Caring For The Uninsured In Our Current System

By Nancy K. Crevier

Who are the nearly 50 million Americans who are uninsured? Surprisingly, the majority are not the stereotype of homeless, unemployed, or illegal immigrants. According to the Agency for Healthcare Research and Quality, a US Department of Health and Human Services division, most of the uninsured are native or natural born Americans, with eight in ten coming from working families.

Dr Z. Michael Taweh is the director of Kevin’s Community Center in Newtown, a free clinic he founded in 2003. Each Wednesday, he and his staff see between 20 and 25 patients within a four-hour period.

“There are at least 1,500 uninsured families in Newtown,” said Dr Taweh, “and even more who are underinsured. Most are US citizens of middle income, and most are working families between the ages of 18 and 65.” Many of the patients that he sees are self-employed and cannot afford to buy health insurance.

In Danbury, Newtown resident Jennifer Ober, APRN, sees between 80 and 100 patients during the three days a week she works at the AmeriCares free clinic. “It’s a mix of citizens and illegal immigrants,” she said. “They’re sick, they’re sick. People are people. Some are part-time students over 18 no longer covered by their family’s plan. Some are self-employed and can’t afford insurance. In the past couple of years, we have seen more self-employed patients who once had insurance, but when premiums increased and income decreased, they could no longer afford it,” she said. Recently divorced women who are unemployed and not eligible for Medicare make up a good number of the clients that Ms Ober sees at the clinic, as well.

The need for free health care was always a fact in Newtown, said Dr Taweh, even before he opened Kevin’s Community Center, but he was surprised by the number of those who have made use of the clinic. “We assumed it would be a small group with not very serious problems. We underestimated the need,” he said.

He was also surprised to find that at Kevin’s Community Center they mostly treat chronic conditions, which require additional services and specialty care. “We never expected to see the scope of problems that we see,” he said. Danbury Hospital and Housatonic Radiology provide free services to his patients needing further diagnostics than he has available in Newtown. The clinic also helps patients find affordable prescription medicines, another problem that goes hand-in-hand with the inability to afford health care.

At the AmeriCares clinic, Ms Ober also sees a large number of chronically ill individuals. “I see people who finally come to us because they are really ill. They may not have had any health care up to that point,” she said. People who once had jobs and health insurance wait until they are extremely ill to visit the free clinic, she said, embarrassed that they cannot provide for themselves. “As a health care provider, the lack of basic health care for all is really a public health issue. Big problems could be prevented through vaccinations and early treatment of conditions,” Ms Ober said.

Reform Is Needed

Dr Taweh and Ms Ober both believe that some kind of reform must happen to make health care accessible and affordable for all Americans. But who should bear the cost and what that reform would look like are the questions, they said.

Kevin’s Community Center is funded solely through private donations. AmeriCares relies on corporate and private donations, and donations of medicines, medical supplies, and other materials from pharmaceutical companies. An extremely small percentage goes toward administration of the programs, keeping the overhead low.

It is the administration of private insurance that needs to be reformed, in particular, said Dr Taweh, in order to make health insurance affordable to every US citizen. “Right now, over 30 percent of each dollar spent on insurance goes to administration. That has nothing to do with services, providers, or the patients,” he said. He believes that if administrative costs could be cut, affordable basic health care could be provided to those who now have no insurance. It takes time and money at both the doctor’s end and the insurer’s end when tests ordered must be justified, or when paperwork becomes so complicated it takes more than one person to fill it out and file it. Education of the public and liability reform limiting noneconomical damages would also bring down insurance costs, said Dr Taweh, as would linking health information doctor to doctor, and hospital to hospital, electronically. The exorbitant cost of prescription medicine must also be addressed, he said, in order for patients to comply with treatments.

“AmeriCares is limited to preventative and acute illnesses,” said Ms Ober. “But the things that make people go bankrupt are surgeries and unexpected medical emergencies. People that I see are afraid to have a lien on their assets, or to lose them to medical emergencies. How do you talk to someone who is saying he would rather lose his life than lose his house? That it is all he has left of normalcy? I think reform is necessary. It is a moral obligation, I think, to provide basic preventative care to all,” she said.

A socialized medical plan may not be the best answer, though, said Dr Taweh, who was exposed to the English National Health System while training for two years in London. “[The National Health System] works to some extent. But there are serious advantages to the American system, even as it is, over social medicine. We have certain preventative measures here that I did not see there. I saw patients wait, in pain, because their problem was not life-threatening. That would not happen here,” he said.

Unimpressed

Dr Taweh is unimpressed with President Obama’s health care plan, or any of the plans that have surfaced to date for reform, believing that none address reducing administrative costs of private insurance companies and liability reform, the biggest roadblocks to affordability. He is also concerned that if the United States were to try to copy a model such as Canada, that those who have insurance now could lose some of the basic services taken for granted. “The way it is proposed, it could hurt more than it helps. I hope we will have a much better plan that is adopted,” said Dr Taweh.

“I don’t see how a government-run system could be as effective as a privately run system with cutting-edge science being applied and used, and the thoroughness in the approach to medical problems,” he said.

A nationalized health plan does mean less concern for liability, he said, but it can also lead to less investment on the part of the health care system, leading to more pain and suffering for the patient, said Dr Taweh. “Maybe it is good that patients here can sue. It makes doctors provide the best care,” he mused. Unfortunately, in order to avoid malpractice suits, providers may ask for unnecessary tests, and that increased cost is passed on to the client.

“We need education and communication between the doctors and the patients,” stressed Dr Taweh. It is perfectly acceptable, he said, for a patient to question the need for any test ordered.

“There has to be some way to include those 50 million uninsured people and keep the costs down,” he said. “We have to have a plan that is strictly our own: not socialized, but not the way we now have private plans. Everybody — the government, the doctors, the patient, private insurers — has to work together to keep costs down. It is fundamentally wrong if you have to choose between feeding your family and health care.”

Seven years into the free clinic, Kevin’s Community Center continues to add Newtown patients every week. The uninsured are neighbors, friends, and family.

They are the people next door.