 14-month-old twin girls was reproduced off a cheap color printer and taped to the window, backlit by the Christmas Eve morning sun. Both the sun and the daughters demanded my attention—the former a brilliant reminder of the glories of the day, the latter the sobering reality of a family rocked by illness.

Mr. Jasper, an otherwise healthy 36-year-old male who recently was diagnosed with a rare, life-threatening disease, would not be spending this holiday with his daughters. In fact, because of our hospital’s flu precautions, he hadn’t seen them in the six weeks he’d been an inpatient. In that time, one of his girls had learned to talk; the other had learned to walk. Mr. Jasper was a distant bystander. He was upset but understanding of his situation—even optimistic, remarkably. However, those girls’ eyes told a different story. What weeks ago shone as the cute countenances of toddlers—silly, carefree, cheerful—now articulated a different tone. “Let my father come home!” they beseeched.

Staring into those eyes on rounds that morning, I was haunted by a thought that had gnawed at my subconscious for weeks. It was likely, albeit not guaranteed, that we’d get Mr. Jasper home to his wife and daughters. However, it would be at a cost. Of course, there would be psychological costs, but I was more acutely concerned with the financial costs. Mr. Jasper, you see, is uninsured.

Unable to afford to fill those prescriptions, his disease progressed, eventually strangling his breathing and tangling him in a healthcare system more willing to pay for the care of disease complications than disease prevention.

Healthcare Reform: Too Late for Many

Thousands of miles away, the U.S. Senate was, at that exact time, voting for legislation to greatly reform and expand the U.S. healthcare system. Passed along partisan lines, the bill now awaits reconciliation with the House of Representatives’ bill. From there, it will go before President Obama for signature into law. If passed, this legislation promises to give healthcare coverage to another 30 million Americans.

For Mr. Jasper, this new law will come too late.

It’ll also be too late for Mrs. Anderson, a middle-aged asthmatic now intubated in our ICU, wheezing against constricted bronchioles. Three days earlier, she was seen in the ED for worsening dyspnea, cough, and sputum production. Her symptoms resolved after a few courses of nebulized albuterol and IV steroids, and she was sent home with a prescription for prednisone and inhalers. Unable to afford to fill those prescriptions, her disease progressed, eventually strangling her breathing and tangling her in a healthcare system more willing to pay for the care of disease complications than disease prevention.

Face-to-Face with Catastrophe

Later that morning, I was asked by one of our ED physicians to see Mr. Reynolds and “persuade” him to be admitted to the hospital. Mr. Reynolds has insurance. In fact, of the 11 patients I saw that day, he was one of only three who did. One had Medicaid, the other Medicare.

Mr. Reynolds had a high-deductible, catastrophic-insurance policy. As such, he was wrestling with the decision of whether to come into the hospital to treat his severe cellulitis with IV antibiotics (our formal recommendation), or treat this at home with oral antibiotics. His face wore the torment of the trade-offs. The former surely would cost him his entire $5,000 deductible; the latter, perhaps his life, or at least a limb. As the erythema glared at me, I struggled to recollect a medical school lecture applicable to this situation.

My last patient of the day was Mr. Ramon. He, too, was uninsured. Felled by diabetic ketoacidosis, he was admitted and, as 19-year-olds are wont to do, rebounded quickly. New-onset diabetes, however, was the least of his concerns. With a girlfriend and young child at home, he had to get out of the hospital and return to his job as soon as possible: mouths to feed. Having seen his father lose limbs, kidneys, eyes, and ultimately his life to diabetes, he was motivated to do the right thing.

Unfortunately, motivation doesn’t pay for insulin. I wondered what would come of him in the next 30 years. Would he be able to care for his disease and live a long and prosperous life, or would this admission be just one in a long series of hospital stays?

Broken System

Every hospitalist is aware of these issues and could no doubt fill pages with similarly horrific stories of a healthcare system long broken. It’s remarkable how much of my time I spend trying to figure out a way to cobble together a passable (the notion of “gold standard” therapy long gone) therapeutic plan for my patients—the Walmart list of $4 drugs has taken white-coat prominence over my “Pocket Pharmacopoeia.”

This isn’t to say the U.S. healthcare system doesn’t do a lot of great things. It does, and that cannot be discounted. It’s also not to say that the bill before Congress is the answer. Still, the fact that medical costs limit many Americans from accessing needed care and have become the leading cause of bankruptcy in the U.S. should arouse concern in even the most ardent opponents of healthcare reform. Regardless of one’s political leanings and feelings about the current attempts at healthcare reform, it’s difficult to stand by and helplessly watch our patients struggle to maneuver within a system that so often seems to work against so many of them.

What’s easy to lose in the D.C. rhetoric and town-hall warfare is that every day, we delay healthcare reform results in undue patient suffering, both physical and financial. It is a system that is broken and needs, in the words of Mr. Jasper’s daughters, to “get well now.”

Before leaving to celebrate the holiday with my family, I was compelled to return to Mr. Jasper’s room. Unfortunately, the patient was off getting a treatment. But his daughters were still there, faces unchanged. Again, drawn to those eyes, I wondered what would become of this situation.

Would he make it home?

How would his family pay the bills?

What would this mean for his daughters’ future?

Would he and his family be forced to declare bankruptcy?

Would the family ever truly recover?

Staring at the picture in the window, I couldn’t help but think of my own children, also waiting for their father to come home from the hospital to celebrate the holidays.

As I turned to leave, my mind lost in thoughts of untimely illness, ill-fated outcomes, and financial devastation, I realized that in America today, nothing more than circumstances kept me from seeing my own children’s eyes staring back at me from that window. TH

Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the Hospital Medicine Program and the Hospitalist Training Program, and as associate program director of the Internal Medicine Residency Program.

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