A Brief Report of Tragic Irony

I saw a patient today, a sweet elderly Hispanic woman of very limited means, and possessing of very limited education, who is lost in the maze of the convoluted Medicare system and cannot obtain her rheumatoid arthritis medications. She doesn’t qualify for Medicaid. Can’t afford other supplemental insurance. She signed up for Medicare parts A and B, but didn’t know she had to sign up for part D, and now she can’t obtain her TNF-inhibitor (for more than half a year now). What’s worse, she was recently told by her pharmacy that she won’t be able to get her methotrexate, prednisone, or quite frankly any of her medications. She’s been in a flare for many months, her disease gnawing away at her joints with irreversible damage.

This is tragic. What’s ironic is that the very system that should help people of her demographic (elderly, of limited means, etc.) has her lost instead in a complicated, confusing maze of complexity.

We tried to help her out as well as we could.  My attending spoke with a drug procurement specialist about her situation. I referred her to a case manager.

But it shouldn’t have even come to this. The system in place to help her demographic should make it easy for people like her to obtain the treatment they need. Sadly, ironically, tragically, many seniors find the system confusing.

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4 thoughts on “A Brief Report of Tragic Irony

      1. Hi
        Sure. I suppose I should say that in the UK it’s not actually a safety net, it’s the main health care system for everyone, regardless of income. There is rationing for everyone, but this is based on published clinical evidence and mostly we get what we need free at the point of need. The threat is this will be moved to a system more like yours, with insurance for those in work and a porous safety net for those who are not. Lots of powerful interests see a chance to make money from health this way.

  1. In the US, there’s no rationing (except in cases of local or national shortage), treatment mostly isn’t free (but can be heavily discounted), and we follow clinical evidence as well. There’s certainly a lot of money to be made in healthcare. A big problem with healthcare as a business is that it doesn’t necessarily serve the patients. Care is fragmented between clinical sites, data management systems, etc., because there’s too much competition. This threatens the quality of patient care. Off-topic: I wish we had a national healthcare database such as those in some Scandinavian countries, because then the quality of research results would rise.

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