Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What’s the difference between health care in the U.S. and Haiti? Not much.

Vincent DeGennaro, Jr., MD, MPH
Physician
May 8, 2017
106 Shares
Share
Tweet
Share

“How long have you had the bleeding?”

“About seven years,” my patient replies stoically.

Ange’s angular face no longer retains the beauty of her youth. The sharp lines around her mouth speak of a long life packed into a brief 42 years. She is well dressed, but her manner of speaking betrays the poverty in which she exists.

Ange has advanced cervical cancer — a completely preventable disease. In fact, cervical cancer can take as long as a decade to develop, during which time — in Ange’s case — any screening test might easily have determined that the abnormal bundle of cells on her cervix needed to be removed. Ange, however, does not have health insurance. As a result, the medical system has bounced her from doctor to doctor without offering real assistance.

While cervical cancer has dropped out of the top-10 cancer killers in most developed countries — thanks to a simple screening test, the Pap smear — it tops the list in Haiti, where Ange is my patient. After performing a brief examination to determine the stage of her illness, I tell Ange that, with the support of a few generous individuals, our program can help pay for her radiation therapy in the Dominican Republic. Like all late-stage care, radiation is expensive — $2,000 per patient — compared to the $3 test that could have prevented Ange’s cancer from forming in the first place.

Ange’s story is no different from the stories of many women in the United States, particularly among the poor and uninsured. Advanced health care means nothing if people cannot get it. According to the Kaiser Family Foundation, some 20 percent of Americans without health insurance live without basic preventive health care services like the Pap smear. What’s worse, under the American Health Care Act (AHCA), which failed in the U.S. House of Representatives earlier this year, Planned Parenthood, the largest provider of women’s care in the United States., would have lost federal support. Its public funding remains a target for elimination among political opponents who object to the organization’s provision of abortion services.

I wonder what would happen to Ange if she lived in the United States. Would her situation be any better? What will happen to the 270,000 American women who today rely on Planned Parenthood for cervical cancer screening? What will happen to the 24 million people who would have lost health insurance under AHCA, per a Congressional Budget Office estimate? In my view, the most important question that remains from that debate is how we might develop bipartisan ideas to guarantee health care for all.

The defeat of Obamacare repeal does nothing for the 28 million people under the age of 65 who, Kaiser estimates, still lack health insurance. Most of these Americans live in the 19 states that refuse to expand Medicaid, the nation’s public insurance program for the poor. How do we as Americans justify our society’s stance among the last in the developed world not to provide universal health care?

I see a sad case like Ange’s every week in Haiti. I see at least one each week in Florida, too, because of the anemic Medicaid funding in the Sunshine State. The truth is that my patients in Haiti face nothing more than a difference in the scale of their health care problems when compared with my patients in Florida. The underlying philosophy in Haiti and the United States is that society should ration care based on who can afford it. Unnecessary cases of advanced cancer will remain the norm in both countries as long as this view prevails. If we cut or eliminate funding for Medicaid and Planned Parenthood, we will start seeing advanced cervical cancer rates rise again. Pap smears can cost $200 or more when paid with cash. Even under the status quo, in which the Affordable Care Act requires insurance plans to cover Pap smears and other preventive tests, the U.S.’ survival rate still ranks only 22nd worldwide in cervical cancer care.

Uninsured Americans rely on a network of local health centers, which often lack many basic blood tests and medications. Doctors are only as useful as the tools at their disposal. Patients can always receive care in emergency rooms, but they will be discharged as soon as the acute issue is resolved. Under such protocols, uninsured cancer patients might obtain a biopsy or CAT scan in the hospital, but they won’t get chemotherapy or surgery after discharge. We must push for more and better care, not less and worse. The defeat of the Obamacare repeal effort should be taken as a clarion call to aggressively push for universal health insurance: A combination of private and public payment options that guarantees a minimum standard of care.

If compassion fails to persuade us, costs should. Cancer, like the strokes, heart attacks and kidney failure that too often result from poorly controlled diabetes or high blood pressure, can be a terribly expensive illness. The money we think we are saving by denying universal coverage for basic preventive health care costs pales next to what we pay when the preventable takes hold, and taxpayers pick up the bill.

Naturally, we will always have the option that awaits most of Haiti’s working poor: Simply let people die. It’s cheap and cost-effective and it hardly ever fails. Haiti’s government, while complicit in the country’s chronic dysfunction, simply does not have the funding to provide care for its 10 million people. The United States has no such excuse. We have the financial resources to insure our citizens, but we regularly choose defense spending hikes or tax cuts instead.

Ange came to my clinic with her teenage daughter, who was directing her young mother’s care. I couldn’t help wondering whether our screening program would one day protect her from a completely preventable death. In our own country, we must learn the lesson now. Most Americans believe the federal government is responsible for ensuring universal health coverage. As we strive to help Haitians and others, the time has come for us to guarantee access to health care for everyone at home.

Vincent DeGennaro, Jr. is an internal medicine physician and president, Innovating Health International. He blogs at An American Doctor in Haiti and can be reached on Twitter @DoctorGlobal.

Image credit: Shutterstock.com

Prev

Give your body a real immune boost

May 8, 2017 Kevin 1
…
Next

The evolution of prior authorizations

May 8, 2017 Kevin 10
…

Tagged as: OB/GYN

Post navigation

< Previous Post
Give your body a real immune boost
Next Post >
The evolution of prior authorizations

More by Vincent DeGennaro, Jr., MD, MPH

  • COVID-19: Don’t listen to the political spin of either side

    Vincent DeGennaro, Jr., MD, MPH
  • A physician is on the scene in the Bahamas after hurricane Dorian

    Vincent DeGennaro, Jr., MD, MPH
  • A family meeting in Navajo Nation

    Vincent DeGennaro, Jr., MD, MPH

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Primary care makes a difference for patients and the nation

    Glen R. Stream, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • Obstruction of medical justice: How health care fails patients with cancer

    Miriam A. Knoll, MD

More in Physician

  • The alarming epidemic of physician burnout and how we can combat it

    Tomi Mitchell, MD
  • A retired physician’s battle with moral injury

    Hayward Zwerling, MD
  • Unveiling the secrets to effective resuscitation and overcoming obstacles

    Deepak Gupta, MD
  • A tense family drama unfolds as a young daughter pursues unconventional career path

    Osmund Agbo, MD
  • Decoding the brain’s decision-making: insights for medical professions and strategies for success

    Harvey Castro, MD, MBA
  • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

    Jay K. Joshi, MD
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician
    • Unveiling the secrets to effective resuscitation and overcoming obstacles

      Deepak Gupta, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Acute GvHD Risk After Allo-HCT Higher With Some Antibiotics vs Others
  • TTFields Therapy Yields OS Improvement in Second-Line NSCLC
  • Mental Health Provider Disclosed Personal Patient Info in Google Reviews
  • Oh, You Have Medicare? We'll Skip That Test.
  • Which Mask Is Best for Wildfire Smoke?

Meeting Coverage

  • TTFields Therapy Yields OS Improvement in Second-Line NSCLC
  • Upper Airway Stimulation Device for OSA Holds Up in Real-World Analysis
  • Morning Naps in Elderly People May Reflect Dementia Risk
  • Extra Follow-Up Confirms Benefit of Nivolumab in Muscle-Invasive Bladder Cancer
  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician
    • Unveiling the secrets to effective resuscitation and overcoming obstacles

      Deepak Gupta, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What’s the difference between health care in the U.S. and Haiti? Not much.
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...