Poverty = lack of doctor visits = higher death rates?

St. Lawrence County ranks near the bottom in health outcomes.

Many people assume that the government helps low income people who really need medical care – people diagnosed with cancer or other potentially life-threatening illnesses. I used to think that, too.

But then I spoke with Ruth Fishbeck, director of the Health Initiative in Potsdam, for a story about health care needs in the North Country. She told me that a lot of sick people don’t get government assistance – even when they can’t afford medical care. So they go without doctor visits, lab work, and medications.

Fishbeck says this is having serious health consequences in St. Lawrence County. It’s ranked among the worst of New York’s 62 Counties by most health measures. Here’s what Fishbeck had to say…

“People are dying. We rank in health outcomes, we rank 58th or 59th out of 62, and that means premature death and sickness. And a lot of it is simply the lack of money to get adequate health care.”

Fishbeck says people who have health insurance just don’t understand how hard it can be to go to the doctor, when it might leave you without money for rent or food.

“So many people are under the impression that there are programs, that the government wouldn’t let somebody with cancer not get treatment because they don’t have money. But that happens every day because there is no program.”

Fishbeck thinks the new national health care law will help more people to afford insurance. The Supreme Court is expected to rule on the law in the next few weeks.

What do you think about health care in the North Country? Is lack of money the main issue – or do you have other concerns? And do you think attempts to make health insurance more affordable will help?

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75 Comments on “Poverty = lack of doctor visits = higher death rates?”

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  1. Pete Klein says:

    There are also many people who do qualify for assistance but don’t seek it out of a sense of pride and/or shame.

  2. Paul says:

    Pete, Even a lot of people that do have health insurance don’t go to the doctor. “Doctors are for sick people” and for many people you wait as long as you possibly can before getting health care. It is like you just go to the doctor to confirm that you are dying like you expected! It is a cultural problem that we have to deal with if these health care problems are going to be resolved.

  3. It's Still All Bush's Fault says:

    Paul, you comment is part of the issue. Another part is supply. If you can’t get into see your family doctor, you only option is an emergency room. I have heard a number of people question the lack of an “urgent care” station in the local area for the times when you can’t see your family doctor, but are opposed to going to the ER. Not enough docs. I had to contact several family doctors before I found one who was accepting new patients.

  4. Paul says:

    The lack of doctors (at least in many areas and especially primary care doctors) is a big issue that I think should have been dealt with in some way before we tried to come up with something that tries to add millions more people to the end of the line.

  5. Pete Klein says:

    Paul, here in the wilds of Hamilton County we do have a great doctor in Long Lake and the HHHN.
    But I will admit to being someone who does have insurance but needs to be dragged kicking and screaming to the doctor except in cases of pain and/or bleeding.
    I fully intend to avoid ever going to a hospital because that is where sick people are and people die there every day.
    I have no intention of ever waging a battle with cancer if I ever do get it.

  6. mervel says:

    Its poverty.

    If you don’t have the money or fear you don’t have the money you are going to delay doing anything about your health. The number one reason for bankruptcy in the US is medical bills.

    The article has it exactly right, there is this myth that if you are low income you can get health insurance through medicaid. This is not true, medicaid is essentially for the totally indigent, no assets and no income. If you and your wife or partner work minimum wage jobs, that is too much, $1000 per month is too much to get medicaid.

    As long as we have the grinding poverty that we have in the North Country and as long as health care is so very expensive this is going to be an issue.

  7. mervel says:

    I hope the Obama health plan can fix this, but it will take billions and billions more in new programs to expand medicaid to really help low income people without coverage right now, are those billions in the bill?

  8. scratchy says:

    we should have single payer like Canada.

  9. Bob S says:

    The number one reason for bankruptcy in the USA is wanton overconsumption of goods and services facilitated by credit card abuse. Medical services are usually written off by the provider when unpaid.

  10. The news article got it right but the blog got it wrong. The recent national legislation was about health *insurance* not health *care*.

