A specific case illustrates the US’s failure in health care

(I assume that Michael Moore’s indictment of US healthcare, Sicko, couldn’t cover many of the ways people are deprived of adquate care, and I think the case below illustrates one of  them.  But even if he did include it, the specific case again usefully makes the point.)

I received the following emessage today.  “UTMB” is the University of Texas Medical Branch in Galveston, TX.  It is well-know for treating indigent people; their emergency room does not ask for proof of ability to pay before one receives treatment.  But there are horrendous gaps nonetheless.

Galveston is about 45 miles from Houston, which contains what is, by some measurements, the largest medical center in the world.  Methodist Hospital, with its teak furniture, piano and fountains in the  foyer, provides treatment for some of the world’s richest people.  And yet, in its shadows…well, you’ve read Dickens…

All of you know Dave Diggins and most also know his wife, Susan. I am sorry to let you know that Susan has been diagnosed with breast cancer – she has two areas in her right breast. At this time, the physicians are talking about chemotherapy treatment in order to shrink them before they consider surgery. The radiology department at UTMB has referred Susan to oncology.

Unfortunately, Dave and Susan do not have health insurance and they would have to qualify for indigent care before they would be allowed to see oncology. Since they do not qualify, they have, at this time, been turned away. It is really hard for the mid-income people who are self-employed to make enough to afford health care and Dave just happens to fit into that group.

They have been put in contact with Sr. Joan James, who works with the Susan Cronin Breast Cancer Foundation that administers grants to people that find themselves in Dave and Susan’s position. However, as you know, obtaining grants can sometimes take longer than anticipated.  [All names of persons changed.]

Perhaps, like me, you weren’t aware that indigence is means-tested in the case of life saving health care.

13 thoughts on “A specific case illustrates the US’s failure in health care

  1. In Texas, all residents who are otherwise uninsurable automatically qualify for coverage under the Texas Health Risk Pool (provided they pay premiums). The article states the couple is “mid-income and self-employed”. Although they may have to make some lifestyle changes to do so, a “mid-income, self-employed” couple should be able to afford health insurance. The couple chose to remain uninsured. Our healthcare system is currently a private system. Was this couple unaware of the current healthcare system? Did they think free healthcare existed in America? Why didn’t they plan with health insurance? There are plenty of affordable plans available. The sad truth is many people would rather consume goods (cars, houses, lattes, clothing, etc.) at the expense of planning to protect their future. I hope they really like their cars and their house, because now it is costing them their health.

  2. Mark, thank you for giving us the perspective of a Texas Health Insurance Agent, but I’m concerned about the confidence with which you judge these people without knowing the details of their lives.

  3. I am always amazed that individuals are blamed or criticized for their lack of health insurance. It could be a personal, life-style choice. Chances are they were outright denied a private health plan (an affordable one at least). Now that the wife has breast cancer you can bet they will never find an affordable health plan. Even the high risk pools that are government subsidized are out of reach for many people. It is unfair to blame these folks for their inability to pay for expensive chemo treatments.

  4. Horrors.

    No one should have to pay premiums for basic, life-saving medical services, except through progressive taxation.

  5. I’m not sure a specific case can illustrate an entire nation’s failure at anything. One could dig up singular horror stories from anywhere in the world; what matters at least as much as how horrible the incidents are is how often they happen.

    Disclaimer: I honestly don’t know who has better health care where. I’m just prodding at the argument here, not its conclusion.

  6. RS,

    I always go off to a dictionary or two in cases like these. It looks as though “illustrates” just means “clarifies by giving a good example,” or even “is a good example.” The example isn’t meant as a proof; it is just meant as a good, telling example.

    I appreciate your comment about who does better health care. I read of another and contrasting example recently, and I’ll put some of it in another post here.

  7. Admittedly, that word “illustrates” stuck with me as I went to bed, making me suspect my complaint had misfired. Thanks for homing in on that to confirm. ;)

  8. There is a fair amount of statistical evidence out there which seems to indicate that
    1) Americans spend more on healthcare than elsewhere
    2) Americans have inferior health care to most comparable countries
    3) The US spends a lot more on research – this means that a lot of new drugs get invented in the US then copied in India and then used everywhere

    I however view anecdotal evidence warily because one thing I think might benefit the public healthcare countries in anecdotal evidence however is that you will probably never be offered the best and most expensive treatments because they are not in the budget, so you THINK you have the best care, when what you have is the best care your country thinks it can afford.

    Maybe the same would happen if your healthcare insurance wasn’t good enough in the USA.
    anyway many rich people in other countries still have private insurance, however, I always thought having upper limits on heath care insurance coverage seems to defeat the purpose, as if I’m reinsuring the insurance company…

    Things that annoy me in NZ, which may or may not apply to the USA are

    that we always have a shortage of doctors BUT
    1) the universities throttle output of doctors
    2) we have all sorts of barriers to foreign doctors practicing so they become taxi drivers
    3) we get our doctors to waste time telling people they have colds and signing prescriptions that a nurse (or frankly a person with a 1 year health course could handle)
    4) We stop people from having all sorts of dangerous operations (like stem cell injections into the heart) despite the fact that they may face imminent death otherwise.

  9. GNZ, just to clarify: I wasn’t offering either the US case or the French case as evidence. I think they are examples of a difference, but they hardly by themselves show there is a difference.

    I was having a hard time understanding the last point. It does seem defensible to insist that the standards of sound medical practice get extended to those whose lives are threatened. Your point wasn’tabout this???

  10. The choices that the medical profession take are defendable – after all that is why we have medical ethics professors. and the standards they decide upon are by definition “standards of sound medical practice” whehter they are ‘sound’ or not. But that doesn’t stop their philosophical calls from having nett results of killing hundreds or thousands of people.

    And If I was to debate with a medical ethics expert I don’t think the debate would be regarding the facts of that, it would be regarding whether it should matter. I think it matters, and I expect pretty much every informed paitient in the situation to agree.

  11. As a system the US seems to have, overall, fairly poor outcomes given the investment (see e.g. here or here), this is normally explained away as the result of the uninsured’s poor outcomes distorting the wonderful outcomes for the insured, but the sort of disparities seen are implausibly large for that.

    Ordinary Americans (e.g. with HMO insurance) get a fairly middling healthcare provision, the latest ‘unique’ feature of US healthcare that supposedly justifies the horrendous spend is short waiting times, but even that seems ephemeral in reality.

    Of course it is possible that the very richest with unlimited access to healthcare get a great service in the US, but then they do in many other countries, and they hardly represent the system operating as normal.

    All this talk of the money spent on research and drug development that the US patient has to somehow fund (with the rest of the world free riding on their backs) is nonsense. Drug spend does not make up a substantial proportion of the US healthcare budget, and it is parochialism of the most amusing sort to think that all drugs are developed in the US when so many large pharmaceutical companies are based and research outside the US (e.g. Bayer, GSK, Novartis and myriad others).

    From my time watching this debate, the main thing I’ve learned is that people in the US know very little about healthcare in other countries but they are very sure that it is worse than theirs – and no amount of evidence is going to disabuse them of that notion.

    I think the Guiliani prostate cancer case illustrates that nicely, and is far from atypical in my experience:

    Giuliani: “I had prostate cancer, five, six years ago. My chances of surviving prostate cancer and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.”

    The reality: “The likelihood of dying from prostate cancer in the two countries is roughly comparable, despite different treatment philosophies.”

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