Our patients can't afford to come in for needed care

"Compared with their counterparts in seven other countries, chronically ill adults in the US are far more likely to forgo care because of costs."

C. Schoen, R. Osborn, S. K. H. How, M. M. Doty, and J. Peugh, In Chronic Condition: Experiences of Patients with Complex Health Care Needs, in Eight Countries, 2008, Health Affairs Web Exclusive, Nov. 13, 2008, w1–w16.

Numerous studies point out what Uwe Reinhardt has said: when an individual's personal threshold of out-of-pocket spending is exceeded, they will perceive health care as a luxury.  In microeconomic terms, “luxury” means “I will do without in dire times.”

Our patients are facing dire times.  Primary care is facing dire times.  We and our patients are suffering from an illogical and harmful system that rewards volume of services over care.  Insurance industry maneuvers to manage care and cost result in untenable costs added to everything we do for our patients.

This toxic brew stems from how our system is designed.  Change can happen if policy makers can find the will to face those with deep investment in the status quo.  We can have an effect on policy makers if together with our suffering patients raise our voices in local and national media.

Here are some suggestions on what one might say:

Other countries achieve vastly superior health outcomes while spending less than half what the US spends per capita on health care

• The main difference is that the other countries support excellence in primary care
• Adequate funding for primary care would take less than 10% of current health care spending
• This funding would
  • Provide all Americans with primary care
  • Make health care affordable because of the savings from improved prevention and early management of conditions
  • Re-invigorate primary care as a career choice

We do all we can to help our patients but we can’t provide inadequate or inappropriate care. 

The current system is blatantly absurd.  Most of the suggested “solutions” are incremental modifications which maintain the fatal flaws of the current system.  We need real change.  Real change can happen if enough of us speak up.

Gordon