Do Doctors Have a Responsibility to Make Health Care Available For All?
Straight Talk | Lack of accessibility to health care is often evaluated as a measure of bias. There is a committee on access of care in the New York State Cardiac Advisory Board. Reports on the availability of cardiac services to the underserved population are a concern there and across the country as it applies to minorities and women. But what about the uninsured?
I recently attended a regional American Heart Association (AHA) board meeting in Atlanta, GA, and the topic turned, as it often does, to efforts to reduce cardiovascular risk. There are programs on healthy school lunch choices, blood pressure screening programs, smoking cessation initiatives, and so forth. In recent years, cardiologists have not been engaged in a major way with the AHA on the local level except in fundraising events. The major lobbying of this venerable health advocacy organization has been the job of lay volunteers—many of whom are patients—and the AHA staff. In these meetings we often discuss, in addition to fundraising, programs to reduce cardiovascular risk on a population basis. Many of the initiatives are driven by what is perceived to be possible in the political climate. My state of Georgia has one of the lowest cigarette tax rates in the country, and yet it has, until now, been impossible to get a bill passed in the legislature to increase it. The AHA backed off its initiatives, waiting for a future opportunity to push for this well-known deterrent to smoking, especially by young people.
It occurs to me that there is another public health issue that could impact cardiovascular health: the accessibility of health care. I am not talking about how many cardiac surgeries or percutaneous intervention programs are nearby, but the population’s ability to actually see doctors. Doctors are great sources of information on the prevention and treatment of disease. The problem is that many people never consult a doctor because it costs a lot of money and, without insurance, the cost is even greater. So, if access to doctors is a contributor to improved cardiovascular health, why aren’t doctors pushing to make this more available? We, as cardiologists, are mostly members of the American College of Cardiology (ACC), an organization that is on record as supporting universal health care. But neither the AHA nor the ACC can legislate the expansion of health care coverage. This falls to state legislatures who have, in many cases, refused to expand Medicaid coverage to enable better access, even though, to the states, it is largely free money. There is now evidence that the states that have enabled more of their citizens to have health coverage have had significantly more patients with diabetes diagnosed and started on treatment. I suspect the same is true for hypertension. States that have accepted the funds for Medicaid expansion have been able to keep hospitals caring for the poor, including many working poor, to remain open. I learned at the AHA meeting that five rural hospitals in Georgia have recently closed and others are soon to do so because of lack of funding. Doctors are needed in low-income, rural areas, but without patients willing or able to pay for services, these areas go without doctors. Recently, 22,000 physicians signed a petition to abolish the maintenance of competence requirements of the American Board of Internal Medicine because it is ineffective and costly for doctors. Surely the doctors and the advocacy lay organizations could apply pressure to assure that access to health care and prevention is available to all. It is, after all, effective and supportive of doctors and hospitals. Tell the states that have not expanded Medicaid coverage, “Take the money!”
Article written by Spencer B. King, III, MD, who practices cardiology at Saint Joseph’s Medical Group’s Atlanta, GA.
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