This article is a reaction to the comments by U.S. Rep. Raúl Labrador, “Nobody dies because they don’t have access to health care.” It has been edited for clarity and length.
That Rep. Raúl Labrador is incorrect is frankly a very small matter compared to the reality of our health care system. I earnestly believe from time spent in Washington, D.C., talking to many of our legislators, that many Americans truly have no idea how bad things have become.
I think his statement can be demonstrated to be incorrect while really elevating the discussion around health care.
The harsh reality of health care as it is currently delivered in our country is that many people do not have the access they need when they need it. I see this every day with uninsured, underinsured and insured patients. The leading reason for bankruptcy in this country is health expenses. And of the folks who declare bankruptcy, upward of 60 percent are insured.
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I have patients whose wages are being garnished and patients who have liens placed on their homes because of hospital bills.
I have three patients in my micro practice right now who will die, probably decades sooner than necessary, because I cannot get them into appropriate specialty care because they are in the “Medicaid gap.” (They are too poor to afford private health insurance but do not qualify for Medicaid in Idaho.)
‘Our systems don’t work’
In primary care, we often talk about the long-term consequence of a lack of health care — what would have happened if that patient would have had a mammogram or managed their blood pressure? In emergency situations, we see people who will not get the care they need out of fear of long ER waits, being overlooked, being told they’re “fine” and returning home to a multi-thousand-dollar bill.
People are dying prematurely, not because of a lack of health insurance. They are dying because of an overly burdened, overly administered, catastrophically costly and opaque system that places one barrier after another in front of patients and physicians.
Our systems don’t work. The way we pay for our systems doesn’t work. Even insured people don’t get the care they need at times because of fear of unknown costs and the incredible burden we put on our patients.
I say this not only as a physician who has worked in many systems both before and after the Affordable Care Act, but also as a patient.
‘There’s a bigger issue afoot here’
Last year I was diagnosed with breast cancer. It was nearly impossible to get appointments in an efficient manner, to know what I was to do next, and no one could tell me what my care was going to cost me. The night before I was to start chemotherapy, I was unable to confirm I was actually going to have chemotherapy.
I will meet my high deductible again this year. I am also three years into starting my own business. Money is tight. We took out a home equity line of credit to make sure we could cover my medical bills.
My patients are from all walks of life and many economic backgrounds. I take care of physicians who are uninsured. Lawyers, pilots, real estate agents, business owners — all uninsured. People on the brink of homelessness, uninsured.
And they all — all — tell me that getting quality health care, when they need it, is next to impossible.
So there’s a bigger issue afoot here beyond directly challenging Rep. Labrador’s statements. Is he qualitatively incorrect? In my experience, yes. Do I have patients I’ve cared for in the last 15 years who have died because of a lack of insurance? Yes. Do I have many more stories about patients who died because of the overall failure of our health care systems as a whole? Yes. Every single doctor has these stories. If they don’t, they’re not paying attention. Each one is devastating.
‘Taping wings on a car, calling it an airplane’
I am grateful that Rep. Labrador is having conversations about health care. I am also grateful that he has discussed alternative models of care delivery such as direct primary care (what I do) as one part of a broader health care solution.
I firmly believe there is a future in separating all routine health care from insurance and inordinate regulatory oversight. When this happens, care becomes cost-transparent, affordable, accessible and, as a doctor, is enjoyable.
It’s insane that we manage, care for, bill, consent, administer and schedule the same way for a wart treatment as we do for cardiovascular bypass surgery.
Someone told me that trying to reform what we have is like taping wings on a car and calling it an airplane. There is so much finger-pointing going on right now politically, but as much as the Affordable Care Act may have helped some people, I have seen a persistent downward spiral of our entire health care system since I started in medicine in 2001. I don’t think any one entity is to blame. Not doctors, not insurance companies, not hospitals, not pharmaceutical companies. The whole system is broken. If we keep the same players and try to reconstruct something on the same foundation, I think we’re going to continue to end up with different iterations of what we already have.
Dr. Julie Gunther is a Boise primary care doctor. She owns the direct primary care practice Spark MD.