March 29, 2024
BANGOR DAILY NEWS (BANGOR, MAINE

Health care out of reach

When anyone asks me what it’s like to be a family doctor in a small, rural community, I have a ready reply. The medicine is the easy part, I say, only half joking. The had part is making sure my patients get appropriate health care.

I work in a practice in Deer Isle, a beautiful coastal spot that also is home to many people without health insurance. We serve about 3,500 people year round, and many more in the summer months when the seasonal residents come to their vacation homes here.

Most of our year-round patients lack health coverage so we often spend as much time deciding what care they can afford as we do diagnosing and treating them. Many people believe those without insurance are in this situation because they don’t want health coverage or they don’t work hard enough.

Well, they’re wrong. Most of our patients work, sometimes two or three jobs at a time. Many of them are lobstermen, supplying the restaurants, fish markets and lobster pounds dotting the coast of Maine. Some work in construction or locally owned retail stores. Others work in jobs related to fishing, such as picking crabs, selling bait, and repairing boats. Some work as seafood distributors.

The majority of these people are self-employed. Or, they work in a small business. They don’t get insurance through their jobs and they don’t make enough to buy coverage themselves.

It can easily cost a family at least $6,000 a year for health insurance. Even major medical policies, which cover only catastrophic care, can cost $3,000 annually – and that’s with a deductible as high as $10,000.

It’s gotten to the point where some people are working just to get health insurance. I know someone who makes $9 an hour, and pays $8 an hour for childcare. They take home nothing, but the job comes with health coverage, so they keep it.

We would never turn someone away because they couldn’t pay. Our practice is owned and supported by a local provider, Blue Hill Hospital, so we can work out long-term payment plans for these patients. That’s only a temporary solution, however.

Even with a payment plan, many of our patients have trouble getting routine medical care. The medical bills quickly add up to an insurmountable mountain of debt. Most island residents, therefore, have to carefully weigh even the most basic medical decision. Are they really sick enough to justify an office visit? Could they do without this particular test? Could they ake a pill every other day, so the prescription lasts longer?

I always have to discuss cost with my patients. It doesn’t help if I just write a prescription, assuming my patient will have it filled, when he won’t, because it cost too much.

Delivering care is only part of my job. I also help each patient make difficult decisions about their treatment choices. First, we talk about the optimum medical approach and then focus on the reality of what we can do based on the patient’s financial resources and the limits of rural medicine. Then I ask the patient to tell me what he’s likely to do.

At least a dozen times a day, I see patients who are struggling to figure out how much of my advice they can afford to follow. Every day I see patients with conditions such as diabetes and high blood pressure. We both know that if they don’t follow treatment, they may wind up having a stroke or losing their sight. But they have no choice.

The whole situation is frustrating and, at times, heartbreaking.

Right now we have a woman patient, married with young children. She and her husband work, but they don’t make enough to buy health insurance. She was recently diagnosed with a progressive neurologic disease.

She needs to see a neurologist but each visit would cost several hundred dollars. As her physician, I’m trying to help her get the treatment she needs without bankrupting her. She also needs diagnostic tests – one is $1,200 just for starters. If she does get the tests and they show what we suspect, then we’ll have to talk with her about starting medications that can cost $600 a week.

Something needs to change. Health care should not be a luxury only the well-off can afford. We have to take action to make sure all the hardworking families in Deer Isle and across the nation have access to affordable health care coverage. When it comes to basic health care, people shouldn’t have to make such choices.

Joe Babbitt is a family physician from Deer Isle.


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