The patient was in pain and had been for over a year. And it was getting worse, not better. Exhausting all avenues of treatment, I decided it was time to refer him to a pain management doctor. Because of the injury to his back, the patient lost his job and his health care coverage. With no alternative for health care coverage, he ended up covered by Medicaid. While health care analysts would count this as a “covered life,” was he truly covered?
If he was still covered by his earlier commercial plan, finding a specialist and scheduling an appointment would be no big problem. In fact, he would have probably seen the specialist within a period of one week. However, he was not so lucky to be among the working class and no longer owned “good” insurance. Many specialists where I practice, as well as nationwide, simply do not participate in Medicaid simply because it historically paid so low that doctors lost money treating these patients. Eight months after I gave him the referral, he is still making daily phone calls to attempt to schedule an appointment with a specialist.
From the starting line, patients who are covered by state plans or do not have any insurance often can not even be seen by the specialists they need to be treated. Most Medicaid plans — traditional and HMO — also have very narrow medication formularies, meaning they do not pay for many medications. Often, patients covered by these plans must use alternative, cheaper medications than the ones their doctors prescribed because they thought the patient needed it.
How is health care disproportionately distributed along socioeconomic lines?
- Patients covered under Medicaid plans do not have much choice in choosing doctors and sometimes even hospitals.
- Coverage for medications and diagnostic tests is often substantially less for the same indications than under commercial plans.
- Many employers are paying less towards health care premium costs for their employees due to the rising costs. Many cannot afford these premiums. Those who make more can buy insurance that covers more services than cheaper plans. Thus, there is a definite division of health care coverage along socioeconomic lines.
- People who file for medical bankruptcy are most often middle class. Many of these people are already living paycheck to paycheck and cannot afford to bear the price of ever-increasing medical costs. Many of them just do not go to the doctor because they cannot afford it. Thus, our current health care system siphons out those with fewer means to afford it.,/p>
- Patients who pay higher premiums can choose from a greater number of doctors and are offered coverage for many more services. Money can buy better medical care.
- Despite that the Affordable Care Act (ACA) was aiming to get all Americans covered by health care insurance, almost 10 percent of the population remains uninsured. Those who remain uninsured are often those who cannot afford to pay any premiums, yet earn too much to qualify for Medicaid. Many of them do not seek medical care because they cannot afford it.
While health insurance covers more Americans than ever before, disparities have been created in the system. Those who earn more money are offered better medical care under their insurance coverage. There is a lot of health care where the poor are denied medical services just because they earn less. And the middle class is especially being squeezed by paying premiums they can’t afford, and those often carry very high deductibles.
In the U.S., we live in a very capitalistic society. While it is acceptable that the cars we drive are determined by the amount we earn, it is not acceptable to decide medical services based on socioeconomic status. All people deserve the best medical care we can offer them. Day after day, insurance companies place obstacles in the way of doctors providing the best care to their patients. A new way must be found before these disparities lead to deaths based on financial self-worth.
Linda Girgis is a family physician who blogs at Dr. Linda.
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