Dear Trump Administration
Hello Mr Ryan, Mr Trump, and whomever else this may concern.
(And, if you are an American of any stripe, then as it turns out it also concerns you.)
I am a family physician. I interact with your constituents all day, every day. I hear about their problems, their struggles, and often the limitations they face regarding healthcare. I try to help them when I can. That’s my job in a nutshell.
So let me tell you about one of your constituents who also happened to become my patient. Let’s call him Bob.
Bob is a middle aged man who worked full time at an entry level manual labor type job. The kind of job you spend 40 hrs/wk working but still hover around the poverty line. The kind of job with no benefits. He didn’t go to the doctor and had no health insurance but as far as he knew he also didn’t have any health problems. Until one day he started feeling unwell. This persisted for a few days and he refused to let his wife take him to the doctor. He was worried about the cost and figured he’d get better in a few days anyway. Only he didn’t. He got worse and his wife called an ambulance.
Enter the healthcare system.
Actually, let’s skip ahead to the final diagnosis. Bob has type 2 diabetes. Newly diagnosed. Easy. Boring. Right? Except Bob clearly had diabetes for some time, unbeknownst to him. When he arrived in the Emergency Department he was in septic shock. He was riddled with large abscesses in his internal organs and soft tissues. Both his lower limbs were necrotic. He had osteomyelitis in multiple locations. What’s really amazing though is that he lived. He had both his legs amputated below the knees and was hospitalized for weeks. All told he had 8 or 9 surgeries. He required weeks of additional IV antibiotics. But he ultimately got better. And his diabetes is well controlled now on pretty minimal medication.
During his hospital stay he was enrolled in Medicaid which, fortunately, will pay for all this medical expense. So let’s look at this from an economic perspective for a quick minute. This is a man who very quickly racked up hundreds of thousands of dollars of medical bills for which the government will pay. He is wheelchair bound now and on disability, again on the government’s tab. He will certainly have additional complications during his lifetime including pressure ulcers, infections, chronic kidney disease, etc. All told this one individual is costing/will cost the government millions of taxpayer dollars.
For want of a couple hundred bucks of prevention.
A routine visit to any PCP would have certainly identified his diabetes earlier and, as it turns out, he only needs like $30/month of medication to control it.
This is the tragedy of healthcare in America. That few hundred bucks of prevention is the ‘entitlement’ you and your fellow Republicans want to remove. This is of course saying nothing of the great personal cost to Bob in terms of his quality of life, physical, and psychological well being. Your bill that was withdrawn on Friday was nothing short of an abomination. Now, you might say I have chosen an extreme example to make a political point. Only I haven’t. I have multiple Bob like patients. Ask any PCP, especially in rural and urban underserved America. I promise you they will all know Bob. They will all have multiple Bobs on their panel.
Obamacare is not perfect, but it is progress. You must understand that prevention is cheap and to continue to make progress Obamacare must be augmented and refined, not ‘repealed and replaced’. Anything else is a complete affront to the American people. So please, cut your political BS and draft some useful legislation with input from actual physicians and other folks who understand that yes, healthcare is complicated. Perhaps you could ask Mr. Obama for some tips.