07 September 2011

Uninsurance shouldn't be a lethal condition

This is depressing:

A 24-year-old Cincinnati father died from a tooth infection this week because he couldn't afford his medication, offering a sobering reminder of the importance of oral health and the number of people without access to dental or health care. 
According to NBC affiliate WLWT, Kyle Willis' wisdom tooth started hurting two weeks ago. When dentists told him it needed to be pulled, he decided to forgo the procedure, because he was unemployed and had no health insurance. 
When his face started swelling and his head began to ache, Willis went to the emergency room, where he received prescriptions for antibiotics and pain medications. Willis couldn't afford both, so he chose the pain medications. 
The tooth infection spread, causing his brain to swell. He died Tuesday.

It can't be denied that his poor decision-making was the proximate cause of this guy's death (and many times I've gotten the maddening call from the pharmacy, "Doctor, the patient only wants the narcotics"). The underlying cause, however, was the fact that he was uninsured. Sure, he should have sprung the $4 to buy the penicillin at the big box pharmacy (though clindamycin can be costly, if he was penn-allergic). But he shouldn't have been in the position to need it in the first place. He should have been able to get the tooth pulled -- or better yet, filled before it needed pulling -- before it became abscessed.

Sadly, this problem won't go away when the ACA goes into effect in 2014 (assuming it does). I'm going to speculate here, but if this guy was so poor that the antibiotics were too expensive, he probably will (would've been) covered by medicaid under the ACA, which means that though his prescription probably would be paid for by medicaid, he still would not have had meaningful access to dental care, because most dentists won't see welfare patients.

But hey, at least we don't live in some sort of socialist dystopia where sometimes people have to wait for hip replacements!  Our Galtian paradise may be a bit rough, but it's got to be to keep the moochers from running over us.

Sigh.

It sucks that we are the only industrialized country not to have some sort of national insurance plan, it sucks that even the modest reform passed doesn't take effect for three years, if it ever does, and it sucks that people still die as a consequence of being uninsured.

Don't let the wingers tell you that there's no human cost to our crappy patchwork health care system. The children of Kyle Willis can tell you otherwise.

18 comments:

  1. Deeply saddening. We in my small three-person family went without coverage, and thereby most access, for the entire time (15 years) we lived in Florida. We weathered thyroid cancer, three lumpectomies, all the usual childhood and adult infections: bladder, UR, UT all by paying cash for the visits, hospitalizations and medicine out of pocket and over time. We eventually wound up with a personal bankruptcy after moving to CA and getting coverage. I know many people who have died of preventable causes for lack of “insurance”; I know many more who are compromised because of our rationing.

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  2. Good points all around. However, I think you skimmed the article a bit too fast: let me point out that you can't always have your wisdom teeth 'filled' -- most people need them extracted because they get impacted and infected like in this guy's case.

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  3. This is the way I expect to die soon, actually. Except that I'm so agoraphobic and fear-filled that even though they built a low-cost clinic half a block away, and it includes a dental office, and I recently received a large tax refund, I can't figure out how to get there, let alone go through treatment. I have to *CALL* someone and drive 60 miles for an appointment to even get on their low-cost treatment plan. Then I'll have to talk to medical people--I can't imagine jumping through all these hoops, so I think instead I won't be around that much longer.

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  4. You mentioned the high cost of clinda for pen-allergics. Kmart used to have clinda 150's on their low-cost generic plan. Not sure if they still do.

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  5. I agree "uninsurance shouldn't be a lethal condition" but this young man could have asked a relative or friend to help pay for the antibiotics or he could have paid for the antibiotics and forgone the pain medicine. Part of this death is personal choice (bad choice, not reaching out for help, not telling the doctor he couldn't afford the scripts?).

    Very sad indeed.

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  6. Tooth extraction is one of the cheapest dental procedures there is. Usually it's about $100 per tooth.

    I have to wonder about this man's mental status. Maybe simple youth did him in. Somebody with more life experience might have asked how much the extraction cost, asked about payment plan options, or as others have pointed out, asked for help to cover it. Refusing the much cheaper antibiotics was the saddest part, though.

