I don’t normally comment on politics here, it isn’t the point of this blog but sometimes I probably won’t be able to stop myself. I worked in San Diego for 4 years, and I saw a lot of the good in US health care, as we were treating newborn infants we rarely had to worry about insurance, and it never intruded into acute care of the babies in our NICU. It affected the UCSD bottom line, but that was for someone else to deal with. I worked with a great group of neonatologists, dedicated to the babies in their care, and the infants got anything they needed for their acute care.
We did sometimes get communications from insurance companies, informing us that they would stop paying for a hospitalization, so we would hustle to discharge the baby quickly. This is one pressure that leads to an increase in home O2 in the USA compared to our use here, which might even be a good thing in some ways if you get babies back with their family sooner.
Every now and then, though, I came across something that would stop me in my tracks. There was one mother with metastatic breast cancer who had not had a full evaluation and treatment because she was not eligible for state supported care, and had no health insurance herself, so to avoid bankrupting her family se did not return to see the surgeon after her initial diagnosis (it turned out he had offered to do the surgery for no fee, but she would still have had many costs that she could not afford). Especially as she was pregnant. When she delivered at 28 weeks, it was too late for anything other than palliation.
This story was brought back to my mind by a perspective article in the PNEJM: ‘Dead Man Walking’. (open access) A story of a man who died because of lack of insurance. Stories such as this brings home the reality of the uninsured and the underinsured in the USA.
‘Obamacare’ is a half-baked solution which was gutted by special interest groups, but at least it stands a good chance of reducing the numbers of people who end up in the situation of the man whose story is told in this article, as long as it doesn’t completely get destroyed. One commentator even suggested on TV recently that the big problem with the US system was ‘too much insurance’! I don’t think he was talking about the excessive profits and lobbying ability of the insurance industry, either.