I saw this on the health care blog, a blog that surprisingly discusses healthcare:

One of the day’s patients was a man in his forties who had been diagnosed with high blood pressure four years prior. Uninsured, he received inconsistent treatment for his condition, leading to a heart attack two years later. The attack precipitated heroic emergency room and then hospital treatments, free to him but expensive to the rest of us, including placement of a stent; however, with the immediate crisis over, lack of money for drugs led once again to gap-filled care. Key in his follow-up care should have been the drug Plavix, considered critical for avoiding clotting after stents, but he couldn’t afford it so he stopped taking it ten months too early. Now, just two years later, he’s developed severe high blood pressure that has damaged both his heart and kidney. Our medical system will provide him once again with heroic and very expensive hospital care, all of which likely could have been avoided if proper health care insurance had enabled his condition to be systematically managed for the past two years. The system as a whole, and likely government funding in particular, will end up paying hundreds of times more because his care was so poorly managed. Of course, we’re also losing a potentially productive man all the while, if not forever.

I think these antidotes (edit I meant anecdote! hah!) about people who don’t have insurance and have poor outcomes really doesn’t illustrate the full picture and furthers this myth that somehow insurance will now mean people will take good care of themselves. For that person, continuous healthcare could have lead to a much better outcome, although it sounds like from reading between the lines, this person’s high blood pressure is more of a problem than just a simple fix. It’s a story of someone who developed severe high blood pressures early in life, and had end organ damage much sooner than most. However, I’ve seen clinical situations where people who have limited access to care are given all they need – social work helps set them up with housing, transportation to doctor’s visits, medications, all the care and social support they need to achieve a good outcome and in the end – they still come into the ER, a mess of what happens when chronic medication conditions are not managed well. I think we forget how independent we are and how much we just don’t like going to doctors and doing the things that are right for our bodies. I think it’s a terrible mistake to just blindly fund healthcare and all these uninsured people will suddenly see the light, stop eating badly, will exercise and become advocates for their own health. It’s easy to see this evidence of goal blood pressures and the much better outcomes… but what is behind that is every three months this patient coming in, daily medications, filling medications regularly, etc.

On the other hand, I did see a clinic while I was a medical student where people who were homeless received care. And how surprised was I when out of the ratty backpack came out a book to write down their sugars and their daily sugars were logged. So I don’t think it’s impossible to help people, and help empower them to want to be an active participant in their health. But I think it’s a mistake to just assume it’s a lack of insurance, it’s often a much larger causal pie – slices of poor access to care, distrust of the medical system, lack of knowledge and motivation about health. I know this is not the focus of the healthcare debate about how to fundamentally change human behavior, but I just can’t help but to think that is what is going to matter in the end not just having insurance.