    You almost have to wonder if there was some mental issue that made him say, if it's not completely covered by insurance then I won't even try to pay for it. Perhaps he grew up in poverty and simply didn't know any better. Many in that situation just wait for a tooth to fall out rather than incur any cost...without understanding that there isn't any margin for error with a serious infection.

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  7. I agree this is tragic and there are many faults of the current US healthcare system. However, having worked in two large ED's on both sides of the country, I have seen many patients like this present and feel that they cannot pay for meds, even the $4 ones. However, they often tend to have iPhones and the such that they some how manage to pay for. It's not my job to tell someone how to manage their money but it seems like personal responsibility has to come into play somewhere in healthcare.

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  8. While not having insurance is a problem, especially for dental care, that is not what this guy died of. You can bet he had enough money for alcohol and tobacco, and likely for street drugs as well.

    A very quick check online came up with about a dozen free dental care clinics in Cincinnati, including one that specializes in the homeless. At any time he could have gone to one of these places and gotten the dental care he needed for free. You can bet there every ER he went to gave him a list of these places. The problem is he would have to make an appointment and keep it.

    I'm not saying there is not a problem with health care in this country, I'm saying that this guys death had nothing at all to do with that problem. He did not die because he could not afford penicillin, he did not die because he didn't have access to dental care. He could have gotten both for free. He died 100% because of the choices he made, no change in the health care system would have made any difference for him.

    There are plenty of examples out there of people that are really in trouble because our health care system, people who are loosing their homes to hospital and doctor bills, peoples whose wages are being attached to pay their doctor or hospital.

    I think it's better to use real examples of real problems with the system. It's wrong to use a case like this for dramatic effect when you know it has nothing at all to do with the problem.

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  9. When you work in the ER you see on a daily basis the problems that people without dental insurance or the hundreds of dollars in disposable income necessary to take care of dental problems face. We see patients where I work that come in repeatedly for antibiotics for infections. They're in constant pain. The free and low cost clinics are booked up and it can take weeks to get in.

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  10. A sobering story. I'm with you, this is America, people shouldn't die becuase of easily treatable diseases.

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  11. Low-income adult dental is hard to come by. Even where programs exist they are often limited to specific populations (kids, elders, developmentally delayed) and type of care (usually emergencies only, no preventative care, no dentures, no oral surgery as likely needed for a wisdom tooth). Add in access problems (limited hours, limited locations, wait lists) and care becomes nearly impossible to obtain for someone who works without sick leave, has no car, etc.

    I work with dialysis patients, many of whom have malnutrition made worse by missing teeth or poorly fitting dentures. There are programs for them to get care at a discount, but that's no help if they can't afford the discounted price. Some of these folks are ineligible for transplant because it's so difficult to obtain dental care!

    As for the choice to get pain meds in preference to antibiotics, cost was likely not the only factor. Imagine you are in what must have been terrible pain and can you honestly tell yourself you would not get the painkillers? What if you needed them to function at work to earn money to feed/clothe/house your kids? Betting that your body would take care of the infection given more time might seem like a reasonable choice...

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  12. It is not at all clear the ACA will
    cover dental care. It may at some
    age level, medicaid in my state
    does dental care upto age 18 only.
    When the fit hits the shan in
    5-10 yrs and $ get really tight, will
    dental care be covered? Suppose
    we say if no avastin, then 1000
    people can get dental care for a
    year (preventive not restorative)
    for the cost of a couple of avastin
    regimens etc. The US is not used
    to thinking in such terms.

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  13. Please, Doctor. The co-pay for my monthly crap covered by insurance that I need is more than a Vicodin script and a PCN script combined, and I have "good" insurance. He just didn't WANT to pay for those things. The co-pay that I'd pay for a tooth pull (eg. wisdom tooth) is $250, and I have the "good" dental insurance too. Would you say lack of proper insurance killed me if I let an impacted wisdom tooth kill me?

