Fertile ground for Medicaid pitch- The Washington Post

Remote Area Medical back in western Virginia, as the battle to expand Medicaid rolls on…

The three-day clinic, which relies on more than 1,000 volunteers, will serve as many as 3,000 people before it ends Sunday. The vast majority of patients — more than 70 percent — come for dental care, Brock said.

Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.

“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.

Medicaid expansion would not fully alleviate the dental situation. Medicaid does not cover routine dental care for adults or dentures. But Medicaid does pay for emergency tooth extractions, so patients would not have to wait a year to have a bad one pulled.

“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”

She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.

- The Washington Post

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I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

 

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.

I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”

“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”

I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?

UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.

I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

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Opinion: Cancer survivor: Obamacare got me covered - CNN.com

 In January, for the first time since my diagnosis 36 years ago, I will have an individual health plan that offers quality coverage for me and my family. I will save $628 every month on premiums. Best of all -- I wasn't even asked if I've ever had cancer.

Opinion: Cancer survivor: Obamacare got me covered - CNN.com

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A Possibly Fatal Mistake - NYTimes.com

A Possibly Fatal Mistake - NYTimes.com

But the cancer has kept growing, and I went to the E.R. again on Sept. 17 when I found that I was losing all strength in my legs. They did an M.R.I. and saw that there were tumors pressing on my spinal cord. They have been treating me with radiation for three weeks now to shrink those tumors and will continue to do so for another week.

I submitted an application to the hospital for charity care and was approved. The bill is already north of $550,000. Based on the low income on my tax return they knocked it down to $1,339. Swedish Medical Center has treated me better than I ever deserved.

Some doctor bills are not covered by the charity application, and I expect to spend all of my I.R.A. assets before I’m done. Some doctors have been generously treating me without sending bills, and I am humbled by their ethic of service to the patient.

Some things I have to pay for, like $1,700 for the Lupron hormone therapy and $1,400 for an ambulance trip. It’s an arbitrary and haphazard system, and I’m just lucky to live in a city with a highly competent and generous hospital like Swedish.

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