Universal Access by Stella Fitzgibbons MD


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?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  20 comments for “Universal Access by Stella Fitzgibbons MD

  1. Private Doc
    August 17, 2014 at 12:49 pm

    You can’t have “universal gubment healthcare” without jack booted gubment thugs taking from one and giving to another.

    I likely have more uninsured patients than anyone on this blog but that still doesn’t mean the gubment should ever force me to see them. And make no mistake gubment mandates are forced with the point of a gun just as much as any robbery on the street. They just use the IRS, CMS or whoever to enforce their dictates with the threat on your life with their powers.

    To say something is a “right” means that people have no right to keep them from it. That means that if you say healthcare is a “right” then you advocate slavery because you are saying that you should be able to force someone to treat you for free and thus you are advocating slavery because you “can’t deny someone their right”.

    I’m sorry healthcare is not a “right” any more than a big screen TV is a right. Most of the uninsured CHOSE to be uninsured because they could pay the insurance premium if they did without their other vices.

    I see them because I want to, because I help people in need when they need help but don’t try and tell me I MUST see them and MUST treat them (for free who are we kidding less than 1% ever pay a dime).

  2. MACF
    August 14, 2014 at 11:21 am

    Universal access to Health Care is the norm in most western industrial societies which consider inmoral that a person should go bankrupt due to health reasons. No study has demonstrated that they have a higher morbidity and mortality than the US and they provide health care witha much less percentage. of their GDP.
    Those countries are not communists, actually their lower coorporate taxes and high standard of living are atracting coorporations to establish there.
    I am wondering what kind of conflict of interest some people have to continue supporting a system that if you work and pay taxes, you still have to buy a health insurance policy that usually does not cover you 100%, requests out of pocket payments from visits to prescriptions and certainly is not cheap at all. To the point that many working individuals decide not to have one. Isn’t that stupid?

  3. GHD
    August 13, 2014 at 7:39 pm

    Yep, got a commie here. From each according to his means, to each according to his needs. The anesthesiologist should work for free since he can. Maybe he can fill up his gas tanks free, too. And housing, food, transportation, education, entertainment, cell phone…..

    • politovski
      August 13, 2014 at 10:57 pm

      so, perhaps a swiftian solution to this issue may be superior? just kill them and eat them, rather than trying to make an equitable system, where we can earn a living and patients can get care? most excellent….

    • Pat
      August 13, 2014 at 11:24 pm

      I didn’t smell communism in this piece, and I’m far and away the biggest anti-communist I’ve known this side of Ayn Rand. I’m not sure that esteemed Stella was preaching proletarian triumph as much as she was simply giving voice to frustration. Of course we all know very well that “equal access” is a polite expectation in medical circles, a presumption in the media and politics, and a phantasmagoria in the hands of bureaucrats. Equal access does not, and never can result in equal care.

      Can it be made better for more? Certainly. But any initiative that involves more government will by definition result in more force, amplifying all the forces which presently constrict access.

      Save the snark politovski – communism was and is pure evil, based solely on the use of force, and I’m damn tired of so many acting as though their good intentions justify telling others what to do.

      • politovski
        August 14, 2014 at 10:16 am

        the snark is well deserved. communism is an economic system, and Russia and china and the so called communist countries were actually totalitarian oligarchies, and really were only communist in name only, as far as economics go. remember the bit about how some comrades were more equal than others, and the special privileges of the upper classes. so, no, I do not want their system of government any more than anyone else. as for economics, i think that medicine is a bit too important to be tied to an economic system, and our fellow citizens deserve a bit better than that. i do not recall anything in the Hippocratic oath about treating patients only when it pays well and suits your world view.

        • Pat
          August 14, 2014 at 12:53 pm

          Describing communism as (merely) an economic system celebrates a criminally stupid illusion that it could have worked, if only done properly by the right people. 100 million dead in the last century argue otherwise.

          Politovski, are you a physician? I ask, because it has been my experience over the past two decades that those who fling “The Oath” around never actually took it. I did.

          If you have indeed read the Hippocratic Oath, then you will note that not only does it not discuss payment or world view, but it does not in any way obligate a physician so see any patient, or all of mankind, something you clearly infer. It ONLY describes what the physician’s behavior will be toward a patient in a relationship voluntarily entered.

          If you want to tell others what to do, then say so forthrightly, but lets avoid false information.

          • Pat
            August 14, 2014 at 1:55 pm

            “”to” see any patient,” not “so”… and BTW Stella, I like your columns, keep ’em coming 🙂

          • politovski
            August 14, 2014 at 5:49 pm

            i am a doc, a family medicine doc. and i did take said oath. and take it quite seriously. and there is no false information. communism is and always will be an economic system. as above, russia and china were oligarchies and dictatorships, run by the worst humanity had to offer (and i would want no part of something like that). and, had little to do with actual communism. i do read quite a bit about history. i am also a libertarian, and have no interest in government telling anyone what to do for any reason. but, i think that as a christian and as a physician, to advocate for something other than socialized medicine/universal access is not something that i can do.

