Chest Pains, anyone?
The emerging mantra that “health insurance is not health care” is a useful one, as mantra’s go. It prompted me to reflect on actual access to health care in my small town 25 miles from Boston.
When we moved here in the 1980s there were several doctors in town, including at least one pediatrician. By 1996 no doctors were listed in the local phone book. This lack was somewhat relieved because we also had a community hospital in town. It had an emergency room, the usual medical services (my wife once had a diagnostic procedure done there), and one would read of old folks who were cared for in their final illness at the hospital.
Around a dozen years ago the hospital was taken over by the Caritas chain. Despite the usual assurances, after a couple of years they closed it, leaving a legacy of toxic pollutants at the site that no one seems to know how to fix. Now we had the option of 3 hospitals 10, 15, and 20 miles away. As a sop, Caritas stationed an ambulance at the closed hospital with paramedics who could give advanced life support. After a couple of years, they notified the town that this was being discontinued. So our fire chief launched a crash program to train staff as firefighter-EMTs to keep advanced life support available. Now, in a tight budget year, advanced life support is on the chopping block, and if it survives this year, it will be vulnerable in next year’s tight budget.
So, in 25 years we have seen actual access to health care deteriorate markedly. This in a town that is one of the wealthier ones in Massachusetts. Non-emergency care requires that we drive to our health center, 15 miles away. On weekends, “urgent care” requires a drive to another health center 20 miles away. For emergency care, we depend on a fragile network that would quickly break down under the stress of multiple health crises. And all through this quarter century, the cost of health care has risen almost continuously and precipitously.
So while we’re thinking about dealing with the health insurance mess, let’s not forget that in many wealthy suburban Boston towns like mine, access to health care is trudging in the direction of the Third World.