“Doc, I finally got insurance!” She danced a little jig with her cane right there in the hallway as my staff was getting her weight and vitals. The medical assistant had to catch her as she lost her balance.
“Really? Woohoo! Off the exchange site?”
“Yep.” She beamed. It had been a tough three years of treating her psychiatric issues, severe osteoarthritis, and diabetes without medical coverage. “I want you to do the works, Doc. Whatever I need, let’s do it.”
Eagerly, I set about ordering her colonoscopy, mammogram, PAP, immunizations, diabetic eye exam, lab work…
I was very excited for her.
I was also a little bit excited for me. Finally, she would stop bringing down my preventive care numbers.
Two weeks later, I got the note requesting a diagnostic mammogram. Her screening mammo had found a suspicious mass in her right breast.
I dialed her number to give her the bad news.
There was the expected silence on the other end of the line.
“Look. Don’t worry about this. Most of the time it ends up as nothing.”
“Are you OK?”
“Doc, how much is this going to cost? I have one of those high deductible plans. It was the only one I could afford. I don’t have the money.”
It was my turn for silence.
Finally, I said, “This needs to be done, I’m afraid.”
“I just can’t do it.”
“Look, this might be cancer. You should not ignore it.”
“I just can’t do it.” She hung up.
Several months later, she sold her house and finally got that diagnostic mammogram and then the biopsy and mastectomy and radiation and chemo….
Was this a win for the ACA? Maybe. We found a cancer that we did not know existed. But what good is screening coverage for patients that cannot afford that diagnostic mammo or colon resection? If this is supposed to help people who cannot afford insurance or healthcare, it seems that it actually falls rather short of that goal. Her treatment, in the end, cost her tens of thousands of dollars. Her entire life savings at age sixty-two.
My post, “Bridging the Gap With Silk Draperies” illustrates further what can happen with high deductible plans. Do they decrease costs by making patients bear more of the weight of cost? Sure. But at what larger expense, I wonder? Is anyone even studying that?
I ask because this is not an isolated incident in my practice and there are many of the ACA plans that I do not take.
Does this mean we should trash the whole thing? No, not necessarily. Perhaps I am naive, though, because I expected more…