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10/24/2013

The doctors and the 'dead man walking'

Affordable care act
The federal government forms for applying for health coverage are seen at a rally held by supporters of the Affordable Care Act in Jackson, Miss., earlier this month. REUTERS/Jonathan Bachman

As far as Tommy Davis is concerned, Tommy Davis is already dead.

But perhaps he would have vanished from this Earth in relative anonymity if not for his two doctors, internists Michael Stillman and Monalisa Tailor, who penned an article this week in the New England Journal of Medicine.

In their piece, the two doctors struggle to define the emotions they felt after learning about Davis' story. Not shocked, not saddened, not disheartened.

"We were simply appalled," they write.

Tommy Davis (not his real name) has a full-time job. His wife does too. Nonetheless, both had been "chronically uninsured" for some time when Davis walked into a Louisville clinic for indigent persons in March.

Davis came in complaining of stomach pain and "obstipation chronic constipation caused by an obstruction in the intestine. He drained his life savings $10,000 to pay for a litany of medical exams. Then he walked out of the clinic with a diagnosis of metastatic colon cancer and a decision to forgo treatment.

But this was not Davis' first time seeing a doctor, as Stillman and Tailor explain.

One year earlier, he had seen another doctor, complaining of similar symptoms. He was told he would need insurance to be adequately evaluated and he was charged $200 for this medical advice.

According to Stillman and Tailor, Davis was poor and ineligible for Kentucky Medicaid. So he went the DIY route when it came to medical treatment, using "enemas until he was unable to defecate."

"Mr. Davis had had an inkling that something was awry, but he'd been unable to pay for an evaluation," Stillman and Tailor write.

"As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements and his gnawing suspicion that he had cancer. 'If we'd found it sooner,' he contended, 'it would have made a difference. But now I'm just a dead man walking.'"

Stillman and Tailor say such "unconscionable" stories have become all too common in the United States and they describe several other uninsured patients from their clinic. Earlier this year, this blog featured another article by a frustrated physician, describing a patient who went to jail to get life-saving surgery.

The Louisville doctors believe "elected officials bear a great deal of blame for the appalling vulnerability of the 22 per cent of American adults who currently lack insurance." The Affordable Care Act, they maintain, is the "only legitimate legislative attempt to provide near-universal health coverage."

Stillman and Tailor believe Davis' life could have turned out differently if he'd been insured after all, there are a number of studies that suggest the uninsured have poorer health outcomes.

"We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance."

Jennifer Yang is the Star’s global health reporter. Follow her on Twitter: @jyangstar

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