    Being a total idiot with misplaced priorities killed him. Sucks, but it is true. Total barfy liberal lean on this little blog post, Mr. Meat.

    Many "socialist" countries have 20% co-pays or more on their free stuff (my friend who moved to Germany says 60% of his stuff is covered by the govt, the rest he has to pay for, which is a significant price), and most socialist countries have no "free" dental coverage for the average person, so what's your point? $4 PCN is cheaper than what you'd get in Norway, Germany, you name it.

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  14. Where I'm from, at a nearby hospital that has an agreement with a dental residency program, they have a dental chair in the ER. For people like this who want it, the dental resident will come down 24/7 to pull your tooth right in the ER as a service to the community, knowing that there will be no reimbursement. All this with proper analgesia, etc.

    Guess how many people stick around to have their tooth pulled FOR FREE? No financial barrier, no transportation barrier. The guy comes to you.

    Per my friend who works in that ER, almost no one, including those who tell the doc they have no dentist. They want their narcotics. Most leave AMA prior to the procedure even after it's explained that there is no expectation of payment. The vast majority of people that go to that ER with tooth complaints want their teeth rotten...golden ticket to narcotics.

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  15. Real insurance is for prevention of financial catastrophe in case of an expensive medical event. Prepaid medical care drives up costs. However, a free-market innovation by that evil corporate giant, Wal-Mart, has made prescriptions for many medications, including antibiotics, available for $4.00. I hope that the treating physician recognized that the patient needed an affordable antibiotic. I don't understand the mindset of even people with excellent health insurance who let insurance coverage determine whether they need something or not. You cannot force a person to value their health!!!!

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  16. I have to agree with those who consider that this man made poor choices. Was he being stupid and reckless for his own health? Yes

    However it wasn't entirely his fault. We don't know if the dentist explained how serious an infection could be. Was this man educated about these clinics? Did he even know if they existed? Someone made a good point about these clinics because they are understaffed and overpopulated. We can't say for sure that he would have gotten treatment quick enough. After all he died in only two weeks.

    I know many people splurge in stupid things like street beggars with iPhones/iPods. (I've seen the white headphones!) However I can't say only this man failed. The system is failing us because people are even going to jail for health care. It has to be more than a single man's poor choices.

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  17. This is not a "lack of insurance" problem. This is a cultural problem. The sense of entitlement that pervades our society is out of control. What ever happened to personal responsibility? So I'm supposed to feel bad for this guy, pay more taxes to help fund a government program that will "help" this lazy person, all the while I have to provide free care to him in the ED, take money away from me that I earned through hard work, (and to use a liberal bleeding heart tactic) - take food and clothing from my own family? Hypothetically, shadowfax, if you had no insurance and your wife was diagnosed with her breast cancer, would you just buy the vicodin and say, "nice knowing you honey?" Didn't think so. I'm sure you would seek ways to help get her the treatment she needed.

    What happened to this man is terrible, but I have no sympathy for him or his family. He refused to seek out ways to help himself. This is in no way my, or your responsibility.

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  18. So your bitch should really be with the greedy dentists, not our current medical system. Those oral surgeons and DMDs have a SWEET system going that makes "bags and bags and bags" of money (your term, not mine) largely because their reimbursements are not regulated by aggressive and competing measures set by low Federal standards. They can set their rates wherever they like, accept whichever patients they prefer- and there's currently no one reining them in.
    In the world of outpatient care, a "dental" visit isn't even billable under Medicare. The diagnosis cannot be coded as anything based on oral or dental pain or infection to receive reimbursement.
    So the fact that this guy didn't fill the antibiotics that are undoubtably on the $5 list at any Wal-Mart and had a negative outcome shouldn't be laid at a physician's feet. Maybe people should clamor for reform in dentistry instead. Or, for those individuals who would see healthcare rationed, a tax on cosmetic procedures- certainly those who can afford a tummy tuck could spare a little for someone who can't afford an angioplasty.
    After all, what kind of monster could save and splurge a little on themselves without assuaging a guilty conscience?

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