Guaranteed Healthcare

I'm a cardiac rehab nurse at a mid-sized community hospital in Northrn California,  Today was just another day at work, but a day that kept bringing me face to face with the reality of how our lack of real healthcare hurts ordinary folks

My job splits in two parts - outpatient, where I run exercise classes for cardiac patients and inpatient, where I do education with cardiac patients during their hospitalization.  On the outpatient side, I rarely confront the pain of un- and under-insurance.  But in the hospital, I'm up against it every damn day.  And today was a little worse than most.

These days, the standard of care in heart disease calls for pretty much everyone to be put on a group of relatively expensive meds.  Most of the patients I see go home with prescriptions for a platelet inhibitor, a beta blocker, a cholesterol lowering med, and an ACE inhibitor.  There is some reason to debate the value of some of this, but they have been broadly accepted as the standard of therapy for people with heart disease.  This means people who have had heart attacks, stents, bypasses, etc. 

There is pretty good evidence that this regimen of meds saves lives.  But they cost a lot of money - several hundred a month.  And today it seemed that I was facing patient after patient who I knew damn well could not afford it.  People with Medicare who had not bought into the absurd part D drug plan.  People with insurance that requires them to pay 50% of their drug costs.  People with no insurance at all.  Restaurant cooks, farm workers, disabled people.

The grinding constant frustration of knowing that the doctor will write the prescription, the patient will nod his head and pretend he'll fill the prescription, and that a certain percentage of them will come back with problems that could have been prevented if they could actually get their meds.  One of the craziest things about all this is that many of these folks have just had very expensive inpatient treament.  The rules of the game in our emergency-driven system are such that if you show up at the door of our hospital having a heart attack, you get treatment - good tratment, usually - whether you can afford to pay or not.  The divide happens when it's time for the followup care and the meds you need to sustain your life afterwards.  so the patient may have had a $20,000 dollar hospitalization, but can't get a reliable access to the hundred dollar a month drug he needs to sustain the results of his hospital care.

I do what I can.  Try to find help for some patients.  Remind doctors to write for the least expensive thing that will work.  Quietly tell the patient which meds are truly essential and which ones they can probably get by without.

But too many days, I leave knowing that some one of the folks I saw today will die for lack of a medicine they could not afford.   

It is time for a change.