By Reena Agarwal, M.D., M.P.H.
The River (Hudson Valley, N.Y.), April 28, 2022
For two decades as a primary care doctor at health centers in underserved communities around Westchester and New York City, I’ve encountered too many patients facing tragically unfair barriers to good health. Every day I am frustrated, infuriated, and saddened by an immoral system I can’t fix and can’t escape—until we pass legislation that will prioritize health over profits.
One of my patients has asthma, which would be easy to control if she could afford a simple steroid inhaler, but the cheapest such device is $270 per month—way beyond her means as a single-mother who supports two children as a housecleaner. There are no generic versions available here for the 25 million Americans with asthma. Congressional researchers found that US inhalers can cost 10 to 40 times the average price across 11 peer countries, for exactly the same drug manufactured by the same companies. My patient cannot afford an inhaler that costs more than her weekly rent. Instead, we make do with subpar medications that don’t fully control her asthma. So she ends up going to the ER, an extremely expensive resource for taxpayers, which discharges her with meds that control short-term symptoms. But after those pills run out, she comes back to me—still unable to afford what she so badly needs to maintain her health.
Recently, I saw a patient with diabetes. I was the first doctor he had seen in years. A day laborer who cannot afford health insurance, he paid for his visit out of pocket. Unable to afford doctor visits and medications, he’d been treating his diabetes with herbal remedies, as too many of the 30 million Americans (almost 10 percent of our population) with diabetes do. In-office blood tests showed out-of-control glucose levels. My staff and I spent the day calling neighborhood pharmacies, checking prices of insulin and diabetes supplies for him.
This is an absolute waste of his and our time. The cost of insulin has skyrocketed in the past 20 years as corporations have paid competitors not to produce generics. Given the cost to society and taxpayers for uncontrolled diabetes and the ability of modern medicine to help sufferers keep it fully controlled, he should have been able to obtain his medicines at any pharmacy and had the cost fully covered. Failure to do so—the result of how our current system works—makes my patients and their families suffer, and our society less healthy, less productive, and less community-oriented.
And even for those who have insurance, a recent statewide survey of New Yorkers concluded that about half skip taking medications or seeing doctors because of cost.
Thinking about all these inadequately treated patients makes me so angry. Why do we as doctors have to jump through so many hoops to get patients what they need? Most medical offices and hospitals have many more staff dedicated to calling insurance companies about red tape than they have doctors.
This is why I am urging our legislators in Albany to pass the New York Health Act. It will guarantee equitable access to high-quality health care for every New York resident. It would include primary, preventive and specialty care, hospitalizations, mental health, dental, vision, and more. Every New Yorker would pay an affordable amount based on annual income. This legislation, which has majority support in both houses, would finally allow my patients to access needed care with no out-of-pocket barriers. It will also allow the state to negotiate volume discounts on drugs, like the Veterans Administration, which achieves price discounts of 50 percent or more.
As a physician who treats patients in desperate need of care every day, it’s heartbreaking to care for people who struggle to afford ordinary health care. It’s frustrating to spend hours seeking the lowest prices on common medications, without which my patients could die.
The New York Health Act can save taxpayers, patients, and doctors time, money, and suffering—while providing more and better health care, healthier and more productive lives. I will be joining physicians, nurses, students, midwives and more in Albany on May 3, imploring lawmakers to pass this life-saving legislation before the end of this session. We can’t afford to wait any longer.
Dr. Reena Agarwal is a primary care physician and board member of Physicians for a National Health Program, New York Metro chapter.
