Houston Chronicle

The Face of Health Care Reform

Guy Clifton, M.D.

December 14, 2008

Houston Chronicle

Despite the financial crisis, the new administration remains intent on covering the uninsured. The country's financial circumstances will make it harder to find the money to pay for expanding insurance coverage, but the loss of jobs will increase the urgency. The last time the nation seriously considered health care reform, it was killed by partisan bickering and business opposition. This time, if reform is killed, it will be by its price tag--$150 billion on a $2 trillion health care system. When I returned home to Houston from Washington for Thanksgiving I was recently reminded why so much is at stake in this national debate.

In Flatlined: Resuscitating American Medicine I tell the story of Anne Casey of Houston, using a fictitious name to protect a real person. Anne supported herself by providing care for the elderly and by making jewelry. I was referred to her by my wife's best friend, Phyllis, who was also Anne's friend from high school days. I came to enjoy sitting in Anne's home studio on Saturday mornings, chatting and picking out materials from which she would create striking pieces.

In 2007 a black lump appeared on Anne Casey's neck--she had the fair Irish skin that is prone to cancers. Her income was too low for insurance to be affordable so she paid cash for a dermatologist to biopsy the lesion. The doctor was notably agitated after seeing malignant cancer cells under the microscope and told her she needed surgery right away, but he could not do it. Anne had malignant melanoma, a potentially fatal skin cancer that is normally removed as rapidly as possible to prevent its spread throughout the body. The down payment alone for a hospital admission would have been $10,000--which she did not have.

Fearing for her life, Ms. Casey began the process of obtaining a "gold card" which permits her to enter the public hospital system in Houston. Four weeks later she got the card, and four weeks after that, a clinic appointment. In order to find out how extensive the cancer was, the doctors needed an MRI before performing surgery. Ben Taub Hospital housed the only MRI for Harris County's uninsured and Anne lay in the hospital for six days waiting for an MRI.

Phyllis, who each day was growing more anxious, called a radiologist friend who agreed to perform the study for free. Meanwhile the black cancer was getting larger every week as the two watched in horror, helpless. After weeks passed without the anticipated call to come in for surgery, Phyllis, desperate to help her friend, called the doctor who had performed the biopsy and insisted that he telephone the doctors at the public hospital to expedite the process.

Four months after the diagnosis of a life threatening malignancy Anne Casey finally underwent surgery to remove a malignant melanoma. Always gracious, she told me in early 2008 that she felt she received excellent care and was thankful for it. I knew that the doctors had done the best that they could with the limited resources available to them. However, if Anne Casey had been insured and if her surgery had been delayed for four months for any preventable reason, it would have been medical malpractice.

There is no need to use a pseudonym now--Anne Casey's real name was Patricia Mackie and she died of malignant melanoma metastatic to her brain on Thanksgiving Day. Her story is not unique--delayed diagnosis and treatment is the reason that 22,000 uninsured Americans die prematurely each year. If you balk at the cost of covering the uninsured or hear of gridlocked health care reform in Washington, remember Patricia Mackie's story and do something about it.

Dr. Clifton holds the Runnells Distinguished Chair in Neurosurgery at the University of Texas Health Science Center, Houston and is author of Flatlined: Resuscitating American Medicine (January, 2009, Rutgers University Press).