    • JRDO
      August 14, 2014 at 9:50 am

      I drove to work today on roads that were built and are maintained by government- does that make me a communist? A significant portion of my business is taking care of patients who are on Medicare (which btw is much easier to deal with than the local private insurance companies/HMOs)-does that make me a communist?

      We, as a society accept many government administered items with universal access such as National Defense, Infrastructure, Law Enforcement etc for the good of the society but we do not with Healthcare. Why is that?

      I agree that it is not good to provide universal access to entertainment, cell phones, steak dinners etc but I would put health care on the list of things that all U.S. legal residents should have access to.

      GHD, I also believe that by personalizing your comments with a pejorative statement that Dr. Fitzgibbons is a “commie”, that your posting is inappropriate and counterproductive to having a substantive debate on the issue.
      Certainly educated people (which I believe we all are here) can have differences of opinion without resorting to juvenile name calling.

  4. politovski
    August 13, 2014 at 5:34 pm

    we can’t have socialized medicine, because then the communists will win and allow the specter of socialism to metastasize throughout our great, capitalistic land. then we’ll have dogs and cats living together, MASS HYSTERIA! that, and, that would be something Christ might advocate.

  5. T Newberry
    August 13, 2014 at 3:24 pm

    Because we decided as a nation long ago that healthcare should be a for-profit business. This is incompatible with universal access.

    • Doug Farrago
      August 13, 2014 at 4:43 pm

      Agreed. And, BTW, I still believe it should still be “for-profit” but not the way it is now. Why does the term “for-profit” come off so evil, anyway? You, Tom, work for-profit. There is nothing unethical about that.

      • Kurt
        August 13, 2014 at 8:29 pm

        That is so very true Doug. Nothing wrong with making a profit to earn a living. One can’t work for free and expect to survive. I tell med students to acquire marketable skills and stay the hell away from primary care.
        I used to have time off but now all the computer generated paperwork requires evenings and weekends to complete. I was born 8 years too late as I would have been retired by now. Don’t know when I’ll have time to do the next batch of MOC BS the ABFM wants us to do.
        I believe you posted here (or mentioned) a study that showed if a practice has more than 12% Medicaid it was likely to fail?

        • JRDO
          August 14, 2014 at 12:35 pm

          Agree that there is “Nothing wrong with making a profit to earn a living.” But, doesn’t it come down to a matter of degree? For example, brand name Lipitor was 300 USD for a 90 day supply 4 years ago but now generic atorvastatin is given away free at many of my local pharmacies as a loss leader. I don’t know what the formula should be as far as what is an reasonable profit and what is egregious profiteering, but hopefully we can all agree that affordable healthcare is a worthy goal that we should strive for- and that should include reasonable profits, but not egregious profiteering.

      • T Newberry
        August 14, 2014 at 3:34 pm

        Well, the love of money IS the root of all evil, but the real problem is that the regulation of the U.S. health care industry has been arranged to prevent the functioning of a truly free market. This is what we get when we combine capitalism and democracy – profit motives lead to legalized systemic corruption.

        In other words, the regulations that were supposed to protect the patients have instead been written to create profits and divert them in specific directions. Which is, by definition, perfectly legal. If you are a practitioner you are probably painfully aware of this because those profits have steadily been diverted away from you!

        • Doug Farrago
          August 14, 2014 at 4:25 pm

          That is why I am going into Direct Primary Care!

          • JRDO
            August 14, 2014 at 5:15 pm

            Good on ya. I think Direct Primary Care is a great idea and I hope it works for a lot of patients and doctors. I absolutely agree that health insurance is many times more of a hindrance than a help. But, Dr. Fitzgibbons started this whole discussion with a lament about her uninsured patients who don’t have access to the care they need. Direct Primary Care is unlikely to provide for the care of Dr. Fitzgibbons’ patients- do you think they should just be thrown under the proverbial bus, or do you think there should be a mechanism (safety net) in place to provide them with the care they need?

          • Doug Farrago
            August 14, 2014 at 6:33 pm

            Medicaid is that safety net. That being said, FQHCs are all around the country for sliding scale fees if you don’t meet Medicaid. Lastly, DPCs actually can work for them too….either people pay the money (most pay triple the fee when you add up their cable, cell bill and such) or maybe DPC docs give away a small % of care because we will be making more than enough now.


    • JRDO
      August 14, 2014 at 10:26 am

      Disagree. Universal access is not incompatible with for-profit business. Many other countries have universal access where doctors and other healthcare workers make a nice profit. Here in the U.S. most citizens >65 years old have universal access to healthcare via Medicare- which is accepted by most for-profit doctors and healthcare institutions.

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