Archive: Daily Archives: August 30, 2009


The Uninsured

I have treated and continue to treat many uninsured patients in my practice. And invariably, when thinking about diagnostic and treatment options for their condition, I come to think how on God’s earth am I able to provide the medical care they need without totally running up a huge bill and huge debt for them!!! Many times I feel totally handicapped, especially when faced with a child who would really benefit from an operation, such as a T&A for a kid with severe obstructive sleep apnea, when there are really no good alternatives, and the family just does not have the $$$$. Does a family then need to go into severe debt or risk bankruptcy to get their child the care they need? Are surgeons and hospitals forced to give charity care? Who decides????

For the record, my practice charges medicare rates for self pay patients and will work with anyone, including payment plans, to help them pay their bill. I have also written off many balances for students, military members, teachers, preachers, etc.

In Wake county, under the program Project Access administered through the Wake County Medical Society (of which SITT was president many moons ago), surgeons like me and area hospitals provide ‘official’ charity care. But there are only so many of these programs in the USA and only so many dollars that businesses like hospitals and surgical practices can donate.

This weekend, an uninsured 40 yr man hit Rex ER with a peritonsillar abscess. I was on call for ENT for the hospital. An operation (acute tonsillectomy) later he was cured of his life threatening problem and the next day sent home to recover. I really have very little expectation to be paid for my service in full and within a reasonable amount of time. And this man is working, in a bar, that just doesn’t provide insurance for its employees. And most likely the cost of an individual policy is beyond his reach. This scenario is played out countless times across America.

In these times when Congress and America is struggling to get a handle on the health care beast (and may I mention what a professional and personal loss I feel with the passing of Senator Kennedy), we should be able to agree on a few basic ideas:

1) Let’s at least in some way, shape, or form cover all the children in our borders for their basic health care needs.
2) Cover our seniors along with their medications. No senior citizen should need to decide between food and their medicines.
3) Then start the hard work to figure out what to do with everyone in between.

Last year I put some of these thoughts to verse:

No insurance!
Self pay!
Oh my God
What a pity!
Unmet needs
Meds & procedures forgone
Helpless kids, victims
Also the docs – do we get paid?
What are your expectations?
That we’ll provide for free?
Time after time?
Isn’t there a better way?
Unmet needs,
too much suffering,
What a pity!

Posted by Douglas K. Holmes, MD