Health Care

I've been a nurse for over a decade now. I've worked in emergency departments and in ICUs, in hospice programs and in faith communities. I've seen firsthand what happens when people don't have healthcare coverage. It doesn't just keep you from seeing your primary care provider - it changes fundamentally how you think about your health. What would normally be a routine problem to take care of, waits. Sometimes these problems go away; more often, they get worse. It is this kind of change in health behavior that is most problematic for individuals and for the healthcare system. This change in health behavior happens slowly over time and is hard to change once set in place. This is why adequate healthcare services, from cradle to grave, is essential for each person.

Take for example David*, a man in his mid-50's that came to see me at the social services center where I was providing health counseling and screening. I'd known David for sometime, and had seen him get more and more sick. He had, among many other problems, severe diabetes that he wasn't able to treat due to being unable to buy testing supplies and insulin. He was maximized on the services available to him in the community but still could not afford the care that he needed. Because of this, David's blood glucose levels would often run well over 500 mg/dL (for those who don't have a point of reference here, this is very high - in the life-threatening zone). I would counsel David on his need to go to the emergency department when his glucose levels would be this high but he rarely went. He simply had lost hope in treating his problems. He could not continue a treatment regimen when he left the hospital and he knew it. So, he stopped going to the emergency department.

The last time I saw David I had talked him in going to the emergency department because he had an obvious severe infection in his leg and his blood glucose levels were sky-high. I pleaded with him to go to the hospital, to which he agreed this once; he probably felt too bad to fight me that time. We got in my car and we headed to the emergency department. On the way, David asked me to stop by his house, so he could feed his dog. I reluctantly agreed - not because I didn't care about the dog, but because if David got out of my car he probably wouldn't get back in. My hunch proved true. David went into his house and a few minutes later came out and told me that he couldn't reach the person he needed to care for his dog. He promised to go to the emergency department later that day. I made sure he knew that he would die if he didn't go. He acknowledged this and thanked me for caring about him. Three days later, someone called me to let me know that David was found dead in his house the day before, two days after I tried to get him to the emergency department. David likely succumbed to an overwhelming infection and died quietly after he lost consciousness.

In looking back, there is nothing more I could have done for David. He wasn't mentally confused or unable to make decisions for himself. I believe David knew he would die and accepted that fate. He was, as much as I've ever seen anyone else, hopeless to improve his own health. Was he depressed? I don't think so. Should I have somehow forced him to go to the emergency department? No. I simply can't do that for anyone despite wanting to. Everyone has the right to make these kinds of medical and health-related decisions for themselves. In the healthcare world, we call this the right of autonomy or self-determination.

As I reflect more on the situation, I wonder if David made a truly autonomous decision. Certainly he chose in the end not to receive the care he needed to survive, but his choice was shaped largely by his previous experiences in our healthcare system. These experiences were fraught with prejudice and maltreatment due to his low socioeconomic class and his lack of healthcare insurance. David probably didn't do everything he could have to stay healthy. But who really does? He certainly didn't deserve to die because he couldn't afford the healthcare he needed.

I write of this experience because I think what is lacking in the whole healthcare reform debate are the personal stories with which Americans can identify. When we hear about the suffering of a friend or neighbor, we tend to have some sort of empathic response - we understand what it might be like to be in another person's position. I'm not sure we have collectively thought about healthcare reform from this perspective. This isn't just a matter of paying more taxes or choosing your own doctor. It is just as much about doing some collectively to address a current problem - that is, that people suffer and die because they can't get the care they need.

Just about the only guarantee of healthcare in this country is if you have a true medical emergency and you go to the emergency department (Note: If your problem isn't a true emergency, you can even be turned away from an emergency department). Outside of that, physicians and other private providers are not required to see you if you cannot pay them. Urgent care centers are not subject to the same federal requirements as are emergency departments when it comes to treating someone regardless of their ability to pay. Forget anything preventative which may save the healthcare system, and by proxy the average healthcare consumer, some money. For example, consider the 35-year old obese male with severe obstructive sleep apnea. Treat his apnea with a $400 CPAP machine now and you will save a heart attack, stroke, and tens of thousands of dollars later.

We have so many shared resources in this country that I find it hard to understand how healthcare services cannot be one of them. We already share things like roads, Social Security, Medicare, public schools, police departments, etc. Can't we share healthcare services, too? If we can't come to a place of understanding the need for healthcare reform by reason alone, can empathy work toward this end? Can we, in understanding the plight of our neighbors, friends, and family members, support reform which will make available to those in need the healthcare services that we all should enjoy when living and working a country as advanced and rich as ours? We've spent $864 Billion on the current wars, but a similar amount for healthcare over the next 10 years seems unreasonable to some. We cannot afford inaction. We must show we care about each other. No one should die because they don't have healthcare coverage.