(CNN) -- With the Supreme Court set to hear oral arguments aboutthe constitutionality of the President Obama's health care law, morepatients than ever have been asking for my thoughts about healthreform.
I practice primary care in southern New Hampshire near theMassachusetts border, which gives me a firsthand look at how healthreform has impacted my neighboring state. Despite flaws with theMassachusetts approach, and the president's Affordable Care Actwhich is modeled after it, I believe that health care reform needsto move forward.
Over the years, I have encountered too many cases of patients whoare inadequately served by our current health care model. Some oftheir stories are heartbreaking, others are deeply worrisome.
Some time ago, I had one middle-aged patient with diabetes, whomI'll call Mark, requiring high doses of insulin to control his bloodsugar. He faithfully saw me every three months, where I made carefulinsulin adjustments so his sugars wouldn't go too high or low. Butall of a sudden, he stopped coming. I didn't hear from him until ayear later, when I received a call from the emergency departmenttelling me Mark was found in a coma because of a critically highsugar level. Thankfully, he survived his hospital stay, and when hecame for a visit afterward he explained how he had lost his job, andthus, his health insurance. He couldn't afford to see me or buy hismedication.
According to the 2010 Commonwealth Fund survey, 72% of joblessAmericans said they couldn't afford to fill a prescription or obtainneeded medical tests. Worse, 40% said that medical bills forced theminto difficult financial decisions, such as depleting their savings,or being unable to pay for necessities like food, heat or rent.These are choices patients should never be forced to make.
But it's not only patients without insurance who suffer. Othersare in a situation like another patient of mine, whom I'll callLinda. She recently told me that her sister was diagnosed with coloncancer, a disease with a strong genetic component. I recommendedthat Linda have a colonoscopy. Unfortunately, her health insuranceplan had a deductible in the thousands of dollars, making acolonoscopy prohibitively expensive.
Last year, a study from the RAND Corporation, a nonprofit,nonpartisan research organization, found that families enrolled inhigh-deductible plans like Linda's cut back on health care that wasclearly beneficial, like cervical cancer, breast cancer and coloncancer screening. According to the study, 'these cutbacks couldcause a spike in health care costs down the road if people end upsicker and need more intensive treatment.'
The Affordable Care Act would help patients like Mark, byproviding him a way to obtain affordable health insurance regardlessof his job status. Beginning in 2014, health reform would expand theeligibility of Medicaid and provide federal tax credits to help buyprivate insurance. On average, 17% of the nonelderly populationnationwide would be helped, with numbers as high as 36 to 40% inparts of Florida, New Mexico, Texas, Louisiana and California. Andfor patients like Linda, health reform would prohibit cost sharingfor many preventive screening tests, including colonoscopies.
My support of the Affordable Care Act is tempered, however, by aserious flaw: Its benefits cannot be fully realized without a strongprimary care foundation. In the United States, the number ofspecialists to primary care doctors is about 70-30, a ratio that'sreversed in the rest of the world. That primary care deficit is afar bigger threat to health reform than if the Supreme Court were torule President Obama's law unconstitutional.
Having health insurance doesn't necessarily mean that you'll beable to see a doctor. In Massachusetts, more than 95% of residentshave health insurance, the highest in the country. However, a 2011Massachusetts Medical Society survey found that more than half ofprimary care doctors were not accepting new patients, while theaverage wait time for an appointment exceeded one month. When youconsider that health coverage will expand to 32 million Americans in2014, whether our strained primary care system can handle thatburden is a serious question. An inability to see a primary careprovider will force patients to already crowded emergencydepartments, where health care is often the most expensive.
The Affordable Care Act doesn't do nearly enough to make primarycare enticing, despite the anticipated shortfall of primary careproviders approaching 30,000 by 2015. Medical students, concerned bytheir average school debt approaching $160,000, often eschew primarycare in favor higher paying specialties. And the bureaucraticburdens of primary care, including paperwork and spending time onthe telephone refuting insurance company denials, are overwhelming.According to an Annals of Internal Medicine study, 30% of primarycare doctors considered leaving the field entirely, citing burnout,time pressures and administrative hassles.
These concerns, however, shouldn't stall health reform. Instead,they need to be addressed as the Affordable Care Act is modified andimproved on in the coming years. Far too many patients can no longerafford to obtain basic care. It's their stories that have made merealize we desperately need to fix our broken health care system,and accept health reform despite its shortcomings. We cannot let thepursuit of perfection become the enemy of doing the right thing.
Patients like Mark and Linda need help now.
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The opinions expressed in this commentary are solely those ofKevin Pho.
