By ANA M. MALINOW, MD
Feb. 28, 2009
Dear Mr. President:
Last week, in the public clinic where I work, I treated a 6-year-old girl who had visited the emergency room for cellulitis, an infection of the skin, over her hand. Usually a relatively minor condition that is easily treated with a 10-day course of antibiotics, cellulitis can sometimes cause severe consequences, including life-threatening sepsis, if not treated promptly.
The reason this patient was notable was because she was uninsured and had been sent home with a prescription that her mother tried to fill but was unable to afford. How much did the antibiotic suspension cost? $500.
When I saw her three days after her ER visit, her hand was swollen twice the normal size, purple, tender and warm to the touch, with a red streak (signifying an extension of the infection from the skin to the bloodstream) up to her elbow. I took one look at her and quickly made the decision to admit her for IV antibiotics, including a consultation with pediatric surgery to ensure that the infection had not spread between the deep layers of her skin.
What struck me most about this visit, other than the child’s deformed hand, was the mother’s shame at not being able to afford her child’s medication. I assured her that I did not blame her, that our health care system was unconscionable, and that we needed a health care system where everyone was included and everyone paid according to his or her ability to pay. She agreed.
I’m not surprised she agreed. From 1943 to today, opinion polls consistently show that a stable majority of Americans favor a government role in the financing of health care. In the lead-up to President Truman’s national health care proposal, 82 percent of Americans agreed that something needed to be done to make health bills easier to afford.
Today, 65 percent of Americans, including 59 percent of U.S. physicians, support a tax-financed national health insurance plan. Why wouldn’t my patient’s mother support national health care?
What she probably doesn’t know is how much she already pays for the health care her child does not get, or gets late. Her uninsured family pays an extra 10 percent out of its paycheck in taxes to pay for our health care system. Her daughter’s hospitalization will be covered by emergency Medicaid, for which she pays through her sales taxes, income taxes, property taxes and other hidden taxes. She will still have many out-of-pocket costs, of course.
I was struck this week by remarks by David Axelrod, your adviser. Referring to the difference between Washington insiders and most polls over the stimulus package, Axelrod said, “This town talks to itself and whips itself into a frenzy with its own theories that are completely at odds with what the rest of America is thinking.” The moral, he said, is “not just that Washington is too insular but that the American people are a lot smarter than people in Washington think.”
I agree. As I talk about a single-payer national health program across Texas (yes, Texas!) and other states, I am repeatedly amazed by the ability of Americans to understand the complex issues of health reform if it is adequately explained to them. People quickly understand that a sustainable solution will come only when we contain costs and eliminate fragmentation.
The more I listen, the more I hear that all Americans want a health care system that is affordable, accountable, accessible, comprehensive, universal and just — not another Band-Aid that will condemn thousands of us to unnecessary pain, suffering, bankruptcy and death. Listen for yourself, and you will hear Americans clamoring for true health care reform.
By Washington standards, single payer is politically unfeasible. But step outside the beltway and you will be surprised by the genuine support that exists for a publicly funded, privately delivered, expanded and improved Medicare for all.
This mother should not be made to feel ashamed. Nor should her child be relegated to suffer like a Third World beggar. Your compromise plan that keeps the private, for-profit insurance industry in the game will perpetuate the shame and the begging. Already, there is a grass-roots movement building against private health insurance and for single payer. It will reach Washington, whether Washington is ready or not.
Ana M. Malinow, MD
Malinow is a Houston pediatrician and co-founder of Health Care for All Texas.