Monday, January 21, 2013

Inaugurations & Uninsured - Four Years Later

On Inauguration Day 2009, I watched the ceremony and parade from an operating room. On the table was a woman without health care insurance who had delayed treatment for fear of bankrupting her family.
As some monitors displayed a bulging mass pushing aside organs in the patient's abdomen, other screens showed the then-new President, Barack Obama, taking his oath and watching the parade. As the surgeons and nurses worked to help one woman without health care coverage, some of them donating their time, the plight of millions of other people in similar situations was on their minds.

Here's what I wrote about that day, as it appeared in The Real Grey's Anatomy book:

On Inauguration Day, cancer surgeon Kevin Billingsley is preparing to remove a suspected tumor from a woman. Scans up on the wall monitors show how the mass is pushing aside all the other organs in the woman’s abdomen. It might not have been so big, if the woman had been treated earlier.

The Real Grey's Anotomy by Andrew Holtz

“I first saw this patient about two weeks ago, she had delayed treatment,” Billingsley says. “Her biggest concern was not, ‘Am I going to die from this cancer,’ but, ‘Is this going to bankrupt me and my family?’”

The patient, Diane Hinds, later recalls the events leading up to her surgery. She had been feeling rundown for several months. She thought her swelling midsection was just weight gain. She didn’t go to see a doctor. Her husband’s job doesn’t pay much and doesn’t include any health care insurance. Eventually the swelling got to be too much. She went to a local emergency room. After a day of tests and examinations she was told that there was a large mass that might be cancer. The bill that came with that frightening news was $6,000.

No one would treat her as long as she couldn’t pay. She applied for Medicaid and other programs without success.

“I had gone to every place that I could think of to get some kind of assistance. I had just sort of accepted the inevitable. And I told my family the same thing.” She had recently watched her brother die of cancer despite nearly a million dollars worth of treatment. “There's no way I could ever pay for it, and even if I could, I would bankrupt my whole family. I'm 64 and I just thought, ‘Why bother?’ That's the way I felt. I was pretty down and out.”

Her oncologist sent her to see Kevin Billingsley. She listened to his assessment and proposed treatment. She declined.

“He couldn’t understand why I would turn down a chance to have my life saved. I said, ‘I don't have insurance. I don’t have that kind of money.’ He came right out and told me, ‘My job is a surgeon.’ I said, ‘I realize that. I just want you to know where I'm coming from. I'm not against medicine, I'm not afraid of the surgery or anything, but let's be practical here with the issue of paying for it.’”

Billingsley referred her to administrators at OHSU who reviewed her situation. She submitted her financial and other information. When the financial assistance staff determined that she did not qualify for Medicaid or other coverage and couldn’t afford to pay for necessary treatment, the hospital agreed to write off almost all of the cost of her care. On average, the hospital says it provides $15 to 20 million worth of charity care each year and also writes off almost $20 million of bad debts. It adds up to about 5 percent of the net patient revenue.

So Diane Hinds got her surgery. And there was more good news: the mass was not a tumor after all. It was a hematoma, a collection of clotted blood. It was still a threat as it squeezed her pancreas, spleen and other organs to the side, but no it’s gone and Hinds doesn’t have to worry about lingering cancer cells. She says the recovery has been slow and steady.

Despite everything she’s been through, she marvels at how Billingsley and the hospital treated her even though she couldn’t pay them.

“How I got so fortunate, I don’t know,” she says.

During the procedure, a computer monitor at the nurse’s desk was showing coverage of the new President walking to the White House. In the O.R. there were wishes that someday they would no longer see patients delaying care and suffering because they couldn’t afford to get treatment.

Four years on, some things are changing. In just over 11 months, almost everyone with lower incomes will be eligible for subsidies that will cap how much they pay for basic health care insurance. By the next Inauguration Day, we may know whether the expansion of coverage reduces the number of people in the United States who feel they are faced with a choice of bankruptcy or death.

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