We spend a lot of time talking about various metrics of quality or access in the American health care system. The problem with many of them is that they rarely seem to capture the issues that people face in dealing with care. Although many metrics are improving, problems remain that still seem insurmountable.
It's true that the number of people with no insurance has gone down significantly since the Affordable Care Act was passed. But that's only one measure of access. In many other ways, access is still surprisingly bad. I rarely use anecdotes to make my point, but in this column I'll make an exception.
I have ulcerative colitis, and have had it for many years. When it was poorly controlled, I lived in constant fear of not being near a bathroom. The half-hour commute to my job often necessitated a stop on the way to work because I feared I would lose control of my bowels. My wife could tell you many stories about how I made innovative use of my babies' diapers in cases of emergencies.
But a number of years ago, after I found that drug after drug didn't work, my gastroenterologist suggested an older immunosuppressant. I'm a doctor, and I recognized it as a drug often used to treat cancer. It carried with it some significant side effects, most notably a small chance of myelosuppression, in which your bone marrow shuts down and produces too few blood cells.
That horrified my wife. But she didn't appreciate that this was, to me, a small price to pay for the opportunity to not be constantly worried about my proximity to a toilet. I weighed the benefits versus the harms. I decided to give it a go.
The medicine changed my life. I have few, if any, symptoms anymore. It's gotten to where I can now feel annoyance when my children need to go the bathroom when we're out. By my last colonoscopy, my ulcerative colitis had gone into remission. I feel as if I have the bowels of a normal person, for which I am utterly grateful.
The medicine is old and it's generic. It costs about $80 for three months even though I haven't met my deductible. But this story isn't about money. This is about the nightmare of how hard it is for me to get the drug.
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http://www.nytimes.com/2015/09/22/upshot/trapped-in-the-system-a-sick-doctors-story.html?
