At a White House meeting on Monday, health care industry leaders vowed to trim $2 trillion from the nation's health care spending over the next decade. It remains to be seen whether these people, representing insurance companies, pharmaceutical companies, and doctors, keep their promise. After all, we've been down this road before, with the major stakeholders in the system offering "voluntary" cost-cutting measures. Still, it is a sign that even health industry leaders realize that the recession has turned a chronic problem into what we in the medical field call an emergent situation.
The 10-second version of the nation's health care crisis is that unemployment has led to massive numbers of uninsured (as I pointed out in the last installment), which puts a tremendous strain on the system, driving up the cost of care and coverage for everyone, which, in turn, adds to the rolls of uninsured.
More than that, though, we have reached the point where millions of people are making critical decisions about their medical care not based on what will get them better, but on if or how long they're likely to have a job and insurance.
Last week, I saw a patient who was bleeding due to uterine fibroids, a condition we typically try to treat first with medication before opting for surgery. Rather than take her chances, however, she decided to schedule a hysterectomy right away because she knew she was about to lose her job and if she needed surgery in two months she wouldn't be able to afford to pay for the doctor's fees and hospitalization -- which would have cost her roughly $30,000 out of pocket.
Another patient who was experiencing irregular bleeding came to see me recently for her annual exam and Pap test. Her insurance was scheduled to lapse at the end of the week. The next day she came in for an ultrasound and a biopsy of her endomterium to rule out cancer. Three days later, I inserted a contraceptive IUD to help reduce her bleeding. So the imminent loss of her insurance had spurred her to scramble to have about $4,000 worth of services in four days.
On the flip side, every week patients who have already lost their insurance call my receptionist to postpone appointments for minor conditions or routine checkups. Such calls appear to be epidemic. According to an April health tracking poll reported in Medical News Today, six in ten Americans are now putting off medical care.
As I've noted before, delaying treatment in the early stages of an illness invariably ends up ringing up more cost and causing unnecessary suffering. Instead of going to the doctor and getting medicine for a urine infection, a patient might wind up in the ER with a kidney infection requiring hospitalization and an IV. Or someone has abdominal pain that turns out to be appendicitis, but she doesn't seek treatment until it ruptures, which is far more serious and can lead to an extensive hospital stay.
Then there are all the conditions for which symptoms haven't even presented yet. As a gynecologist, I pick up about a dozen potentially life-threatening problems a year in the course of routine screening. It could be a mole, an enlarged cyst, blood in the stool, an irregular Pap result or a breast lump. In each case, when detected early, these and other comparable problems are treatable, usually on an outpatient basis with minimal costs. But if left untreated, they fester and can end up becoming major costly health crises that someone -- either the patients or taxpayers -- has to pay for.
I shudder to think how many cancers, future heart attacks and strokes are going undiagnosed as every day more Americans put off mammograms, colonoscopies, Pap tests and routine blood work. In that sense, the full cost of the current crisis in both lives and dollars won't be known for years to come. The president and Congress need to address -- really address -- the issue this spring and summer if only to stop the bleeding.
Russell Turk, M.D., is an obstetrician and gynecologist in Fairfield County, Conn.