  11. myown says:

    It is pretty clear the number one reason for bankruptcy in the US today is related to medical expenses. And job loss is number 2.



  12. Paul says:

    myown, thanks. It is interesting, in the second story it said that about 80% of the bankruptcies caused by medical debts were for people with health insurance.

  13. laurie says:

    It’s convenient to blame majority of bankruptcies on overspending and credit card misuse. Then you can simply blame people for being irresponsible and go on living in a bubble believing it could never happen to you. But there have been enough studies done and articles written in recent years to know that medical expenses are by far the leading cause of personal bankruptcies in the US.

    The idea that providers just write of debt people don’t pay is fanciful dream — that doesn’t happen until they’ve collected on every asset you have. Case in point: A co-worker of mine was in a car accident years ago that has required multiple surgeries over the course of 5-6 years. The person who hit her had car insurance. She had health insurance of her own. Despite that, she racked up over $108k in medical bills. She exhausted her retirement savings within the first few years just trying to keep her head above water. This spring she tried to declare bankruptcy, but the judge denied it because she’s now healthy, has a good job and owned a house. He told her to sell her house instead.

    Just like that, everything she worked for — gone. These are not isolated stories. This is happening to millions of people. We’re all just a serious illness or injury away from losing everything we have.

  14. Paul says:

    Bob S., that is a big problem but the data show clearly that those issues are number 3 on the list of why folks go bankrupt.

  15. JDM says:

    “And do you think attempts to make health insurance more affordable will help?”

    Lowering the cost of health care is the way to go.

    Trying to chase ever-increasing health costs with ever-decreasing government assistance is a losing proposition.

  16. mervel says:

    Myown is right and so is JDM, go figure.

  17. Larry says:

    JDM, I agree. The root cause of the problem is the high cost of medical services coupled with the high cost of unnecessary treatment. Making insurance more available/affordable will not help unless that is coupled with a forced reduction in costs. This is an instance where government can actually do some good if they choose to.

  18. knuckleheadedliberal says:

    Great Larry! Glad to hear you are supporting Obama in his attempt to reform the system. Now if you can convince some of your Conservative friends to join us we might have a chance to make things better.

  19. Larry says:

    Obama’s plan extends the availability of insurance and requires people to purchase it (or be fined). This hardly reforms the system; in fact, it seems to perpetuate it. Unless costs are brought under control, it will fail; to say nothing of the fascist overtones of requiring people to purchase insurance.

  20. Peter Hahn says:

    If you don’t have insurance you can’t afford to go to the doctor for anything. If its an emergency or you are dying you will be taken care of by some hospital and they will pass on the cost to everyone else.

  21. Peter Hahn says:

    Cost control means restricting access to expensive (and probably unnecessary) procedures. I don’t know if you can make the procedures cheaper. Could you make heart transplants cheaper for example? (not to say heart transplants are unnecessary or should be rationed).

  22. Peter Hahn says:

    I mean is there some kind of market competition that would bring down the cost of a heart transplant?

  23. Larry says:

    I am referring to things like ECG reviews by Drs. who never meet patients, $2500 for 5 mile, non-emergency ambulance rides, hospital room & board rates that exceed luxury hotel rates, etc. We could save a fortune by eliminating ridiculous items, to say nothing of reducing exorbitant Dr. fees. There are sound reasons why “public utilities” are regulated. Medical services belong in that category.

  24. It's Still All Bush's Fault says:

    It might be interesting to see the itemized bill for a heart transplant to better understand how you arrive at the total.

    I remember a previous post where a commenter told the story of his rotator cuff surgery and commented on a $10,000 suture anchor that was nothing more than a 25 cent piece of stainless steel.

  25. Pete Klein says:

    In a culture where everyone is trying to live to be 100 no matter the cost, you will never get control of the cost of health care.

  26. Peter Hahn says:

    You want the insurance company putting your heart transplant out to bid?

