One could not define The New England Journal of Medicine as a bastion of tax-and-spend liberals. Harvard folks who publish it are a conservative lot. They print health studies and editorials only after great scrutiny. The publication remains the single most widely read journal in the medical community.
Medical residents compete to read the weekly journal first. All sorts of devious tactics surround how to get an early peek. In typical dull fashion, a laundry list of ails and the treatment quality for children appeared in the October 11 edition. The overall conclusion of the article will send shock waves.
Only 46% of America’s children receive appropriate medical care when visiting physicians.
At issue were inadequate lab tests, improper asthma medication, screenings, annual checkups, and obesity evaluations and prevention. The obesity epidemic among our nation’s children creates risks for a myriad of chronic diseases that may well plague them throughout adult life. This study looked at predominantly insured middle and upper-class children. If close to half of those children are getting poor care, what does that mean for the poor and uninsured?
The study and its findings preceded the President’s SCHIP (children’s health Care) veto. Despite ridiculous spin about rich children possibly abusing the program, there might be a very legitimate reason to scotch it. It’s not effective. In its current form less than 25% of Florida’s eligible children are helped by SCHIP and that may well be the case throughout the country. This is true of the Medicaid program in general. Too many are left out. The free clinics are overwhelmed and typically limited in treating the uninsured.
My volunteer work at a local free clinic (CARES Senior Free Clinic, New Port Richey) might better clarify the plight of the uninsured. Most of my effort involves providing needed prescriptions. That’s a good thing. However, new problems are difficult and often expensive to evaluate. The treatment of new patients with limited prior care can be very frustrating.
A recent patient, Ms X, mentioned her continued headaches, ongoing gastritis, visual complaints, inability to sleep, and stress. Her medical history showed serious head trauma in the past. She had not seen a gynecologist in over two years. She had not had a neurological examination since leaving the hospital several years ago.
A patient with these problems needs a significant workup, including a neurological evaluation, ophthalmologic exam, gynecological exam along with an upper and lower GI series, blood work, and a potential for other tests and specialists. It is possible that there is not a thing wrong with this patient other than stress, much of it related to an inability to get needed health care.
The free clinic can provide the referrals and suggest what tests might be needed, but it becomes the patient’s responsibility to follow up and find the providers. The patient has no money, the tests and evaluations could run into the thousands of dollars. Whenever I volunteer in the clinic I am always confronted with a patient that has medical needs well beyond the means of the clinic.
Don’t misunderstand, many are helped in the clinic but don’t ever believe that the care available to the uninsured is close to what is obtainable for the insured. But even the insured are getting shortchanged. That brings us back to the Journal article.
I could stand with the President on the SCHIP veto, if he provided the solution that would solve access issues that leave, on the low side, 47 million Americans uninsured and, on the high side, a potential for 90 million Americans uninsured at some time during the year. In addition, a realization that almost half our insured kids get inadequate care. How can anyone defend this continuing meltdown of our health care system and criticize Canadian health care or any national plan that protects the health needs of its population?
The showdown is coming between those that defend the current system of care and those whose mounting anger about it is justified. Too many cannot afford or obtain the care needed for loved ones. The sooner the face off occurs, the better. Speeches glorifying the greatness of our health care system by organized medicine and elected officials ring hollow. We need a health care tax and we need national health care.
Dr. Marc Yacht is the former director of the Pasco County Health Department. He is the editor in chief of the Florida Medical Association quarterly magazine, serves as Vice President of the West Pasco Habitat For Humanity board, volunteers at the CARE’s Senior Clinic and blogs at GoToTell.com.