This Christmas, in a similar tradition to years past, the church my family attends had a huge tree. It was beautifully decorated and towered over the church pews. From top to bottom it was covered with “paper angels”—slips of paper requesting something for a child. One tag was for an 18-month-old who simply wanted warm pajamas. Another was for a 12-year-old girl who wanted hair accessories. A surprising number were for children whose parents asked only for school supplies. Not surprisingly, since I live in Massachusetts where the winters can be harsh, there were many requests for warm winter jackets.
This year was different from other years, though. The woman who spoke to the congregation about the tags told us, “Please only buy what is on the tag. Don’t buy an extra toy or anything else for the child.”
I wondered, was she being unkind? Here’s what she said next, “In these hard economic times, we’re worried that we’ll still have tags on the tree that no one takes. This means that some children will not get anything. If you have the means to buy an extra gift, please take more than one tag.”
In the office where I see patients, I hear a similar message—one that I’ve not heard nearly as much in past years. My patients tell me over and over, “Doctor, I can’t afford the co-pays to buy the medicines you prescribe. I can’t afford the co-pays for physical therapy or to see my social worker or psychologist.” Then, inevitably they ask me, “Can’t you just get me better without ordering anything with co-pays?”
I’ve been a medical doctor for more than a dozen years, and there have been many times I’ve wished for a magic wand. Never more than in the past six months. I would wave my wand and heal people—for free. Give them back their health—their lives. But, I don’t have one. And no, I can’t heal people when they don’t have access to prescription medications, diagnostic tests, and other health specialists. (Though there are certainly health issues that will likely heal over time without a lot of intervention, such as a back sprain/strain or the common cold).
After New Year’s a patient of mine, who I’ll call John, came in to see me. John is always an hour early and sits in the waiting room chatting with anyone who is available. He looks younger than his 48 years. The slogan on the sweatshirt he sometimes wears—“Best Grandpa”—seems at odds with how he appears.
John greets me every visit with an infectious grin, and of course I can’t help but return it. This visit he told me that his power was out for five days the week of Christmas. “My wife and I were freezing,” he said. I asked him why he didn’t go to stay with family members or friends or even at a shelter. “Dr. Silver, people might have broken into our home,” he said. “We don’t have very much as it is, we have to protect what we have.”
The $170 John lost in spoiled food that was in his refrigerator is only part of the reason that he can’t afford the co-pays for his medications. John, like so many of my patients who come from nice suburban neighborhoods in Massachusetts, was living on the fringe before the hard times hit. Now, he is living in poverty. Still, many don’t qualify for state or federal aid. They have jobs and are working to pay their bills as they pile up.
I can’t add to that pile. But, I also can’t heal them without the help of medications and other doctors. If only I had a magic wand…
Have your co-pays increased recently?
Do you avoid taking medications your doctor prescribes because you can’t afford them?
Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.
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Comments: 4
Doctor,
Unfortunately, I've not only been there, I've done that and also been exposed to that.
In apologise to you if I normally sound very cynical about your profession, because the majority of physicians (and physician assitants) that I know entered the profession for the same reasons that Hippocrates envisioned.
My major rant is against the so-called "Insurance" companies that take money and refuse to cover what they say they will without having to go to court (and losing what they would have spent anyway).
The latest insurance ply of "pre-existing" condition is total bull and we all know it. I've been bitten for over 100K$ myself, and I know that many of your patients either have been, or will be bitten. If a person changes insurance companies, they refuse (regardless of new laws) to cover any chronic condition. I currently have glaucoma...that's existed for over 5 years. My daughter had extreme scoliosis (written up in JAMA). I also had what was originally diagnosed as cervical myelopathy, etiology unknown.
My daughter was pre-approved by my current at the time, insurance to have corrective surgery. After surgery, they refused to pay.
I have been turned away from many practices for many nurological symptoms (it turned out, I had broken my neck in Vietnam and there was a bone spur in my spine)...
In recently moved nto Canada. I am not covered under Canadian Health Insurance...HOWEVER, I have had two doctors willing to examine me pro bono. I have also received over $800USD in "samples" to stabilize my condition. I currently have standing appointments for the next several months because nthe doctors are concerned. Nine months from now, when I am eligible for Canadian insurance, they will consider charging...what???
These folks need to survive the same as American M.D.s, but are more than willing to work for the same reasons that Hippocrates set up the medical profession.