Why Is This ‘Okay’?

I write the following with great frustration. If we do not accept some level of personal responsibility for our own health, our health care system can never be fixed.

Today’s diatribe was stimulated by an event that happens every day to every U.S. doctor.

Case
One month ago, a seven year-old child was seen for a possible rhtyhm problem of the heart. The child was eligible for Medicaid but the mother had not applied. Considered urgent, I saw the child and did preliminary tests but could not bill anyone because there was no funding source. An exercise stress test was scheduled for the following month. Mother promised to apply for Medicaid in advance.

Yesterday was the day for the stress test. The family failed to keep their appointment. When our office contacted the home, mother responded that the child was sick with strep. She wanted to reschedule the stress test for when the child was well. Mother still had not applied for Medicaid.

Last week mother took the child to the pediatrician. Because the child was sick the pediatrician evaluated the child while knowing this would be ‘free’ care because mother refused to fill out the Medicaid application forms.

WHY IS THIS OKAY?
A-B-C-D below happens every day in thousands of variations across our country. Neither doctor nor hospital can “Just Say No,” both for moral as well as legal reasons.
A) The patient gets care.
B) The family pays nothing.
C) Without a funding source, the doctor and hospital are not paid.
D) Doctor and hospital must still pay their fixed costs.

Personally, I believe such rejection of personal responsibility is corollary of the belief that health care is a right. Whatever the reason, I ask again, why is this okay? What if everyone behaved like my patient’s mother?

Imagine a scenario where affordable health insurance is universally available such as promised by H.R. 3590 (PPAHCA). Suppose that someone chooses not to enroll. That person goes to a doctor because of a heart murmur. Should the doctor see the patient?

If you believe that the doctor should care for the above patient regardless, then there is no such thing as personal responsibility in healthcare.

What about other countries?
In universal health care countries, you must be “on the list” to get care. This means if you are a citizen, you will be enrolled in the government system: you cannot decline. In countries without universal health care, you must have private insurance or pay up front to get medical care. Without one of those two, you do not get care.

System MD

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