Sunday, July 31, 2011

When it Just Isn't Fair, Part One

The world is full of people who don't take their meds for high blood pressure, don't follow a diabetic care plan, or are so obese they cannot walk. People have all sorts of reasons for not following a doctor's advice.  Hey, it's a free country; people can do whatever the hell they want.  As long as they are well informed about the possible consequences and are able to make their own decisions, let the chips fall where they may. 

You never hear a patient say things like, "I didn't KNOW I wasn't supposed to smoke when I am on oxygen!".  Clearly it is a decision that the patient makes on his/her own and damn the consequences.  Even if the consequences include further complications, severe burns and/or blowing your home sky high in this case.  No less deadly than deciding not to take care of diabetes and high blood pressure I suppose. 

There is difference between outright irresponsibility, choosing not to take care of yourself and being unable to afford your treatment.  So many people don't have insurance, so where does that leave them?

In one of two places. 

Group one has no insurance and uses the ER for everything from a rash to a mosquito bite.  Some are such frequent fliers we know what kind of car they drive, know their address when the ambulance tones out for their 143rd ER transport for abdominal pain this year, and can accurately predict their visits based on the day and date.    I don't know how they survive because they are not, for the most part, working.  They come late at night when they know they will be given a supply of meds to "tide them over" because the pharmacy is closed.  They want every test possible and they want it now. They have no intention of paying their bills.  They are usually heavy smokers.

Group two may have a job and  no insurance.  Or may not have a job at all.  They are trying to make ends meet, cannot legitimately afford their care or their meds.  They are undemanding and try hard to keep their costs as low as possible.  They are the ones who will struggle for years to pay their medical bills.  The hospital will hound them for $25 and send it to a collection agency.

It is especially tough on people who work for themselves.  And hurt themselves while working.  The double whammy is that not only are they not able to afford an ER visit, now they are out of work.

The system works so very well for some people and not at all for others. Why can't we fix this?