Access to Healthcare

I have spent the last 12 years being a patient advocate for healthcare. From searching for affordable medication options for patients to providing point-of-care services to the underserved, at my core I believe healthcare is a basic right. If the United States was founded on the pursuit of “life, liberty, and the pursuit of happiness”, I don’t believe life and happiness comes without access to healthcare. Without liberty or freedom to choose how to receive healthcare, we are not truly free.

Some may think this post is in reference to the SCOTUS decision to overturn Roe v. Wade, and you may be partially correct. However, that is only one piece of the puzzle.

As a healthcare provider, the ripple effect of that decision is far-reaching. To take away a medical procedure for EVERYONE regardless of medical necessity over a religious/philosophical debate is chilling. In a country that was born out of need for religious freedoms, we seem to have lost our way from allowing such freedom to be a person’s choice. There are very legitimate reasons where an abortion would be recommended to prevent further harm to the mother, such as ectopic pregnancy.

A fetus can survive several weeks in an ectopic pregnancy, but will not receive the nutrition it needs outside of the uterus to thrive and come to term. Left untreated, it could further cause complications to the mother including blood loss and fallopian tube rupture. If any other organ in the body were to be at risk for rupture (i.e. appendix), we would recommend surgery to prevent further harm. Not only is it very painful for the mother, but it also can cause irreparable damage which would potentially prevent future pregnancies. I will not engage in my personal stance on the matter, but from a purely medical background, when we restrict for all, we are restricting for some who NEED it.

But I said the reason for this post wasn’t solely the SCOTUS decision. Yesterday at work, I handled at least 25 prescriptions that were unable to be received by the patient. Some of these medications were simply too expensive through the patients’ insurances, while others were being held to get approval from the insurance company and required additional paperwork to show the rationale for the treatment chosen. This has been a protocol for insurance companies for decades, but recently the sheer numbers of prior authorizations needed have become overwhelming.

We have gummed up the healthcare field with red tape and barriers to treatment instead of trusting our practitioners to make the recommendation based on the patient’s needs and preferences. I am no fan of patients playing doctor by utilizing Google as a medical reference, but in pharmacy school we were taught to respect patient AUTONOMY. or ability to self-govern and decide to receive or deny treatment. This is the basis of INFORMED CONSENT. I cannot force a patient to receive treatment, even if I strongly believe they need it. It’s not my decision to make.

So as we look at the SCOTUS decision or just general healthcare and medical needs, why are we continuing to tell patients what they can’t have. If you are someone who doesn’t ever feel abortion is something you could live with, I respect that. If you are someone who feels there would be circumstances where you would consider abortion and would like to be able to choose for yourself in those situations, I respect that also.

What I cannot understand is how we reached a point in our country where healthcare is only for the wealthy and should be dictated by people who are not medical professionals. From judges to insurance companies, what medical knowledge do they possess to recommend or not recommend treatment for a patient? And I can already hear the argument that insurance companies hire medical professionals to make these decisions, and while that is true, they don’t have a personal relationship with that patient to really KNOW what is best in their situation. They are looking at aggregate data and dictating medical care based on risk management.

More important, in my mind anyways, is the length of time that patients go without being treated waiting for an approval or substitution. The patient’s risk, mental state, and/or physical state continue after we have diagnosed. Once we know the problem, we have a ethical obligation to treat. Withholding treatment to save money should be illegal. Let us first start treatment and THEN we can figure out what might be a lower cost option to prevent medical waste.

The same is true for referrals. If a practitioner feels that a patient would benefit from a referral to a specialist, the only waiting that patient should have to do is for the next available appointment. These artificial barriers are hurting patients to allow insurances and middlemen (such as the pharmacy benefit managers) to PROFIT.

I have a condition in both of my eyes called keratoconus – an eye disease that affects the structure of the cornea, resulting in loss of vision. I currently wear special contacts to correct my vision, and I am awaiting approval for a minimally invasive procedure to prevent the progression of the disease. I was initially denied by the insurance company because my specialist did not have TWO YEARS worth of measurements and data to show the progression. One eye is beyond the point where this procedure, known as corneal cross-linking, would help. So it would seem to me that it should be a priority to delay the progression of the better of the two eyes. After all, my livelihood kind of depends on my ability to SEE, and left to progress, I could be looking at a much more invasive and costly corneal transplant later in life. Why is this not a decision made by my specialist and me? Why am I still waiting months after my two years of data to allow the specialist and the insurance company to fight it out?

If you know me, you know I could interject about pharmacy benefit managers and turn this into a book. I’ll save my words on that for another post, but know that this ties in here as well. These are all examples of the same problem, and all the SCOTUS decision did in my mind is shine a brighter light on the bigger problem. Healthcare decisions are not made by healthcare providers. We need better access for all, and we need to give power back to the providers who are spending the time to assess and treat patients. If you aren’t looking them in the eyes, you shouldn’t be able to say NO. It’s too easy to say no from behind a computer, but it’s much harder to deprive someone of basic needs when you have to see the pain and emotion in their face.

I will continue to be an advocate for quality, affordable healthcare for all. If you need help, I will do all I can to make healthcare available to you so you can continue your pursuit of “life, liberty, and the pursuit of happiness”. The next time you are being told NO in healthcare, ask yourself, “Who is the person telling me no, and are they qualified to do so?”,