Looking back on it, I buried the lede:
In my second year of medical school, I took a small-group course with a famously terrifying surgeon. He told us his moral motto: “A physician never takes away hope.”
I never figured out how that motto could guide doctors through a system where our patients are dying from treatable diseases. Part of my job, it seems, is precisely that: to sit down with patients and, as gently as possible, take away hope.
Consider Vanessa and Jimmy. They met in New Orleans when she was 18. She was working cleaning motels, and he took her on a tour of the tugboat he was captain of. Vanessa says they came to St. Vincent’s because the shipyard Jimmy worked for opted out of providing insurance even for full-time employees like him. They looked for insurance on the open market, but couldn’t afford it.
When Jimmy’s labs showed a dangerously high white blood cell count, we sent him to the ER. It was pneumonia, and there was a huge tumor underneath. Current guidelines would recommend screening Jimmy for this kind of cancer every year, but we have neither the equipment nor the funds to offer screening. So it got caught late.
After Jimmy was diagnosed, I helped Vanessa fill out the paperwork to request financial assistance for cancer care....
Vanessa called from a hospital in Houston in early November, distraught, asking me to help her decide whether or not to let the doctors turn Jimmy’s breathing machine off. She was afraid she wouldn’t be able to live with herself, no matter which she chose. I gave her the advice I’d give a friend: that I trusted her love for her husband and her ability to decide from a place of love. Jimmy died late that night.
Vanessa’s request for UTMB funding wasn’t approved. She has received a $17,000 bill from UTMB for the visit when Jimmy went through the ER, and a $327,000 preliminary bill from the Houston hospital.
If the Affordable Care Act had been in effect last year, they would have been able to afford insurance, get treatment early and avoid bankruptcy. I use stories like theirs—cancer stories—when I am encouraging my patients to check out the insurance exchanges.
But the real catastrophe is all those people losing their policies, and the fact the website doesn't work as advertised. And what about those people who get treated in ER's? Ted Cruz said that was okay, didn't he? Turns out we don't really take care of people who can't pay:
The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.You can compare that to this document from the Texas Attorney General's office. Nothing in that PDF document says you have to be cured before you stop meeting "hospital criteria" entitling you to charity healthcare. UTMB, after all, is a "public hospital." But: "When UTMB refuses to treat them, it falls to us to tell them that they will die of diseases that are, in fact, treatable."
This is the state of medical care in America. And yet the serious problem of medical care in America, is whether or not a website will be up and running before Christmas, and whether or not some insured people will get to keep the cheap and probably worthless insurance policies they now have.