My community clinic sees a depressing number of uninsured people with serious health problems: diabetics with proteinuria, rheumatoid arthritis ladies who can’t afford anything more up-to-date than methotrexate, and my biggest nightmare: the patient over 50 with bowel habit changes and iron deficiency anemia. Yeah, you kind of put off your screening colonoscopy until age 52 or so, and you got away with it. Or maybe you had some polyps that were nipped out and you have repeat scopes every 3 years. Even if you do get colon cancer it will probably be diagnosed long before anemia develops.
Back to the clinic: we have called every gastroenterologist who sees patients in our county, and the most welcoming reply we get when we ask them to see these patients is “Sure, we’ll set up a fee-for-service account. We can scope him here since the hospital doesn’t like non-resource patients.”
But even if we pay for the office visit and procedure, what do we do if the scope shows a cancer too big to nip out? The kindest surgeon in the world has to schedule surgery through a hospital (all of which do a wallet biopsy before the admissions office will even talk to us) and find an anesthesiologist willing to work for free. And what if chemo or radiation is indicated?
The county south of us has a pretty good health system…and a 3-month waiting period for enrollment in addition to the residency requirement. And even if our state decided to expand Medicaid, nobody wants to see patients for the pittance it pays doctors.
Now…would somebody please explain to my patients why universal access to healthcare is a bad thing?