May 21, 2018
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Bear witness to Medicaid misery

By Dr. Erik Steele

To be poor and without health insurance in America is to walk largely out of sight in the dark alleys of health care waiting to get mugged by the thugs of ill health, inadequate care and societal indifference. So the suffering that will result when thousands of Maine’s poorest residents — many our friends and family members — are cut off from their Medicaid health insurance a few months from now will be invisible to most of us. We will not be present when and where the uninsured ill will suffer for want of adequate care.

But I don’t want any of us to be lucky enough to have all of that resulting misery hidden from our view, so I propose that some of us bear witness to that suffering and then tell that truth in a way that makes it impossible to ignore. I propose that Maine’s health care community, its social services community, its law enforcement community, its media community, its academic community and all others who do not wish to stand by band together and refuse to let that suffering be invisible. I propose we tell the stories of the avoidable suffering that will result from these cuts every chance we get, to anyone who will listen and especially those who will not, whenever the opportunity presents.

I propose we talk constantly about the untreated mental illness turning routine human thinking into chaos, and of the cancers discovered too late. Let’s describe at every opportunity the pain and misery of going untreated, and the many other prices so many will pay for our unwillingness to provide affordable care for all.

In particular, those of us in the caring professions should not be silent witnesses to all of that preventable harm. Health care professionals should lead this effort, for we will see the impact of this cruel social choice every day, and very close up. Across Maine, thousands of patients will come to us with evidence of what it means to be uninsured and working class in America; sicker, poorer, more likely to live with avoidable complications of chronic disease and more likely to die because of inadequate care.

Our voices of witness can be even more effective if we don’t simply tell stories of suffering and harm. We should also tell the stories of money wasted when short-term cuts lead to higher long-term costs that could have been avoided. We will be seeing, for example, patients in the emergency department much sicker than if they had regular care elsewhere. We will see patients admitted to hospitals because they could not afford their medications. We will see cancers that could have been prevented, strokes that could have been avoided and much more. Every time we do so we should tell those stories to our political leaders and remind them of the opportunities we missed to prevent harm and save money through better decisions about how care is delivered.

There was a recent example of this power of witnesses’ stories in the Bangor Daily News. Jonesboro physician Stephen Blythe wrote eloquently of his 23-year-old patient with Crohn’s disease and posed for us a simple dilemma: his patient could work if he could take his medications, but if he worked he lost his MaineCare and could not pay for medications that cost more than all the money he made working.

There’s a collective wisdom that can be developed from such stories. It’s a wisdom that would suggest, for example, that if nothing else, society has a vested interest in paying for health care treatments that allow people to work. It’s a wisdom that must be gained if we are to stop thinking the answer to our state budget problems is to keep tossing people off health insurance rolls, and to start refining social program benefits such as MaineCare’s in ways that are smarter and more cost effective.

Nothing I said here today will change what is about to happen in Augusta. However, if we bear loud witness and shine a bright light on what’s going to happen, we might someday change it again to something even better. In the meantime, I hope you and yours avoid the dark alleys.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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