Coverage: How Employer Provided Insurance Creates Unavoidable Gaps in Care.

Carla usually arrives in my office wearing a big smile, even if I don’t have good news about her diabetes or blood pressure. But at our last visit, she was wringing her hands and tapping her feet nervously.

“What’s going on, Carla?” I asked with concern.

Carla looked down at her feet, hiding her tears. “I don’t know what’s going to happen, with me or my husband.”

She was losing her health insurance, and this would be her last visit before coverage ran out. It wasn’t just herself she was worried about;  Carla’s husband has liver cancer, and they need her insurance to cover his treatments.

Carla is 58 years old and for the last 15 years she has worked two jobs: one at a local hardware store, and the other doing housekeeping in an office building. I’ve heard her say on different occasions how she wanted to quit the housekeeping job — it had gotten too hard on her knees — but she stuck with it for the benefits. Then came a wave of layoffs, and Carla lost the housekeeping job and the insurance that came with it.

I wish I could say that Carla’s story is unique, but it’s only unique in that it made my heart ache.

In our fractured health system, access to care is usually tied to employment and millions of Americans like Carla are one layoff away from losing coverage. And for those that do have insurance, the skyrocketing cost of premiums, co-pays and deductibles means that patients often pay thousands of dollars out-of-pocket before coverage even kicks in.

I’m five years into my medical career, and have seen my share of births and deaths. But Carla’s visit made my heart ache to the point of tears because her pain is entirely unnecessary. Carla is doing everything she is supposed to do to support her family.  She is a middle aged woman, literally busting her knees at two jobs, to make ends meet. Like so many Americans, working hard was just not enough. When she lost one of her jobs, Carla lost health coverage for herself and her husband. They are both years away from qualifying for Medicare and will now join the expanding pool of the uninsured.

The US is unique among developed nations. In the wealthiest country on earth, we watch our fellow citizens die early of preventable diseases, and fall into financial ruin simply for getting sick. Every day marks the creation of yet another “Go Fund Me” for an American citizen, facing bankruptcy due to their health bills.

Almost any physician in the U.S. could tell you a story like Carla’s. Doctors are sick of helplessly watching our patients disappear for lack of insurance, sick of fighting with insurance companies who refuse to cover their treatments. Perhaps that’s why a majority now support improved Medicare for all, a system where care is publicly financed but privately delivered, and everyone is covered for all medically necessary care.

Can we afford to switch to a single-payer system? We can’t afford not to. The U.S. already spends more than any other nation on health care, and nearly one-third of the more than $3 trillion that we spend on health care each year is wasted on administration, insurance bureaucracy, and corporate profits — not patient care. Single payer would save hundreds of billions in health spending, even while expanding coverage to everyone.

I don’t know when I’ll see Carla again. For her sake, and for the millions of Americans in her shoes, I’ll keep on fighting for a system that values patient health over profits.


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