  27. Larry says:

    Don’t be ridiculous, Peter, of course not. I don’t want an insurance company to do anything but pay legitimate claims for costs that are necessary, rational and regulated with the public interest in mind.

  28. Mayflower says:

    The Obama administration has taken on reduction of health care costs in multiple ways. Those provisions aren’t being discussed because no one waged a propaganda campaign against them:

    No orchestrated hysteria about preventative care that reduces costly diabetes and heart disease. Nothing more than a few snickers about improved nutrition and exercise for obese children. Not even an eyebrow wag over electronic records that reduce the practice of repetitive testing. These are quiet and essential reforms that add up to serious savings.

    So, at least some provisions slipped under the bombardment about “socialism,” “government take-over,” and “Grandma’s death panels.” And that is going to be our only progress on this issue unless/until the Republican Party adopts a more meaningful strategy solution than “repeal Obamacare on Day One.”

  29. PNElba says:

    Larry – you must be one of those long-gone Republicans of the past that actually believed there was a role for government in regulating business practices. Regulation of health care (or anything else) – them’s fighten words among today’s republicans.

  30. Peter Hahn says:

    Larry – what you want has been rebranded as “death panels”.

  31. Peter Hahn says:

    Government death panels and health care rationing.

  32. Larry says:

    Well then, what is it that you want? A continuation of the current madness? National health that provides mediocre care for all? Single payer that will bankrupt us? How about some constructive contributions that don’t involve the use of tired cliches and re-heated rhetoric. I think what we have here is a blind hatred of things Republican and a blanket refusal to contemplate anything that comes from a Conservative perspective. You just can’t get over Bush beating Gore and have been crying about it since.

  33. Peter Hahn says:

    Larry – every single payer is cheaper than we are. I would be happy with better regulated health care – by expert panels deciding what should be covered -bases on what has been shown to be effective. I would be also happy if they considered cost. That is – something might be effective, but if there is something else that is a lot cheaper, but equally effective – or even almost as effective – that would be a better use of health care dollars.

  34. Peter Hahn says:

    As it is, treatment A costs 10 times treatment B and both are equally effect (but maybe unnecessary) we go with treatment A every time.

  35. Peter Hahn says:

    And insurance pays but builds the cost into all our premiums.

  36. PNElba says:

    Larry – Cool off. What I want is just what most Republicans wanted 4-5 years ago. The same thing they have in MA. The same thing that the Heritage Foundation proposed. It’s now called Obamacare. Single payer would have been better, but I guess it is what’s called a compromise.

  37. mervel says:

    Cost control in the end means everyone makes less money. If you look at every other country that spends much less than we do on health care, particularly in Europe, those working in the health care industry all make less than they do in the US. In the end that is what it will be about.

  38. SirLeland says:

    I’ve said it before, and it’s really very simple. Unless and until our policy makers approach healthcare in this country as a fundamental human right (as we currently do police protection, or fire protection), as every other developed country on the planet approaches this issue, there will sadly be little to no change.

    And the facts are there and available to us:

    Under our current system, we pay more per capita on healthcare than any other developed country, and we also receive worse outcomes as a result.

    Our health care system is currently the leading cause of all bankruptcies, and also all foreclosures, in this country, and the majority of those bankruptcies and foreclosures that transpire are from people who had private health insurance.

    To those like myself who are fortunate to have private health insurance, but who complain that they don’t want their tax dollars going towards other people’s healthcare, guess what? We are already paying for other people’s healthcare, and we have been for many years now. We pay it in the form of higher premiums, because 50 million of our fellow citizens who have no coverage are forced to go to the ER for treatment. So we’re paying for other people’s coverage. We just don’t call it a tax. But it’s the same thing.

    It is true that in the U.K. and Canada and other countries with a national Health Service, that you may have to wait a little longer for non life-threatening elective surgeries (such as a knee replacement, for example), but it is not the government in those countries who decides who gets a heart transplant, or cancer treatment, or what kind of treatment. It is the doctors who decide.

