Patients Without Borders

Note from Greetings: It's a sad statement when our country is in need of 3rd world services due to the inactions of this country

November 18, 2007

By SARA CORBETT, NY Times

Long before the dentists and the doctors got there, before the nurses, the hygienists and X-ray techs came, before anyone had flicked on the portable mammography unit or sterilized the day’s first set of surgical instruments, the people who needed them showed up to wait. It was 3 a.m. at the Wise County Fairgrounds in Virginia — Friday, July 20, 2007 — the start of a rainy Appalachian morning. Outside the gates, people lay in their trucks or in tents pitched along the grassy parking lot, waiting for their chance to have their medical needs treated at no charge — part of an annual three-day “expedition” led by a volunteer medical relief corps called Remote Area Medical.

The group, most often referred to as RAM, has sent health expeditions to countries like Guyana, India, Tanzania and Haiti, but increasingly its work is in the United States, where 47 million people — more than 15 percent of the population — live without health insurance. Residents of remote rural areas are less likely than their urban and suburban counterparts to have health insurance and more likely to be in fair or poor health.

According to the Department of Health and Human Services, nearly half of all adults in rural America are living with at least one chronic condition. Other research has found that in these areas, where hospitals and primary-care providers are in short supply, rates of arthritis, hypertension, heart ailments, diabetes and major depression are higher than in urban areas.

And so each summer, shortly after the Virginia-Kentucky District Fair and Horse Show wraps up at the fairgrounds, members of Virginia Lions Clubs start bleaching the premises, readying them for RAM’s volunteers, who, working in animal stalls and beneath makeshift tents, provide everything from teeth cleaning and free eyeglasses to radiology and minor surgery. The problem, says RAM’s founder, Stan Brock, is always in the numbers, with the patients’ needs far outstripping what his team can supply. In Wise County, when the sun rose and the fairground gates opened at 5:30 on Friday morning, more than 800 people already were waiting in line. Over the next three days, some 2,500 patients would receive care, but at least several hundred, Brock estimates, would be turned away. He adds: “There comes a point where the doctors say: ‘Hey, I gotta go. It’s Sunday evening, and I have to go to work tomorrow.’ ”

It’s Not Just the Uninsured

I see this all too often, firsthand. (Note from Greetings)

By BOB HERBERT, NY Times OpEd, November 17, 2007

Sandra Hightower never thought of herself as particularly political. She worked, and much of her free time revolved around her daughter, Brittney, a fiercely outgoing teenager with a passion for cheerleading at her high school in Nacogdoches, Tex.

But “after getting slapped in the face with reality,” Ms. Hightower said she’s ready to go to Washington herself if that would help get Congress to do something about the health insurance crisis that is responsible for so much unnecessary suffering and death in the U.S.

The tedious, hair-splitting debates over health care that we’re getting from the presidential candidates — those who talk about health care at all — seem out of sync with the enormity of the problem. For families without the protection of health insurance, the devastating combination of serious illness and imminent financial ruin can be absolutely mind-numbing, stunning in its tragic intensity.

For Sandra Hightower, the nightmare began in the summer of 2005 when Brittney had to have a cyst on an ovary removed. More cysts developed and in early 2006 doctors found that Brittney had cancer. She underwent surgery in Houston and the prognosis, according to Ms. Hightower, was good. “Everything was fine,” she said. “All results came back clear.”

Ms. Hightower did not think at the time that she would take too much of a financial hit because she had health insurance at her job, and the policy covered Brittney.

“All I had on my mind was Brittney,” she said.

The cancer recurred three or four months later and more surgery was required, followed by chemotherapy. The 15-year-old who loved to dance, and who wasn’t sure whether she wanted to be a model or a pediatric nurse, was now having to battle for her life like a warrior in combat.

The next round of bad news came in a double dose. One night, after coming home from school, Brittney suddenly found that she couldn’t walk. The cancer had attacked her spinal cord. As the doctors geared up to treat this new disaster, Ms. Hightower received word that her insurance policy had maxed out. The company would not pay for any further treatment.

Ms. Hightower was aghast: “I said, ‘What do you mean? It was supposed to be a $3 million policy.’ ”

She hadn’t understood that there was an annual limit of $75,000 on benefits. “It was just devastating when they told me that,” she said.

Most of the debate about access to health care has centered on people without insurance. But there are cases like this one all over the country in which individuals are working and paying for coverage that, perversely, kicks out when a devastating illness kicks in.

Americans with inadequate health coverage — the underinsured — are a major component of the national health care crisis. Like the uninsured, they can be denied desperately needed treatment for financial reasons; they often suffer financial ruin; and in many cases they die unnecessarily.

“This is a very significant problem,” said Daniel Smith, president of the American Cancer Society’s Cancer Action Network. “We want to help educate Americans more broadly about the idea that while they think they might be insured, when they’re diagnosed with something as devastating as cancer their policies may not give them the coverage they need.”

Sandra Hightower became almost frantic with the combined tasks of caring for her daughter and trying to figure out how to pay for the increasingly expensive treatments.

“Her back surgery, with the reconstruction and all that, was over three hundred and some thousand dollars,” she said. “I had to start doing fund-raisers, bake sales. And the community kicked in, my community here in Nacogdoches. Definitely the high school. And people donated to a benefit fund at the bank.”

After several months, Brittney was declared eligible for federal disability benefits, which enabled her to qualify for Medicaid. “But we still owed for everything before that,” said Ms. Hightower.

Brittney fought like crazy to survive, her mother said. But in the end, she didn’t make it. She died, at age 16, on June 5.

“I see her everywhere,” said Ms. Hightower, who still owes thousands of dollars in medical bills. “When I go to the grocery store, I see her favorite food. I go shopping, and I see the perfect little outfit that she would love.

“I’m so lost right now. And I feel like I failed my baby because I couldn’t bring in all the help she needed.”