Trump’s ‘dy­ing in the streets’ line vs health care re­al­ity

Pre­ven­tive care and rou­tine screen­ing can make a big dif­fer­ence

Kuwait Times - - HEALTH & SCIENCE -

WASH­ING­TON: US Pres­i­dent Don­ald Trump has of­ten said he doesn’t want peo­ple “dy­ing in the streets” for lack of health care. But in the United States, where chronic con­di­tions are the ma­jor dis­eases, peo­ple de­cline slowly. Pre­ven­tive care and rou­tine screen­ing can make a big dif­fer­ence for those at risk for things such as heart prob­lems and can­cer, es­pe­cially over time. That edge is what doc­tors and pa­tients fear will be com­pro­mised if Repub­li­can ef­forts to re­peal the Obama-era health law lead to more unin­sured peo­ple. The unin­sured tend to post­pone care un­til prob­lems break through.

It’s a mes­sage that law­mak­ers are hear­ing from doc­tors’ groups and con­stituents, in let­ters and emails, and at town hall meet­ings. About 10 years ago, Cathy Cooper of Ocala, Florida, was bat­tling a blood can­cer. Against doc­tor’s ad­vice, she con­tin­ued to work full time as a para­le­gal, through chemo­ther­apy and ra­di­a­tion, just to pre­serve her health in­sur­ance. Cooper said she would sched­ule chemo on Fri­days, spend the week­end sick from side ef­fects and re­port back to work Mon­day.

Now in her early 30s, Cooper is healthy. She has her own busi­ness as a pho­tog­ra­pher spe­cial­iz­ing in ma­ter­nity, new­borns, fam­i­lies and se­niors, and a fam­ily of her own. Her health in­sur­ance is through Health­ With her can­cer his­tory, Cooper is wor­ried about changes un­der de­bate that may re­duce op­tions for peo­ple with med­i­cal con­di­tions. She said she voted for Hil­lary Clin­ton in the pres­i­den­tial elec­tion.

Med­i­caid cov­er­age

“The ‘dy­ing in the streets’ thing - it’s an over­time process,” said Cooper. “If I didn’t have in­sur­ance, it (can­cer) could just keep form­ing in­side me and I wouldn’t know. Then I’d go into the hos­pi­tal, and there’s noth­ing they could do. And then, yeah, I could die in the street. But that’s be­cause I wouldn’t have had in­sur­ance to get things checked out prior to that point.”

In Char­lotte, North Carolina, Dr Oc­tavia Can­non said that’s ba­si­cally what hap­pened to one of her pa­tients sev­eral years ago. The pa­tient, a work­ing mother with three young chil­dren and more than one job, was unin­sured af­ter los­ing pre­vi­ous Med­i­caid cov­er­age. She went to Can­non, an os­teo­pathic obgyn, be­cause of ab­nor­mal bleed­ing. Can­non said she knew some­thing was hor­ri­bly wrong on the ba­sis of her ini­tial phys­i­cal ex­am­i­na­tion. The pathol­ogy lab con­firmed ad­vanced cer­vi­cal can­cer.

“In six months, she was dead,” Can­non re­called. “All I could think was ‘Who is go­ing to take care of th­ese ba­bies?’ If she had only come in for a Pap smear.” Such sto­ries are swirling around the Se­nate de­bate as Ma­jor­ity Leader Mitch McCon­nell, R-Ky, pushes to­ward a vote on leg­is­la­tion rolling back much of for­mer Pres­i­dent Barack Obama’s Af­ford­able Care Act. The GOP bill has been fac­ing head­winds since the Con­gres­sional Bud­get Of­fice es­ti­mated it would lead to 22 mil­lion more unin­sured peo­ple by 2026.

Ad­min­is­tra­tion of­fi­cials say the non­par­ti­san bud­get of­fice has been wrong be­fore about health cov­er­age, and its an­a­lyt­i­cal meth­ods may give too much weight to the cur­rent re­quire­ment that most peo­ple carry health in­sur­ance or risk fines. (Repub­li­cans would re­peal that im­me­di­ately.) Health and Hu­man Ser­vices Sec­re­tary Tom Price said Trump’s goal is more peo­ple with health in­sur­ance, not fewer. “No­body is look­ing at it in its to­tal­ity,” Price said re­cently on NBC. “We will bring down pre­mi­ums, we will in­crease cov­er­age, we’ll in­crease choices. And I be­lieve we’ll in­crease the qual­ity of care pro­vided in this na­tion.”

There’s not much de­bate about the neg­a­tive con­se­quences of be­ing unin­sured. Stud­ies by the Na­tional Academies have found that the unin­sured are more likely to re­ceive too lit­tle care, and too late; be sicker and die sooner; and re­ceive poorer care in the hos­pi­tal. But sur­pris­ingly, there are ques­tions about whether gain­ing cov­er­age pro­duces tan­gi­ble health ben­e­fits. Ma­jor gov­ern­ment sur­veys have doc­u­mented clear im­prove­ments to fam­ily fi­nances as­so­ci­ated with Obama’s cov­er­age ex­pan­sion. On health it­self, the ev­i­dence is mixed.

Hav­ing in­sur­ance is a start

Med­i­caid ex­pan­sions in New York, Maine and Ari­zona in the early 2000s were as­so­ci­ated with a 6 per­cent de­cline in death rates in those states, com­pared with neigh­bor­ing states that did not ex­pand cov­er­age for low-in­come peo­ple. A study of Mas­sachusetts found a sim­i­lar trend. But in Ore­gon a Med­i­caid ex­pan­sion study that found a marked re­duc­tion in de­pres­sion failed to de­tect sig­nif­i­cant im­prove­ment in blood sug­ars, blood pres­sure and choles­terol lev­els - risk fac­tors for heart dis­ease and di­a­betes.

Dr Cyrus Hamidi, a solo fam­ily medicine prac­ti­tioner in Sparks, Mary­land, said hav­ing in­sur­ance is a start, re­duc­ing bar­ri­ers to ac­cess for pa­tients. “If you have to pay to go to the doc­tor, then you worry about pay­ment in­stead of what you need to do to re­duce the risk of drop­ping dead,” he said. Gay­win Day, a union elec­tri­cian from Austin, Texas, said be­ing able to get cov­er­age un­der Obama’s law in the af­ter­math of a med­i­cal cri­sis has been “a life­saver.” Day, in his early 60s, was be­tween jobs and unin­sured when he had a stroke in March. A cou­ple of months later, a “spe­cial en­roll­ment pe­riod” en­abled him to get sub­si­dized cov­er­age through Health­, open­ing doors to phys­i­cal ther­apy and fol­low-up med­i­cal care. Now, Day no longer uses a walker or cane. He’s think­ing about re­turn­ing to work. “No­body wants any­body dy­ing in the streets, but if I hadn’t got this . ... I could just be shriv­el­ing up in my bed,” he said. He didn’t cast a bal­lot last year. “I don’t vote,” said Day. “I do a lot of pray­ing.”—AP

OCALA, Florida: In this photo Cathy Cooper leaves her photo stu­dio in Ocala, Fla.—AP

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