    Single payer is cheaper than for profit private, and it is also more streamlined and more efficiently and less expensively delivered.

    But the private insurance lobby in congress is a bear. The fact is that that
    is how they make their money and profits…their entire business model is dependent upon denying people coverage and care. It’s barbaric. And it’s beneath us. We are still the most dynamic and wealthiest country in the world, and we need to do much, much better.

  39. SirLeland says:

    And Mervel: If you ask any doctor or health care worker in Europe today if they would rather switch to our system of providing care from theirs, the answer is 100% a resounding “No” (after a good chuckle).

  40. knuckleheadedliberal says:

    My baby brother and didn’t have health insurance and he was worried about the cost of medical care. He got sick and his friends told him he needed to go to the doctor but he waited a couple of days until he was really sick. He called some friends who took him to the Emergency Room where they put him on IV and started doing tests. He kept asking how much each procedure would cost. In the end it didn’t matter to him because he didn’t have to pay for any of it. He died. Ten years ago next month.

  41. mike says:

    Surprising how people will surrender there freedoms. I dont think an unelected bureaucrat, I don’t know in some far of office should decide my health care any more than some big insurance exec. Big goverment is no different than big business.

  42. tootightmike says:

    Last I checked, the death rate was 100%. The big difference is how much you spend trying to avoid it, and sometimes I think the doctors just want you to support the system.

  43. mervel says:

    Sir Leland what do doctors and nurses in the US say about taking a 40-50% pay cut?

  44. mervel says:

    Its not just doctors, it will be across the board pay decreases, what will the Nursing unions say? What will the drug companies do?

    I essentially agree with you that our system does not work I think it gives us the inefficiency of a government system combined with the greed and corruption of a totally private system, we get the worst of both.

    My point is that if anyone thinks we can just pass a law and this will all be ok they are in a major dream world.

  45. mervel says:

    Obama’s plan is a giant unfunded mandate, there is no money behind it, it is essentially a cynical joke. Unless we apply billions possibly trillions of new dollars to the health care system we can pass all the laws we want, there won’t be any care for the poor and vulnerable. We can’t afford right now to provide medicaid to people making 1500 bucks a month, how in the world is the government going to afford to pay for everyone? You can’t get there from here.

  46. knuckleheadedliberal says:

    Yes we can!

  47. Peter Hahn says:

    Marvel – its not an unfounded mandate. That’s what the rule that everyone has to have insurance is for.

  48. Pete Klein says:

    Allow me to aggravate some people, maybe most, by saying the cost of health care would come down if we would just get rid of all the marvels of modern medicine and drugs developed since 1990.
    None of this stuff comes cheap.
    Another possibility would be to eliminate heroic measures to save or extend anyone’s life past 65.
    Nursing homes have become a problem and have become a big business simply because we keep people alive for no other reason than to keep them alive, no matter the cost.
    But here is the funny part. Now we are complaining about how much it costs.
    Go figure.

  49. Reality Check says:

    One of the last times I was in the North Country I spent a bit of time with a family that had been displaced by a fire in their previous home. They all were staying in a one-room apartment.

    A 20-something mother, her boyfriend, her cousin and the grandmother (who was on oxygen) all sat and chain smoked in the same room as the mother’s three year old son. There is a hardcore, dedicated ignorance to health in a significant part of the North Country’s population.

  50. mervel says:

    Peter it is unfunded in the sense that it does not apply any real government money to expand health care coverage.

    I hope it works I really do. The key and big big question in my mind is will it drastically reduce what we all have to pay for health insurance? I mean from what I can see so far health insurance costs are not going down, but going up. What if health care costs skyrocket next year?

    Mandating that some guy making 2000 a month go pay 25% of his or her salary to buy health insurance isn’t much of a plan. If the exchanges work I assume it will mean lower health insurance costs. To me if we can’t afford medicaid we certainly can’t afford this.

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