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Give the ACA a chance

November 2013

Published in the November 2013 issue of Today’s Hospitalist

NEILL BLOMKAMP’S RECENT MOVIEElysium” envisions the world of the future as one with the same problems as now, only worse “particularly when it comes to the different medical care given to the rich and the poor. The rich live on a luxurious space station where everything from childhood leukemia to horrific injuries can be cured at the touch of a button, provided you have the ID chip to prove you’re a rightful citizen of Elysium. Down below, a doctor in an overcrowded public hospital tells the mother of a dying child, “We can’t cure her. After all, we’re not on Elysium.”

I thought about that movie one day as I rounded on my uninsured hospital patients. The young diabetic who needs weeks of wound care and intravenous antibiotics, the stroke patient who couldn’t afford a trip to the clinic to get blood pressure pills, the guy whose colon cancer could (and should) have been removed before it spread “all those were a routine part of the day. But then an injured patient came in who needed specialized surgery.

The surgical specialist didn’t even apologize. He just looked at the face sheet and never even saw the patient. “I’m not coming to the hospital for an uninsured patient. Send this one to the county system.”

Calling in favors
Well, the county system hasn’t taken a transfer from our community hospital in months; they’re too crowded with the sick and injured people who show up in their ED. So we started looking for a hospital “and a surgeon “who would accept the patient. When I went home at 7 that evening, my colleague at the hospital was still making phone calls. So was the CEO, a nurse who cares more about patients than about balance sheets.

I’m thankful that, unlike Matt Damon in the movie, I don’t have to find an illegal space shuttle to transport my patients to quality care. But even with ED nurses and doctors like my partner calling in favors all over town, this patient’s operation was delayed for hours longer than it should have been. And that delay may make a big difference in recovery time.

So when I hear that members of the House of Representatives, all of whom are comfortably protected by the government’s generous health care benefits, have voted to defund the Affordable Care Act, I get a little cranky. I have yet to hear one such Congressperson advocating for more money for preventive care to lower the number of intensive-care admissions I see in uninsured patients. And I hear less still from my own state’s anti-abortion legislature (I’m in Texas) about improving funding for prenatal care “or for that matter, for the health care of children once they’re born.

Health care for all
This country has hospitals closing every year. The ones that remain to serve us have to struggle to keep their doors open as they care for uninsured patients, particularly in states that refuse to participate in the Medicaid expansion that would increase federal support for health care. And the trauma centers that can save the lives of accident and crime victims? They can’t stay financially afloat without either government support or a large number of patients who have the kind of insurance benefits that our government officials enjoy.

Both federal law and simple humanity forbid hospitals from turning away patients. Unlike a private doctor’s office, emergency facilities have to examine all the patients who come through their door and admit them if they have the ability to handle their problems. The Affordable Care Act, if it increases the availability of medical insurance, should allow health care facilities to keep their doors open to all of us … provided we give it a chance.

I’m trying to be professional and leave out the name of the surgeon who refused to help my patient. Maybe he had practical objections or maybe the case sounded a little too difficult. But that is probably not the case because the operation was finally done by a general surgeon who drove in from home at 10 p.m. because, according to him, “that’s what doctors do.”

But I can’t help wondering where that first surgeon might stand on implementing the Affordable Care Act.

Stella Fitzgibbons, MD, has been a hospitalist since 2002. She currently divides her practice between a surgical hospital and a general facility on the north side of Houston.