It's just before midnight in the busy Rhode Island emergency room where I work as a doctor, and there are still more than 50 people waiting to be seen. I hurry in to see my first patient of the night. He's a young man who has been waiting more than four hours to see me. I find him lying on a thin stretcher, face contorted with pain, clutching his lower back. He explains that he has been having spasms and electric shocks radiating down his right leg that began after lifting a heavy box. At first he avoided seeking medical attention due to lack of health insurance, but after three days of missing work he finally felt he had to do something. After a thorough exam, I confirm my initial suspicion. "You have a slipped disk in your lower spine," I explained. "It's probably pressing on the nerve going to your right leg."
"Can you fix it doc?" he asks. Unfortunately, I can't. He needs to be seen by an orthopedist and will likely require physical therapy, steroid injections and if all else fails, surgery. Without insurance, he's unlikely to be able to afford any of these treatments, and so instead he will suffer at home, hoping it gets better on its own, missing weeks or months of work and losing out on his only source of income.
Later on, I see a middle-aged woman complaining of blood in her urine for one week. She's been waiting nearly seven hours to see me. I run a urine test, which confirms a small amount of blood. In a woman her age, the bleeding could be nothing, or a simple urinary tract infection, or it could be an early sign of bladder cancer. I explain to her that she will need to follow up with a specialist and have a procedure where they put a camera in her bladder to check for cancer. "How much will that cost?" she asks. "You know I don't have insurance."
I give her a rough estimate of the cost and a referral to the specialist. She thanks me kindly (despite her long wait, she is by far the nicest patient of my shift), but tells me there is no way she will be able to afford the cost of the procedure. "I'll just have to pray it goes away on its own," she says as she leaves. I also pray that it does, because if it doesn't, by the time she seeks care, the cancer may well have spread beyond her bladder and become incurable.
Not only are both of these real patients that I saw on a single night shift, they are nearly identical to dozens, if not hundreds, of other patients I have seen over the past decade. As any of my emergency medicine colleagues can attest, not having health insurance can be painful, debilitating, humiliating and deadly. In fact, the U.S. Institute of Medicine estimates that more than 18,000 Americans die each year due to lack of health insurance. (1) Compare that to the 5,000 Americans who die each year from not using their seatbelt while driving. (2)
Of course, while buckling up is free, health insurance costs money -- a lot of money. The good news is that for the millions of Americans who don't get health insurance from their work, including those with pre-existing medical conditions, signing up for health insurance today is far cheaper than it was just yesterday. This is due to the creation of the new statewide health insurance exchanges and the insurance subsidies made available through the Affordable Care Act, or Obamacare, as it is famously and infamously known.
That's why one of the best things you can do today to save your life (and those of your family members) is to sign up for health insurance if you don't already have it.
I know that many on the political right argue that the new individual mandate for health insurance coverage under Obamacare is an infringement on personal liberty and an unnecessary intrusion by government into what should be an individual decision. For the sake of this piece, I will concede the point entirely. But just because your state requires you to wear a seatbelt (and place your child in a car seat), does that mean you would choose not to do so in protest? Of course not. The only people that lose out if you don't sign up for health insurance will be you and your family.
I also know that an equally vocal group on the left argue that Obamacare doesn't go far enough, and that many of the most affordable policies being offered through the health insurance exchanges will have high deductibles and copays and may not cover certain classes of medications at all. They argue that a national single payer health plan would be far more equitable, and provide better and more affordable care. Again, for the sake of this piece, I will concede the point. But just because your car manufacturer was too stingy and uncaring to install airbags, does that mean that you aren't planning to wear your seatbelt the next time you go for a drive?
I certainly hope not. Because if you or a family member is in a car accident next year and ends up in the hospital for an extended stay, paying a $5,000 deductible is going to be far more manageable than paying the full $500,000 hospital and rehab bill. When the hospital sends you to collections, which they will, you can probably work out a plan to pay off the $5,000 over the next year or two. But with a $500,000 bill, you're looking at the same fate that already plagues tens of thousands of Americans each year without health insurance -- loss of your home, assets and credit through personal bankruptcy.
Still not convinced? Well, consider this final point. All of the politicians and pundits you see on television decrying the evils of Obamacare already have health insurance themselves. So by all means, go ahead and join their protest if you are so moved. But just take a moment first to sign up yourself and your family for health insurance.
Oh, yeah -- and don't forget to wear your seat belt.
Adam Levine is an Assistant Professor of Emergency Medicine and Co-Director of the Global Emergency Medicine Fellowship at Brown University. He currently serves as the Clinical Advisor for Emergency and Trauma Care for Partners In Health/Inshuti Mu Buzima and as a member of the Emergency Response Team for International Medical Corps. His research focuses on improving the delivery of acute care in low-income countries and during humanitarian emergencies. The views expressed in this blog are his alone and do not necessarily represent the views of any of the organizations mentioned above.
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