October 1, 2013

October 1, 2013

A seemingly innocuous day. And a momentous one.

It began like any other, if you could ignore the news of a federal budget showdown: postponing Obamacare for a year (stretching to forever) vs shutting down the federal government. The Great Government Showdown was on!

In the morning, I drove to clinic listening to a run down of what would and wouldn’t be affected by a government shutdown—shuttered National Parks, no federal guarantees for home loans, National Health Service Corps on hold.

And then the day began like any other.

(Before I tell about my first patient of the day, I should mention my policy on clinic stories.  Either I ask patients’ permission to share their stories, or I shift around identifying details to make the patient unrecognizable.)

In the first appointment slot of the day was a new patient, who hadn’t been to see a doctor for about 15 years. It was time to check diabetes, which ran in his family. His teeth hurt, badly, over the past few months they were worsening and giving him debilitating headaches. Now his jaw hurt. And he had sprained his ankle playing football the year before, and it continued to give him pain.

Antibiotics for a developing dental abscess, an ace bandage and strengthening exercises for the ankle, routine labs for preventive care. But there was something missing about the story.  Why today? There was no new job, no job loss, no new complaints, only previously acute problems that had begun to turn chronic, routine screening that had already been delayed by a decade.

Was one of his symptoms worsening, did I need to focus more on that problem? Not so.

“My health insurance started today,” he said. “What with Obamacare, I qualify now!”

His chief reason for coming to see the doctor—he was finally insured!

And with that, I could give him the antibiotics he needed to keep from turning a cavity from poor access to dental care into an abscess that could land him in the intensive care unit with disseminated infection.

Of note, in Chicago, we have County Care, an early Medicaid expansion roll-out program, and this was what gave him coverage.  People who sign up get onto Medicaid right away.  He hadn’t needed to wait. But he had heard on the news that October 1 was the day that health insurance began, and so he had been waiting for October 1, waiting to see a doctor.

He is not the only one waiting.

The health exchange websites were flooded with interest, overwhelming the systems.  There were glitches to healthcare insurance exchange rollout, glitches made worse by enormous demand–where New York’s health insurance market had 2 million visitors in its first two hours.

I am glad I could provide one person the health care he needed, that he was accessing because of the start of Obamacare. Was it worth shutting down the federal government?  I think so, multiplied by the millions of people who will get the care they need, before they become expensive emergency room patients, and turn into public health statistics on the deadly effects of a lack of access to care.

Better yet, let’s have Obamacare AND a functioning federal government to prevent another economic meltdown that would further devastate the health of my economically vulnerable patient population.

October 1, 2013.  I will remember it for my first patient of the day, a man with worsening health problems who finally came to the clinic for the care he needed  because he finally had health insurance.

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