Some thoughts about medical care and the public good. Having been well-insured, I have lingering guilt about the cost of the elective surgeries I have had. The conditions I had would likely have become disabling, but they were not life threatening. 

My father and my grandfather would have accepted the disabilities and found ways to live with them without complaining. And that leads me to think about Medicaid. What’s wrong with the following line of thinking?

Patient A is a single mother with three young kids. In another state she would have been covered by the expansion of Medicaid. She has no surplus income. With the help of careful shopping, food stamps, the food bank, thrift stores, and her church she feels that her kids have a reasonably healthy diet, and, when they go to school they won’t be embarrassed by the clothes they wear. There are times when she is late with her rent payment — car problems and other unforeseen emergencies — but her landlord is patient and understanding and, with more scrimping, she has always caught up. There is no family available. The guy she married brought her to Montana.

Her health has been generally good, and she hasn’t been to the doctor since before her first child was born. Doctors are for kids. Now there are the symptoms. At first, she shrugs them off. It isn’t the first time she has felt unwell. This time, the symptoms don’t go away; they increase. But she hangs on. There is no money for doctors, and she has always gotten well. Finally, she can’t go on, and she ends up at the doctor’s office and the hospital. It’s going to be very expensive.

The physicians and the hospital know she has no money for treatment, so they write it off. (Even as I, who could afford to pay them, have had medical bills written off when the treatment wasn’t covered by insurance.) But this puts the squeeze on them, what with the high costs of today’s high-tech, specialized medicine, the thousands and thousands of insurance regulations, the need to make ends meet. So they raise the rates on paying patients and look for ways to get more money out of the insurance companies. 

Of course, these new costs are then passed on to the tax-paying consumers where all such costs end up. Her treatment now is much more expensive than it would have been if her first symptoms had been treated under Medicaid. It appears  that the taxpayers are paying more now at the back end than they would have paid up front for Medicaid.

At bottom, though, medicine is not just about economics; it’s about physical and mental well-being. How does she feel abut not having gone to the doctor earlier? What happens to the kids? Now that she has no income, what is the landlord going to do? And it goes on and on.

And then, since we see a steady shift of wealth from working people to an elite few, there are more and more people like her every day.

But, even if she had had Medicaid, the program is so burdened by regulations and fraud that she would have a difficult but not impossible task to find a physician who would treat her.

Where does she, and where do we, go from here?

O’Neil is a resident of Kalispell.