The patient was in pain and had been for over a year. And it was getting worse, not better. Exhausting all avenues of treatment, I decided it was time to refer him to a pain management doctor, eight months ago. Because of the injury to his back, the patient lost his job and his healthcare coverage. With no alternative for healthcare coverage, he ended up covered by Medicaid. While healthcare analysts would count this as a “covered life”, was he truly covered?
Now, if he was still covered by his earlier commercial plan, finding a specialist and scheduling an appointment would be no big problem. In fact, he would have probably seen the specialist within a period of 1 week. However, he was not so lucky to be among the working class and no longer owned “good” insurance. Many specialist where I practice, as well as nation-wide, simply do not participate in Medicaid simply because it historically paid so low that doctors lost money treating these patients. Eight months after I gave him the referral, he is still making daily phone calls to attempt to schedule an appointment with a specialist.
From the starting line, patients who are covered by state plans or do not have any insurance often can not even be seen by the specialists they need to be treated. Most Medicaid plans, traditional and HMO, also have very narrow medication formularies, meaning they do not pay for many medications. Often, patients covered by these plans must use alternative, cheaper medications than the ones their doctors prescribed because they thought the patient needed it.
How is healthcare disproportionately distributed along socioeconomic lines?
- Patients covered under Medicaid plans do not have much choice in choosing doctors and sometimes even hospitals.
- Coverage for medications and diagnostic tests is often substantially less for the same indications than under commercial plans.
- Many employers are paying less towards healthcare premium costs for their employees due to the rising costs. Many cannot afford these premiums. Those who are paid more can buy insurance that covers more services than cheaper plans. Thus, there is a definite division of healthcare coverage along socioeconomic lines.
- People who file for medical bankruptcy are most often middle class. Many of these people are already living pay check to pay check and cannot afford to bear the price of ever-increasing medical costs. Many of them simply do not go to the doctor because they cannot afford it. Thus, our current healthcare system siphons out those with less means to afford it.
- Patients who pay higher premiums can choose from a greater number of doctors and are offered coverage for many more services. Money can buy better medical care.
- Despite that the Affordable Care Act (ACA) was aiming to get all Americans covered by healthcare insurance, almost 10% of the population remains uninsured. Those who remain uninsured are often those who cannot afford to pay any premiums, yet earn too much to qualify for Medicaid. Many of them do not seek medical care because they cannot afford it.
While more Americans are covered by health insurance than ever before, true disparities have been created in the system. Those who earn more money are offered better medical care by virtue of their insurance coverage. There is a clear disparity of healthcare where the poor are denied medical services just because they earn less. And the middle class is especially being squeezed by paying premiums they can’t afford and those often carry very high deductibles.
In the US, we live in a very capitalistic society. While it is acceptable that the cars we drive are determined by the amount we earn, it is not acceptable to decide medical services based on socioeconomic status. All people deserve the best medical care we can offer them. Day after day, insurance companies place obstacles in the way of doctors providing the best care to their patients. A new way must be found before these disparities lead to deaths based on financial self-worth.
Copyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP
Spot On!!
As a Medicaid Provider and employer that gives health insurance…I see both sides. I struggle to afford giving my staff good insurance, and also struggle with Medicaid patients who need lots of care and my hands are tied when they aren’t allowed meds. But also deal with Medicaid pts who don’t show, don’t lusten to advice and have a better cell phone than I do!!!
Very well said. Having been in healthcare for 46 years as a nurse and spent 12 of those years working in the United Kingdom (I know, not a perfect system but a patient’s socioeconomic status doesn’t matter quite so much there!
I despair that in the US we shall ever find a system that can meet the needs of all our people.
Thanks for saying this.
Excellent article. Govt. rarely if ever makes anything more efficient than the private sector, yet short of a single payer system it is hard to see how the problem you describe can be fixed. Such a system would likely create a new set of winners and losers however. There is no easy answer to this.