As published as a commentary in The Hartford Courant, April 30, 2004.

Health Care Shouldn't Be a Luxury

Bruce Gould, M.D.

Increasingly in my practice, the number of patients who cannot afford their medications and treatment alarms me.

It's been a serious problem for those without health insurance as well as for those who rely on Medicaid since the state decided to make them pay premiums and co-pays. Even $1.50 or $2 for a prescription drug or a visit to the doctor can be too much for the very poor. It amazes me that our government is trying to balance its budget on their backs.

People without good health insurance seldom go to the doctor for routine problems. Often, they don't go even when they know they are really sick. It's just too expensive.

When they finally get to the doctor and find out they have heart disease, diabetes or cancer, the disease is usually more advanced and more likely to kill them. And, of course, the long-term drug or treatment regimens that can help them manage their illnesses are often out of their financial reach. Instead of the discounted prices negotiated by large insurers for their members, the uninsured are expected to pay full price. No one is bargaining for lower prices for them.

Those of us in primary care deal with this awful reality every day and wonder when this country will decide to really tackle the problem.

Unlike almost every other industrialized country in the world, we look at health care the same way we look at entertainment or automobiles: If you can afford it, you can have it; and if you can't afford it, you can't. Health care should not be treated like any other commodity. Being unable to go to the doctor or buy medicine is not the same as being unable to buy a large-screen TV or take a trip to the Bahamas.

In 2000, about 253,000 Connecticut residents had no health insurance. Nearly 70 percent of them were employed, but they didn't get health care benefits because their employer didn't provide them.

There are efforts underway around the state to try to ameliorate the desperate situation. Acute-care hospitals throughout Connecticut provide millions of dollars worth of uncompensated care to patients every year. Many physicians and other health care providers donate their services to the uninsured and underserved in many different ways. For example, at the University of Connecticut Health Center, our students, working with faculty and community physicians, run health care clinics in Hartford at the South Park Inn, the YMCA Emergency Shelter for adolescent girls and the Salvation Army Marshall House Shelter. They provide care to agricultural workers on farms across the state through mobile clinics operated during the summer months. Our School of Dental Medicine, through its faculty practice and its clinics, is the largest single provider of dental care to the state's poor.

We believe we have an obligation to improve the health status of the poorest in our state because we are a publicly supported medical and dental school, because we are developing and training the next generation of health care providers and because if we don't take up this challenge, no one else will.

Our efforts, though essential, are only band-aids. What we need is a national commitment to ensure all our citizens can get the health care they require.

Bruce Gould is associate dean of primary care for the University of Connecticut School of Medicine, director of the Connecticut Area Health Education Program and medical director of St. Francis/UConn Primary Care Center at the Burgdorf Fleet Health Center.