~Lifelong Health: Lack Of Preventive Care Exacts A Toll, Eventually ~

by Margrett Dawson Wallace
(Pelham, Georgia USA)

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Lifelong Health: Lack Of Preventive Care Exacts A Toll, Eventually...
Dr. David Lipschitz

A wonderful friend of mine who has an incredible green thumb just had a massive stroke. Working from dawn until dusk, he struggled to make ends meet, barely keeping his head above water. He knew he had high blood pressure, but he rarely saw a doctor and felt he could not afford his medications. Since his stroke, he is permanently bedridden and, after a month in intensive care and three months in a rehabilitation hospital, he will likely spend the rest of his life in a nursing home, which will be a great cost to taxpayers.

Sadly, with adequate preventive care and medications that cost as little as $10 for a three-month supply, his stroke could have been prevented. He represents a typical story of the uninsured working poor, earning too much to receive Medicaid and too little to afford insurance.

His unwillingness to take medications is not surprising. More than 80 percent of Americans without insurance and drug coverage are letting prescriptions go unfilled, missing doctors' appointments and refusing to have medical tests. This information comes from a Consumer Reports survey showing that the number of adults polled who did not fill prescriptions increased from 27 percent in 2011 to 50 percent this year. Many others are cutting back on groceries or putting off paying bills in order to pay for prescriptions.

Lack of access to health care, poverty and little education are the major predictors of ill health and a significantly shorter life expectancy. The Centers for Disease Control (CDC) recently released statistics on the life expectancy of Americans. Hawaii was ranked No. 1 because Hawaiians live the longest (on average, 80 years), followed closely by residents of Minnesota, North Dakota and Connecticut. By contrast, life expectancy in Mississippi (No. 50) is 73.9 years, and Louisiana and Alabama are only slightly better. (Arkansas ranked 45th.) Women live about three years longer than men, whose life expectancy is reduced to less than 70 years if they are poor and black.

In the coming years, if the Affordable Care Act remains the law of the land, millions of uninsured Americans will have better access to care through Medicaid. But does Medicaid coverage make a difference? In a paper published in the New England Journal of Medicine, the effects on health of substantially expanding Medicaid rolls to adults in New York, Arizona and Maine was reported. The impact was compared to surrounding states where the rolls were not expanded. Over five years, the study showed that Medicaid coverage significantly decreased mortality. And the benefit was most obvious among nonwhites and residents of the poorest counties.

Physician visits increased, medication compliance improved and admission to hospitals (with insurance) was associated with a greater intensity of care, longer stays in the hospital and better outcomes. Delayed care of medical problems due to costs was reduced and those covered reported an improvement in their perceived health status to either excellent or very good.

The evidence is compelling. If you are poor, uneducated and uninsured, your risk of illness is greater, life expectancy is reduced, productivity is impaired and the cost of care in the long run is increased. Furthermore, providing insurance to this population provides significant health benefits.

Few physicians disagree with the need for insurance. But many question the mechanism by which it will be achieved. Continuously reducing payments to doctors and hospitals is backbreaking, leading to disillusionment within the health care community. Failure to address tort reform, high administrative overhead, and the enormous amount of unnecessary care will continue to make costs totally unacceptable.

In a recent piece on her blog Heartfelt, Dr. Melissa Walton-Shirley, a Kentucky cardiologist, raised concerns about the ability of Medicaid to meet the need. Reimbursement is low, physicians may not be paid for months and Medicaid is so overextended that it will have to change from the ground up if the program is to be successful.

My summation of this article is...I ask that we all, as Americans, for our "Human Rights" think about the devastating negative effects of lack of access to health care. It is a sad reality that health-care providers working in the trenches are not developing a road map for change. After all, they - rather than politicians, lobbyists and policy makers - truly understand the need and suffer the burden of a dysfunctional system almost as much as those who receive the care. Unless they lead the reform effort, change will be a long time coming.

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