nejm.org/doi/full/10.1056/NEJMp1312793 The authors, who work at a university clinic for indigent persons, tell a story that illustrates the dilemma faced by millions of Americans who are lost in healthcare limbo — they are too poor to pay for medical insurance but make too much to qualify for Medicaid in their home states. Mr. Davis [a pseudonym] had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evenings end, hed been sent home with a diagnosis of metastatic colon cancer, the pair write. A year before he presented with advanced incurable disease, the patient had gone to a local primary physician for symptoms suggestive of colon cancer. The physician took a brief history, told him he needed insurance for further tests, and charged him $200 for the privilege. By the time he was seen at the emergency department, he had developed complete obstruction of the colon and metastatic disease. Mr. Davis had had an inkling that something was awry, but hed been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer, Drs. Stillman and Tailor continue. They explain that the patient knew that earlier diagnosis and treatment might have saved his life, and recount what he said: If wed found it sooner, it would have made a difference. But now Im just a dead man walking.
Posted on: Tue, 05 Nov 2013 20:54:40 +0000