This column is prompted by some devastating news I received a few days ago. A young woman I have known since she was in college received word that she had stage 4 colon cancer. She had initiated her visit to the doctor because of fatigue and the concern of her friends. Although she has good insurance through her employer and a living wage, she had not gone to the doctor in years. There are others like her. And the consequences of not seeking regular medical advice extend beyond the patient.
The truth is, not going to the doctor and not following doctor’s advice drives up the cost of health care. I am wondering how much this behavior also plays into the opposition to the Affordable Care Act. My current theory is that the answer is quite a bit.
A Google search pulled up a 2000 article from the New York Times that said that one large reason for not going to the doctor was fear. Many people have so much dread of finding something serious during an annual checkup that they use WebMD or look for natural remedies. I think some of people in this category believe that easy access to health care will lead to overuse. “Why can’t they do like I do and stay healthy?”
Another reason people don’t go to the doctor is because they don’t have a personal relationship with one. Specialists, who generally allow more time per visit, are not a substitute. They are unlikely to perform a full physical, including blood and urine tests, that could catch another emerging condition. People who fall into this group may think, “I can’t see a doctor who cares about me now. Why should I support more people looking for doctors?”
The third reason people don’t go to the doctor is that they are waiting for Medicare. This government program is almost a bonus for getting old. Most people who have reached 65 and are covered by Medicare may not have had a lot of serious health problems until they retired. They also may not have experienced the debilitating costs of serious illness and therefore don’t understand why health care for younger people should be subsidized by the government to the extent it is for them.
The ACA addresses the need for a personal doctor patient relationship by encouraging health care systems to adopt the primary care physician model. There is more medical training in establishing a trusting relationship with patients. And being familiar with the patient makes it easier to see physical changes that suggest investigation. Family Health Services and St. Luke’s both encourage choosing a physician who you feel comfortable with and seeing them at least once a year.
Without our entire population engaged in the health care system, the data used to set insurance premiums, to determine best practices, and to find areas where more care needs to be provided is not complete. Bad health habits are not the only thing driving up costs.
All of us can do more to make sure that our health care dollars go a long way. We need to look after our own health as well as see to it that health care is accessible to everyone. And yes, follow doctor’s orders when they suggest we give up our unhealthy habits.