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.