In Texas, Those In Medicaid Gap Are Left To Die...

The Atlantic published Wednesday a heartbreaking story documenting the victims of Texas Gov. Rick Perry's cruel refusal to expand Medicaid in his state:

When Claudia, a mother of seven who lives in a Dallas suburb, feels sick, she doesn’t bother trying to make a doctor’s appointment. Without health insurance, even a simple consultation would cost more than a day’s pay.

“I just take something over the counter or wait till I can't take it anymore,” she told me.

One such time occurred in 2002, when she had a complication after a gallbladder surgery.

“I was home for six days when I started to be in pain again,” she said. “I had just been in the hospital, so I was holding it off because I was worried that they'd send me another thousand-dollar bill.”

After several days of laying on the couch in agony, she gave up hoping that it would go away on its own. “I went to my husband crying, saying it was too painful. He agreed to take me,” she said.

Back at the hospital, doctors said the initial operation had punctured one of her bile ducts, and the bitter fluid was now leaking into her body. “The doctor told me that if I had waited longer, I would have been dead,” she said.

Claudia works in a warehouse for up to 11 hours a day, and though she’s occasionally wracked by aches and pains, she hasn’t gotten a physical in four years. Her children are healthy, but she admits that no one in the family has been to the dentist in a while. Her 19-year-old daughter pays for her own contact lenses with earnings from her job at McDonalds: Two paychecks for every optometrist visit.

That anecdote, however, is far from the worst. Some cancer patients are simply being given palliative medicine as they slowly die:

Oswald kept calling the county regularly to check on the status of his appointment with a specialist. “I would say, ‘I’m dying of cancer here. If I don’t get the treatment soon, I’m gonna die.’”

In November, he went to St. Vincent’s, the Galveston free clinic where Pearson works. There, doctors took samples of his tumor and he was officially diagnosed with tongue cancer. That clinic didn’t have oncologists or ENTs on staff, either, but his diagnosis there proved to be the key to getting a specialist appointment. The Indigent Care program finally found an opening with an oncologist on December 31.

The time between when Oswald first described his symptoms at an ER and his first appointment for cancer treatment was about one year. McCammon said that ideally, head and neck cancers should go from diagnosis to treatment in 100 days or less.

“Head and neck cancer has about a 50 percent overall survival rate. Half our patients die, no matter what we do,” McCammon said. “But if they’re not able to get access to care, their cancer goes from curable to incurable.”

After UTMB cut back on charity care, McCammon began practicing palliative medicine, offering symptom management, counseling, and pain control for patients who could no longer get cancer treatment.

“The most vulnerable ones are the ones who make just too much to qualify for the county [Indigent Care program], but not enough to afford health insurance,” she said. “And obviously not enough to self-pay for cancer care, which ranges from $30,000 to $70,000.”

Not surprisingly, these victims of barbaric Republican politics are aware that there is a better (single-payer) way:

Oswald said he wasn’t familiar with Medicaid. He did want to tell me about one healthcare policy idea he had heard long ago, though.

“I once had a girlfriend who was from Costa Rica, and she said that there, they take your medical right out of your paycheck, so when it comes time to go to the doctor, it doesn’t cost anything,” he said. “I thought that was kind of neat.”

A thought here: these doctors and hospitals crying crocodile tears are to blame, too. Texas has some of the best hospitals in the country and surely they could find a way to treat these patients -- or advocate more forcefully for the Medicaid expansion if they really cared. Instead, some are content to blame the federal government and imagine that their random acts of charity are sufficient:

Brian Swift, with the Tarrant County Medical Society, said Project Access was a shining example of how groups of doctors could organize their own indigent care programs without federal help.

“It's an example of a community coming together to decide what the community needs,” he said. “You don't have to have all this intrusion by the government to make this work.”

Who wants to buy these doctors -- and Rick Perry -- a ticket to Costa Rica?