stah110717I presented this patient in an article I wrote for a local media outlet:

Mrs. M. is a 51-year-old widow with two teenagers who worked as a short order cook until she was 50. She knew diabetes was a possibility, partly because she was a little overweight but mostly because it runs in her family. She may have even been told she had it once or twice but she didn’t go to the doctor regularly until after her husband died when she was 48 and she became eligible for Medicaid. While a lot of people can suffer from diabetes for years without having complications, Mrs. M. began suffering complications soon after her diagnosis. She developed neuropathy (numbness) of her hands so bad that she could no longer cook and became unemployed. Last year she developed chest pain that was due to blockages in her heart that were not operable. She also suffered greatly from heartburn but like many people couldn’t tell the difference between these pains and her heart pains so each time would call for an ambulance. She made multiple trips to hospitals. For each of these episodes she would be treated either in the emergency room or be hospitalized and would have a heart catheterization. Her income was only $8000 last year so her family was eligible for Alabama Medicaid. Medicaid paid the hospitals $420,000 on her $2,000,000 bill this past year. Alabama’s share of this was $140,000. She paid no taxes.

I wrote this to create a contrast between a Medicaid patient’s actual care in the current inefficient, fragmented system as compared to what the world of the possible might be under Obamacare if fully implemented:

Mrs. M lost her husband and took a job as a short order cook. She had previously had health insurance but now, because she is not making above the federal poverty guidelines and works for a small company, is on Medicaid. She has been seeing a health professional regularly because of her family history of diabetes and can continue to see her even with the change in insurance. She is working hard and doesn’t diet or exercise as she should. About a year ago she was told she has pre-diabetes. She was placed on a mild pill to control her cholesterol but more importantly was offered nutritional services and some support to help become more physically active. After losing 20 pounds, her blood sugar and cholesterol normalized and she has been off all medication for a year. The office calls to check in on her every month or so. For the past year her health care costs were $200 (2 office visits and a chronic care management fee paid to the doctor’s office). The state of Alabama paid $20 towards this. Mrs. M. paid $900 in taxes to the state of Alabama.

What surprised me was the intensity of the response to the scenarios. The worst was a person who felt that we should allow folks too poor to pay for their own health care to die. She believes that by providing this patient access to effective government funded healthcare we condemned an innocent non-poor person to a shooting death by the Medicaid recipient’s (sociopathic) children. This person actually signed her real name.

I was reminded by a former resident of the Incidental Economist blog (found here). They analyzed the Oregon Medicaid study in much more depth than I have and their complex read and my superficial read are in agreement. Access to healthcare through Medicaid insurance is an unmitigated good but the study is underpowered to detect how much of a good.

The most interesting observation they made relates to the interpretation of the study by the press and the public. If you believe, in your heart of hearts, that your life expectancy should not be dictated by the zip code you were born in and that we as Americans have a responsibility to our fellow citizens then you tend to cite the social determinants as a barrier and see the ACA as an imperfect means to begin correcting the inequities. This study proves that after 2 years of health care coverage people have an  improved sense of well-being  If you believe, in your heart of hearts, that health care is a service delivered by entrepreneurs to wealthy people or delivered as charity to the deserving poor, you cite Robert Sade and point to this study as evidence that health care access is not always associated with excellent health. This study proves that giving health care access to poor people is throwing good money after bad.

I suspect you can tell what the ink stain looks like to me.

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