The wrong card

September 17, 2011

September 17, 2011


Walter maneuvered the empty school bus down the narrow car-lined street on the hard-knock West-side of Chicago when he saw the man pummeling a woman with his fists.  Walter slammed the brakes, shoved the gear into park and bolted out the door.  It was just the way he was. Walter was a railroad man; a fifty year-old tough guy.  He moonlit as bus driver for extra dough.  The railroad had good benefits especially the gold-plated health insurance policy he never used.  But his life was about to change and he would soon confront the cruel realities of health care in America.  Where the health care a man received depended on the health insurance card in his wallet.


Walter bounded towards the fracas and placed himself between the brute and his bloodied victim.  Walter never saw the gun.  The bullet ripped through his upper chest, shattered his clavicle, collapsed his lung and lodged into the nerve that controlled his right arm.


I met Walter three weeks later in my primary care office after he was discharged from the rehab center at my inner-city hospital.  The lung damage from the bullet had worsened his emphysema. He needed oxygen at night. His right arm throbbed in pain and was weakened from the nerve damage.  He would never work again despite his many attempts. He would never live without pain.  He soon lost his railroad job and the insurance card that came with it.  He went from Good Samaritan to No Insurance. He stopped coming to see me because he could not pay.


Months later, I met Walter by the front desk of my office. He needed a refill of his pain medications.  He had lost his home and camped on the couches of family members and friends.   A deep depression overcame him.  He began to drink and contemplated suicide.  I convinced Walter to see me and promised to treat him for free.  It took six years many letters and phone calls to convince the state to provide Wallace with a Medicaid card.


One would think that once he had a Medicaid card that life would get better.  And it did to a degree because he could still see me without shame and get medications.  But I was an exception.   Walter like many Americans on Medicaid had trouble obtaining specialty care because many specialists refused to take Medicaid.   Medicaid was not as desirable as his railroad insurance.  And most doctors just refuse to accept it.


The Accountable Care Act will create the opportunity for many other patients like Walter to get on Medicaid.  We know that when poor people are given Medicaid they go to the doctor more and they feel better and are less depressed.   More women get mammograms when insured and more patients take prescription medications.  Walter is living proof of the obvious concept that providing health care to the poor and uninsured is a good idea.   But as Walter discovered the Medicaid card did not equate with access.   A recent study in the New England Journal of Medicine (June 16, 2011)  on access to specialty care in Chicago showed that two thirds of children with Medicaid were turned down by specialists compared to 10% of children with insurance.   Walter is a case study of the inequalities of our health system and of the problems to come when more patients swell the Medicaid ranks in the US in 2014.  More patients will have cards but what good will these cards be if doctors and hospitals will not accept them. 


A better solution- Medicare for All- one payment system for all providers and patients so there can be no cherry picking or denial of patients because of the type of card.  It is fair, it preserves choice and it will end some of the more egregious inequalities in health care that plague the most expensive health care system. So the next patient like Walter can get the health care he deserves.



Comments (1)

  1. Phyllis Ansell:
    Sep, 19, 2011

    What a sad situation for so many people. Retirees who worked hard all their lives and have some insurance cannot afford their medication and have to choose between groceeries or pills

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