Is Healthcare a Right or an Entitlement?

Is Healthcare a Right or an Entitlement?

Michelle Chaffee

Michelle Chaffee

Some of you who have followed my posts over the past few years know that I am a cancer survivor. It’s been almost two years since I was very unexpectedly diagnosed with ovarian cancer. I have shared some of what it’s been like to suddenly find myself in the position of being a patient after spending a career caring for people who are sick, believing I wouldn’t find myself on the other side of this equation. I still struggle with the reality that I have had cancer and that I will have to monitor for it rearing it’s ugly head, for the rest of my life. What I haven’t shared is how the costs of healthcare contributed to my situation, delayed diagnosis and increased my chance for a recurrence. I am sharing it now because as I continue on this journey, I am starting to think the current system is discriminatory and I know it needs to change.

When I was diagnosed with ovarian cancer, I hadn’t been to my doctor for my yearly recommended examination for about 20 months. When I called to make my yearly appointment, I was told I had an outstanding bill I had been unaware of because I had moved and they didn’t have my new address. The bill was a result of “coinsurance” that was from a necessary and fairly routine procedure, still it was substantial enough that I had to set up payments over time because I couldn’t afford to pay it in full. I was told I could not see my doctor until there was a zero balance. I felt fine and had no concerns of any illness so I skipped my routine exam that year. Fast forward almost 2 years later when an unusually potent migraine resulted in a suggestion by my neurologist that I get my hormone levels checked. I contacted a new gynecology group because I couldn’t be seen by my regular ob/gyn because of the balance that still remained. On this routine exam, a very large mass was found on my ovary. So large that even though I was assured it was benign, it needed to be removed. During the surgery, the mass ruptured but the doctor told me not to worry because “It’s not cancer.” She told me the rupture was because it was so large that it made it difficult to remove. She called me about a week later to tell me it was in fact, cancer and the rupture, unfortunately complicated the staging and made recurrence more likely. The fact is, if I had gone to my regular appointment, it would have been discovered when it was much smaller and may not have ruptured. I am not blaming the doctor or the organization where I received care but, it wasn’t discovered because I owed the clinic money and they wouldn’t see me until the bill was paid. I don’t let myself think about that too much, but it’s the truth and it’s the way healthcare works in our current system.

The cost of just the surgery to remove the cancer was over $250,000. This included just one night in the hospital and no chemotherapy or radiation treatment. I had a good insurance plan but even with that, my responsibility was over $30,000. I can safely say most Americans would find it a challenge to add that expense to their yearly budget. The ongoing costs of testing for a possible recurrence are approximately $20,000 every year. That is on top of the nearly $10,000 I pay in premiums each year because I am self employed. I can’t afford this so I stretch out the time between scans and labs further than my doctor recommends.

In the back of my mind I know this could mean I don’t detect something as soon as I should again and that it can literally mean the difference between life or death.

I also know that if I owe a balance again at the hospital where I get my testing, they can refuse to treat me and I have been down that road before.

So as I write this, I find myself waiting again to find out if something discovered on a diagnostic test done almost 9 months after the doctor ordered it, is something that could take my life. Not only that, I brace myself for the cost of repeated imaging, biopsies and what may follow and I am angry, frustrated and of course, afraid. I know I am not alone and for many, it has been worse. I have worked in healthcare long enough to remember when people were denied insurance coverage because they had an illness like cancer or diabetes or a heart defect. I heard the desperation of new mothers who were grateful their precious newborn had received life saving heart surgery but had already reached their life time insurance maximum and had no idea how they would pay for the ongoing care their child needed to stay alive. The Affordable Care Act changed some of that, at least we aren’t denied coverage but it costs too much and patients can still be denied care if they owe a system money. So we constantly pray we don’t get sick again and try to find the right balance between what we can afford and what will keep us alive.

For those of you out there who say “Healthcare isn’t a right,” I tell you to save your breath unless you have faced a condition that could take your life or the life of someone you love.

To those of you who say patients should forego a smartphone or daily “fancy” coffee drink in order to pay for healthcare I say, what fantasy world do you live in where eliminating those things would make even a miniscule dent in the healthcare costs millions face?

You can also put aside the delusion that someone is sick because they did something wrong. I hate to break it to you but just because you exercise, eat healthy or have no family history of disease doesn’t mean you are magically immune to a life changing diagnosis. It can happen to anyone and I am walking proof of that reality. I ate right, exercised, never smoked, have no family history of cancer and like millions of others in this country I got sick anyway.

I find it especially ironic as I travel to other nations and collaborate with healthcare leaders to improve delivery of care to their citizens that I, a struggle to access the care I need in the United States of America. So I pose the following to ponder:

Should we get the same rights as prisoners?

