SALT LAKE CITY — No matter how Dr. Kyle Jones put it to his 50-year-old patient, the results of the physical were not adding up to a clean bill of health.
They were shaping into a profile of a man heading toward a sudden serious heart attack or disabling stroke sometime in the next 10 years.
Put him and three other men the same age with the same health history and habits in same room, and he's the one most likely to be taken out by one or the other catastrophic event. The standard prescribed lifestyle changes — more exercise, less fat — will help but won't counter what's really wrong with him: no insurance.
When you're one of the 360,000 working Utahns whose only health plan is to ignore a problem until you can't, risk factors are compounded and illnesses turn serious and more expensive to treat, Jones said Wednesday in explaining why he has joined the White Coats.
The new front-line coalition of more than 900 Utah physicians, nurses, clinicians and academics — including Nobel Prize winner Dr. Mario Capecchi — have signed a letter urging members of Congress to give final approval to federal health care reform legislation.
"He only came in to see me because his employer required a physical to keep his job," Jones said, noting that the employer who mandated the check-up didn't offer health insurance to help play for it. If his employer had offered health insurance, "his risk factor goes to 4 percent. His life is now in jeopardy because he doesn't have insurance and he has pre-existing conditions that make him uninsurable. He is stuck in a rut, unable to get out."
Different versions of the same story — patients treated for conditions that would have been caught much earlier if they had been insured — happen every day around the state and across the country. It's not because medical treatment is poor, but because the system of health care is broken, said White Coats member Dr. Kim Bateman, a physician in Ephraim. He said lack of insurance doesn't prevent someone from being sick, but lack of it is certainly making people sicker, sometimes fatally. Bateman added that a noticeable and increasing number of patients are coming in with untreated infections, complications from diabetes and asthma that are the direct result of not getting basic medical care because they don't have insurance.
Health care in the U.S. doesn't fail in a clinical way, Bateman said, but it fails by making care less and less affordable or completely inaccessible through insurance loopholes like pre-existing conditions, ever-higher deductibles, and co-pays and ever shorter lists of benefits.
Lack of insurance doesn't prevent someone from being sick, but lack of it is certainly making people sicker, sometimes fatally, Bateman said, adding that a noticeable and increasing number of patients are coming in with untreated infections, complications from diabetes and asthmas that are the direct result of people not getting basic medical care because they don't have insurance.
Health care in the U.S. doesn't fail in a clinical way, it fails by making care less and less affordable or completely inaccessible through insurance loopholes like pre-existing conditions, ever-higher deductibles and co-pays and ever shorter lists of benefits.
The system is also rife with waste, Bateman said, citing a son-in-law's recent $9,000 hospital bill for an emergency appendectomy that included two CAT scans ($2,800) to confirm a diagnosis that Bateman had made over the phone.
"Perhaps it was an example of defensive medicine, or maybe it's just needing that 1 percent more assurance that it was the correct diagnosis, Bateman said. Or it's just the nature of a system that rewards procedure and treatment over prevention, he added.
Bateman and other White Coats members attending a Wednesday rally for reform said the legislation, which could be voted on as early as this week in Washington, is not a panacea and is far from perfect.
However, it does a number of things that are being lost in the political infighting, said Dr. Scott Poppen, a Sandy physician and White Coats spokesman. It makes insurance affordable and available, it would improve and accelerate Utah's own reform efforts, it bars excluding people for pre-existing conditions, strengthens Medicare, makes health more transparent, cuts costs and improves quality and "starts us down the long road of controlling costs."
Opponents say reform is an idea the country doesn't want and can't afford.
Dr. Claudia Fruin, a Bountiful pediatrician and Utah chapter president of the American Academy of Pediatrics, said that attitude begs the larger questions:
"Do we want and can we afford the laid-off father of six who can no longer buy his daughter's growth hormone, the 19-year-old who ignored an infection and had to have surgery and weeks of expensive antibiotics, having 110 people lose insurance every day, the continued bankrupting of Americans unlucky enough to get seriously ill and seriously in debt, the $12,681 in annual insurance premiums for working Utah families, the 1,200 people who died because they didn't have insurance and another 1,200 by 2019 if nothing is done?"
The legislation is "a foot in the door," said Poppen, a proponent of both federal and Utah-based reforms. "There's a lot of work left to do, but the strengths of the bill make up for its weaknesses and will accelerate what Utah is trying to do."
Not according to the majority of Utah lawmakers, who along with at least 34 states have passed "Washington, Keep Out" bills and resolutions pronouncing federal health care reform everything from socialized medicine to a government takeover of health care to a clear violation of the state sovereignty under the U.S. Constitution.
Reform has been politicized in Congress as well, with Democrats intending to cover the uninsured now, not in a lifetime or two, and Republicans intending to scrap the whole thing. Both sides agree that pre-existing condition exemptions by insurers must end, but Democrats argue that history shows insurers will have to be forced by government regulation to do it.
Republicans argue that government regulation has never let the health care system operate in a truly free-market environment and that the reason the health care costs are out of control and the system is fraught with waste and even fraud is government getting in the way.
The rally came on the same day that new estimates from the Utah Department of Health indicated that the number of uninsured kids in Utah dropped 28 percent, from 75,900 to 54,700, in part through the expansion of the Children's Health Insurance Program and Medicaid.
The department's numbers also show the number of uninsured adults ages 19 to 64 going the other direction, increasing by 10.4 percent.
The reduction of uninsured children is a good thing because primary medical care for children makes them much healthier adults, Poppen said. "But more children with coverage means that more parents have lost their jobs and with it their insurance, which makes their children qualify for CHIP and Medicaid."
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