President's Page

President's Page
March 2008

Plight of the Uninsured:
New DCMS Committee for the Uninsured

Health care across our nation and within our own community is in dire straits.

I recently was in conversation with a young physician as he shook his head and said, “I guess it will have to implode before anything is done!” He practices anesthesia at a hospital with a large load of uninsured and Medicaid (“underinsured”) patients. In order for this hospital to keep anesthesiologists on staff, the hospital had to guarantee his salary. He said he never generated as much income as his guarantee. I said, “Young physician, the implosion has happened already!”

Forty-seven million Americans have no heath insurance coverage. At least that many are underinsured. Because of access problems, I consider Medicaid and CHIP patients to be underinsured. Texas is consistently last in the nation with 25 percent uninsured. Almost six million Texans are continuously without insurance in a given year, and 8.5 million lack insurance at some point in the year. Nationally, there are 9.4 million children without insurance, and 1.4 million of those are in Texas. Among Texans 45 to 64 years of age, 23 percent have no insurance.

Uninsured persons with chronic diseases fail to visit a doctor when necessary half of the time, and seven out of every 10 people without health insurance receive no preventive care at all. This leads to the 2500 premature deaths in Texas each year due to lack of healthcare coverage.

The U.S. spends two trillion dollars a year on health costs, which equals about $7000 per person. This is approximately twice what other large industrialized nations spend. Half of every healthcare dollar spent goes to treating 5 percent of the population.

I have dozens of pages of such statistics on my desk. Statistics do not lie but they do not tell the whole truth. The real truth lies in the stories of individuals who are suffering. I see these patients daily.

Minnie is a 65-year-old diabetic who just became eligible for Medicare and was able to resume seeing me. After quitting her job at a grocery store to care for her grandchildren, she lost all insurance and went without medication or consistent care for 3 years. She now has severe diabetic neuropathy and peripheral vascular disease and is confined to a wheelchair. She now needs more medication and more care, and her overall prognosis is poor.

Rebecca, age 52, works for a small company that does not provide health insurance, and after her divorce 2 years ago, she lost her health insurance. For a year, she has had abdominal bloating, urinary urgency, and loss of appetite. She finally came in to see us and has moderately advanced ovarian cancer.

We physicians see patients like these daily. Most are not as ill as Minnie and Rebecca. However, many are suffering, and many more are worried about what could happen to them and their families should they become ill. Faced with this harsh reality, we usually end up treating these patients for reduced or no reimbursement. Many practices, especially primary care ones, are in danger of folding. Doctors are working longer hours with less and less reimbursement. The health of our profession is threatened by the lack of a rational health care system.

Last spring, our DCMS Delegation introduced a resolution at the TMA House of Delegates calling for the formation of an Ad Hoc blue ribbon Committee for the Uninsured. The charge of this committee was to be “a single source of research, advocacy, and consensus solutions to the plight of the uninsured and other real or perceived problems with our healthcare system, and to direct focused efforts for the benefit of our patients (the general public), print media, televised media, state legislators, and national legislators, etc.” In other words, it was to be a forward-looking think tank. It was passed with seemingly overwhelming support with only minor amendments. In my opinion, the TMA Board of Trustees failed to form this committee as the resolution called for and subsequently assigned this function to another standing subcommittee that already is overwhelmed with the minutiae of Medicaid and CHIP rules and regulations.

We need to partner with our patients to solve the problem of the uninsured and underinsured. As physicians, we have the best vantage point to come up with practical solutions. In my opinion, our AMA has offered only minor solutions to tweak this fundamentally flawed system, and AMA only seems to be offering more of the same plans destined to fail.

In the coming months and years, huge changes are coming to the delivery of health care—our Presidential election may provide unstoppable impetus. We as a profession are not ready. We need to offer innovative solutions and be ready to compromise. If we do not, we will be run over by the freight train of Universal Health Care that is coming down the tracks.

DCMS is in the process of forming an Ad Hoc Committee for the Uninsured and Underinsured patterned after the resolution we submitted to TMA. It will be populated with concerned physicians with diverse views, and common ground will be encouraged. Together with our patients, we will find strength and optimism.

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