Shouldn’t we at least get the same rights that criminals in this country get? The supreme court has held that those under government control must have “ Adequate food, clothing, shelter, and medical care as a component of the protections accorded by the Eighth Amendment and that “Deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’… proscribed by the Eighth amendment,” equating this pain with cruel and unusual punishment. Does “Cruel and unusual punishment” only apply to prisoners? It seems pretty cruel to make law abiding citizens suffer because they can’t afford medicine or treatment or to force them to choose between food or medical care.

Are we discriminated against if we are sick?

It used to be that healthcare provided through programs like Medicare, Medicaid and CHIP seemed sufficient to mitigate an accusation that there was discrimination based on a citizen’s ability to pay for adequate healthcare. Unfortunately, over time there has been an increasing group of Americans that don’t meet the criteria to receive these supplementary services but also can’t afford the cost of the healthcare available to them. I don’t consider myself poor but I can’t afford $30,000 a year or more for basic healthcare. Do I have the same rights to life and general welfare as anyone else? If treatment to save my life is available, should I be denied it because I don’t have the ability to pay? Did the founders of our country mean to make good health only available to the wealthy? It isn’t just what used to be considered the poor or elderly who can’t afford basic healthcare or medication anymore. Hard working people who have made contributions to their communities and are necessary to our countries security and growth can’t afford necessary care. This is a problem for all of us.

Where do we draw the line?

For those of you who continually argue that the government doesn’t pay for our car insurance or life insurance I will explain the difference. Driving a car isn’t necessary for survival, neither is providing an inheritance for your heirs. These things aren’t the same as access to professional healthcare services that prevent you from dying. Suggesting these things as examples of why healthcare isn’t a right, is a faulty argument and insulting to anyone who is sick. Our founding fathers and leaders were concerned for the health and welfare of our citizens. Franklin D. Roosevelt even tried to enact a “Second bill of rights” that included access to adequate medical care and the opportunity to enjoy good health. They couldn’t have imagined how costly healthcare would become as the model ushered in with the advent of health insurance, has progressed and costs have skyrocketed.  I am not even insisting the government cover the cost. Even making it affordable, meaning something I can pay for that doesn’t consume my entire grocery budget for a year is a good place to start. At the very least, insuring people with truly life threatening disease have an opportunity to take advantage of the treatment we can provide seems reasonable to me and maybe it’s time to make it an undeniable right of every American.

Michelle Chaffee Founder & CEO alska

The NHS underfunding is a choice. And people are dying. [video]

It’s really hard to capture and keep even the most interested and motivated persons attention long enough to explain how and why the NHS is being underfunded and the truly catastrophic impact of this.

This rather excellent video series does this perfectly.

Share and RT, write to your MP. It’s your choice too; stand by and let the NHS die, or do something about it.

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The NHS is Collapsing. Part 3: The collapse is a choice, not a necessity

It’s my job as a doctor to interpret trends and analyse hodgepodge information to predict an outcome. I look at the NHS and see a single direction of travel: collapse without rapid and drastic intervention.
In a series of posts we will look at exactly why and how this is happening. This is what I see- you can decide yourself what you see.

In the part 1 here, we looked at why the NHS budget must rise 3-4% per year just to stand still.

In part 2 here we saw exactly how this isn’t happening and the catastrophic effect it’s having on the National Health Service.

Now we examine why.

It’s clear the trend of rising demand and falling budget is not compatible with a sustainable health service, and after six years, the NHS is about to collapse. The question we have to ask is why would our leaders stand…

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The Significant Seven: an Exploration of the Counter-Evidence for a ‘7-Day NHS’

The Department of Health’s favourite line is “There are 8 independent studies showing a ‘weekend effect'”. I’ve been through these 8 before, and the terms “independent” and even “studies” are used fairly loosely. This has been the stick Jeremy Hunt and co have used to justify their unfunded and unmodelled 7-day NHS plans, and to beat the junior doctors with. This week the stick broke.

To borrow the Ministry of Truth’s own language: “There are now 7 independent studies showing that the 7-Day NHS plan is a bad idea”.
Juniordoctorblog explores the counter-evidence against the 7-day NHS spin.

The ‘Weekend Effect’

Three separate studies this week came out against the established narrative of ‘poor care’ at weekends creating excess deaths.

“Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission” by Meacock et al in 2016

All previous research has…

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Secular Talk on Donald Trump’s Confused Position on Healthcare

Beastrabban\'s Weblog

This is an interesting piece. Kyle Kulinski takes apart The Donald’s weird and confused answer on the question of healthcare in the Republican presidential debates. The moderator notes that Trump has said that he wants to repeal Obamacare, and opposes the introduction of universal healthcare, because it would lead to massive tax rises across America. So she asks the obvious question: What would he replace it with?

At which point, Trump starts humming and ha-ing, stating that there are a lots of examples of what could be done. He would repeal Obamacare, but make sure everyone was covered. He would introduce greater competition, and go back to free enterprise. He states he would repeal the arbitrary red line about insurance, and then criticises the insurance companies for pushing up the cost of healthcare to unaffordable levels, and profiting from it. He then states that the costs would come down if…

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Kindness and compassion – why they matter.

