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    When being uninsured hits home

    A physician's effort to help with a relative's medical bill sheds light on the plight of the uninsured

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    Patricia I. Carney, MD, FACOG
    What does it mean to be uninsured in America? Can we as physicians truly appreciate what it means to be 1 procedure or hospitalization away from bankruptcy? How do 46 million uninsured Americans deal with the high cost of healthcare in this country? Is it something you ever even think about?

    I come from a solidly middle class family. We always paid our bills and we were never in debt. My parents are first-generation Italian-Americans who bought into the American dream hook, line, and sinker.

    In 1964, our small suburban community built a hospital. My father developed and ran the hospital's physical therapy department for more than 20 years. He was actively involved in its fundraising and community events. I worked there as a candy striper when I was 14. Both of my brothers worked there for several years. My father died in that hospital 15 years ago. This hospital has grown to almost 250 beds and is now part of a major medical system.

    Life isn't always fair. My older brother has struggled all of his life. With a lot of grit, determination, and support from my mother, he managed to graduate from high school. After high school, he worked in maintenance at the hospital. He then moved into hotel and restaurant maintenance and cleaning. Not glamorous, but for the most part, he has stayed employed and has lived independently for many years. My mother remains active in helping him maintain his finances.

    One year ago, my brother got sick: fever, chills, and a cough that dragged on for more than a week. Finally, he went to see a nurse practitioner, was treated, and recovered. His treatment included an x-ray at our community hospital. Then for the next year, month after month, I listened to my mother on the phone telling me the latest in the "great chest x-ray saga."

    Finally, I decided I needed to say something to the hospital, maybe in the hopes of jarring loose someone's social conscience. The following is the letter I sent to the chief executive officer, chief financial officer, and director of public relations:

    Dear Mr. ______________:

    My name is Patricia I. Carney. I am a physician. That fact is probably the main reason you are even reading this letter. But this letter is not about me. It is about healthcare in Pennsylvania; it is about living on the edge without insurance; it is about your hospital. Let me tell you a little story, Mr. Xxxxxxx.

    My brother (Michael Xxxxxxxxxxx) is 51 years old. He has struggled financially his entire life. He has never depended on any kind of "assistance" or aid from the government. He has never earned more than $10,000 a year. He incurred medical bills in the past and then paid off his debts.

    For several years, Michael worked as a dishwasher at Denny's—the same Denny's you can see from your hospital. It was a blessing to our family when he was able to get a new job at Xxxxx Xxxxx in the kitchen. It really didn't pay much better (still less than $15,000 per year), but it had health insurance. As with most health insurance, there was a waiting period before it went into effect.

    Recently, my brother got sick while still in the waiting period for his insurance. Knowing how expensive emergency room visits can be (and how inappropriate it is to use the emergency room for primary care), he saw a practitioner in her office. She was concerned that he might have pneumonia and gave him an order for a chest x-ray. He went to Xxxxxx for the x-ray. He paid his bill to the practitioner ($90), he paid his bill to the radiologist who read the x-ray ($46), and he paid for the medications at the pharmacy. Fortunately, he did not have pneumonia.

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