Guest editorial: The news keeps getting worse on our non-system of health care

One could not define The New England Journal of Medicine as being a bastion for tax and spend liberals. Harvard folks that provide the publication are a conservative lot who publish, after great scrutiny, health related studies and editorials. The publication remains the singular most read journal in the medical community. Medical Residents find a certain amount of one-upmanship as to who reads the weekly journal first. All sorts of devious tactics surround how to get an early peek.

In typical dull fashion, a laundry list of ails and the treatment quality for children appeared in the October 11, 2007 edition. The overall conclusion of the article will send shock waves. Only 46% of America’s children receive appropriate medical care when visiting physicians.

At issue were inadequate lab tests, proper asthma medication, screenings, annual checkups, and obesity evaluation and prevention. The obesity epidemic among our nation’s children creates risks for a myriad of chronic diseases that may well plague them throughout adult life.

This study looked at predominantly insured middle and upper-class children. If close to half of those children are getting poor care what does that mean for the poor and uninsured?

The study and its findings preceded the President’s SCHIP (children’s health Care) veto. In spite of the ridiculous spin about rich children possibly abusing the program, there might be a very legitimate reason to scotch it. It’s not effective. Currently, less than 25% of Florida’s eligible children are helped by SCHIP and that may well be the case throughout the country. This is true of the Medicaid program in general. Too many are left out. The free clinics are overwhelmed and typically limited in treating the uninsured.

My volunteer work at a local free clinic (CARES Senior Free Clinic, New Port Richey) might better clarify the plight of the uninsured. Most of my effort involves providing needed prescriptions – that is a good thing. However, new problems are difficult and often expensive to evaluate. The treatment of new patients with limited prior care can be very frustrating.

A recent patient, Ms X, mentioned her continued headaches, ongoing gastritis, visual complaints, inability to sleep, and stress. Her medical history showed serious head trauma in the past. She had not seen a gynecologist in over two years. She had not had a neurological examination since leaving the hospital several years ago.

A patient presenting with these problems needs a significant workup including a neurological evaluation, ophthalmologic exam, gynecological exam along with an upper and lower GI series, blood work, and a potential for other tests and specialists. It is possible that there is not a thing wrong with this patient other than stress, much of it related to an inability to get needed health care.

The free clinic can provide the referrals and suggest what tests might be needed, but it becomes the patient’s responsibility to follow up and find the providers. The patient has no money, the tests and evaluations could run into the thousands of dollars. Whenever I volunteer in the clinic I am always confronted with a patient that has medical needs well beyond the ability of the clinic.

Don’t misunderstand, many are helped in the clinic but don’t ever believe that the care available to the uninsured is close to what is obtainable for the insured. But even the insured are getting shortchanged. That brings to attention the Journal article.

I could stand with the President on the SCHIP veto if he provided the solution that would solve access issues that leave, on the low side, 47 million Americans uninsured and, on the high side, a potential for 90 million Americans uninsured at some time during the year. In addition, the realization that almost half our insured kids get inadequate care. How can anyone defend this continuing meltdown of our health care system and criticize Canadian health care or any national plan that protects the health needs of its population?

The showdown is coming between those that defend the current system of care and those whose dissatisfaction with health care are well justified. Too many cannot afford the care needed for loved ones. The sooner the face off comes, the better. The anger and frustration of both those insured and of course the uninsured is ugly.

Speeches glorifying the greatness of our health care system by organized medicine and elected officials - rings hollow. We need a health care tax, we need national health care.