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Our Non-System Of Health Care Keeps Getting Worse

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By MARC J. YACHT, Special to the Tribune

Published: October 26, 2007

One could not define The New England Journal of Medicine as a bastion for tax-and-spend liberals. Harvard folks who provide the publication are a conservative lot who publish, after great scrutiny, health-related studies and editorials.

The publication remains the single most read journal in the medical community. Medical residents find a certain amount of one-upness as to who reads the weekly journal first. All sorts of devious tactics surround how to get an early peek.

In typical dull fashion, an article about a laundry list of ails and the treatment quality for children appeared in the Oct. 11 edition. The overall conclusion of the article will send shock waves through the medical community and the average citizen who may learn of the monograph: Only 46 percent 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 predominantly looked at 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 the uninsured?

The study and its findings preceded the president's SCHIP (State Children's Health Insurance Program) 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.

In its current form, fewer than 25 percent 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 mentioned continuing 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 more than two years. She had not had a neurological examination since leaving the hospital several years ago.

A patient presenting these problems needs a significant workup, including a neurological evaluation and ophthalmologic and gynecological exams, 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 providers. If 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 who has medical needs well beyond the ability of the clinic to provide.

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. Still, even the insured are getting shortchanged. That brings us back to 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 to be uninsured at some time during the year.

In addition, understand 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 who defend the current system of care and those whose dissatisfaction with health care delivery has caused terrible hardship and guilt. Too many cannot afford the care needed for loved ones. The sooner the face-off comes, the better.

The anger and frustration of both the insured and, of course, the uninsured are real. Speeches glorifying the greatness of our health care system by organized medicine and elected officials ring hollow.

We need a health care tax. We need national health care.

Marc Yacht, who lives in Hudson, is a physician and former director of the Pasco County Health Department.

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