Massachusetts has been on the forefront of social change in the part 5 years. We are the first state to legalize gay marriage and the first to offer (nearly) universal health "care". I put it in quotes because we are offered insurance but there is not enough care.
I work at a community health center in a very needy community with a tremendously high rate of diabetes, HIV, drug abuse and mental illness. We are what's called a "safety net provider", a clinic that provides care to people who can't go elsewhere. We are also the portal of entry for many chronically ill Puerto Ricans who emigrate for better health care. We have many very talented and dedicated providers eager to care for these difficult patients, but we are drowning.
We see over 200 new patients in our clinic every month, mostly through our acute care clinic and have absolutely no way of providing adequate ongoing care or chronic disease management. Waiting lists have expanded to the point of uselessness, providers get burnt out and frustrated and the patients wait. It is likely that our health center, the safety net provider for our part of the state, will close its doors to new patients in the coming months, leaving no other options for hundreds, if not thousands of needy people.
Although most of these people have social security numbers and qualify for state-sponsored insurance, there is no access to care. Limited numbers of offices accept this low-reimbursement insurance and those that do are absolutely overwhelmed. Very few graduates from medical school choose family practice, internal medicine, or pediatrics residencies. Those that do often go on to specialize and have more lucrative practices. I am one of 2 of my intern class of 66 that practices general internal medicine. 64 have gone on to become cardiologists, oncologists, and gastroenterologists--all specialists that rely on primary care clinics for referrals.
On another level, this is a feminist issue. Most of the med school grads bound for primary care jobs are women. Young women sometimes get married and have babies. Balancing work and family is difficult in the best of circumstances, but being a primary care provider with pressure to see more and increasingly sicker patients without higher pay and a flexible schedule is horrendous. Frankly, despite my altruistic nature, sometimes I don't think it's worth it.
I don't know what the answers are to improve access to care, but the solution will have to be multi-dimensional. The work environment needs to be supportive and family-friendly, medical schools and residencies need to promote primary care jobs more effectively, we need more doctors, and reimbursement for the poorer patients (and often the sickest) needs to be better.
I am proud to be from a state with progressive values and I think we will learn a lot in the upcoming year about our broken health care system. I think big business, republicans, and democrats are all thinking about single-payer health care in a new way, but we can't expand a severely broken system without disastrous consequences for our most vulnerable citizens.
By the way, gay marriage is working out MUCH better.