Original post from Loving Baby



One dictionary defines Kindness as going out of your way to be nice to someone or to show a person you care. Other definitions say kindness embodies generosity, selflessness and love. Compassion one dictionary states is, caring more about the thoughts and feelings of others than your own,  another definition says compassion is, a feeling of deep sympathy and sorrow for another who is stricken by misfortune. The question is for those of us that work in healthcare are kindness and compassion just words banded about at the many conferences and meetings we attend, or do they reflect the care we give and the services we provide? The truth is kindness and compassion are just as important as the medical care we provide, the equipment we use, the policies we are guided by and the safety of our patients.

When I gave birth to my first daughter medically the care we received was life saving for us both. However the poor aftercare, devoid of kindness and compassion, confounded my traumatic birth and left me coping with PTSD. The effects for me and my family have been long lasting and life changing.

While of course it matters the medical care we give, without it being enveloped with kindness and compassion we can unknowingly cause harm and heartache to those we are seeking to care for. Simple acts of kindness and showing compassion in our dealing with patients and as staff, each other, can go along way in making very difficult and sometimes traumatic situations such as the death of a loved one, the diagnosis of a terminal illness or caring for a desperately ill child just that little bit easier to bear.

So as people who work in a healthcare setting how can we keep kindness and compassion at the centre of care? What can we do as individuals and teams to keep kindness and compassion firmly in focus?

Patients put their trust in us to help them when they are at their most vulnerable, sometimes even placing their very lives in our hands. They rely on us to not only to give good accurate evidence based information, medical care that will help them enjoy a better, healthier, life, but also that we protect them from harm not only physically, but emotionally. But with the pressures of the modern healthcare system we can lose sight of the simple things, the language we use and the things that make a hospital visit or stay easier. We forget sometimes the kind words and the ‘feeling of deep sympathy and sorrow for someone who is stricken by misfortune’. Hospital in particular can be a scary place. Away from home, without loved ones around, often in pain or worried about what will happen all patients can do is look to those there to care for them for reassurance and comfort.

Do patients come first?

Two things are important to help us keep kindness and compassion in all we do. These are, the culture of our workplace and also our own personal, inner, values. Both culture and inner values are linked, they feed each other. How?

Does the culture we work in allow for kindness and compassion, does it help them nurture and grow? Are we working as a team, supporting each other, trusting each other?  Are individual talents and gifts allowed to flourish? Does our culture show that patients come first, that patients are viewed not as a label or a diagnosis but a mother, a father, a daughter or a son. Do we reflect in our language that we care, that we have time for, but also want to listen to patients and that their thoughts, needs and opinions matter?

What about patient needs? Does the culture allow for patients to feedback their needs and thoughts, are these valued and appreciated or just token listened to? Is the culture flexible to meet the needs of more complex needs, if the patient is blind or disabled, does the patient need family to communicate due to language needs or maybe learning difficulties. Or maybe mental health issues mean a patient needs extra support and understanding.

Or, is the culture based on policy, data, paperwork and procedures. Is the culture target driven and what’s best for staff not patients? Does the culture dictate the care given, unyielding to the needs of those it serves? Are patients made to feel like they are a burden, bothering staff or too afraid to ask for help?  This can be hard with so many demands and lack of resources, it can feel overwhelming maybe impossible to give care that is not only medically good but shows genuine kindness and compassion too. So what can help?

Firstly staff need support. Good communication, praise and kindness to each other are vital. Good management is also important. Allowing staff to grow, treating them with respect and making them feel appreciated will help keep a culture healthy. Its important too that staff are listened to. Winning minds and hearts of staff starts with an approachable management. Feeling that issues can be raised, ideas can be shared and they have an active role to play in improving services builds up staff and makes hearts swell with pride. Often if managers listen to their staff they will know what the service needs, what patients need and how care can be given in a productive but kind and compassionate way.

The second important link for showing kindness and compassion is our own inner values. We can ask ourselves?

  • Do we see labels or people?
  • Do we take responsibility for our own actions or do we blame the culture?
  • Are we showing kindness with each other and patients?
  • Do our actions show that compassion is our focus?
  • How do we view patients, are they a privilege or a burden?
  • Does the way we manage or treat work colleagues set an example in kindness.
  • Are we critical and indifferent to the needs of others?

These can be hard questions to face. But why must we look at our inner self and values? Because if all of us maintain our inner values, if we remember we are accountable for our actions, if we stay true to ourself and not let others dull our shine. If we keep patients as our focus and do everything to make care given right, if we speak up when we see something is wrong and do all we can to be an example of kindness and compassion then we affect the culture. Often thinking about how we would feel in that persons shoes, or thinking about what we would want for our family member needing care can help us keep our inner values on track. Our inner values and a healthy culture go together, with everyone displaying values that are patient focused there is no poor culture.

If we are struggling with our inner values then reflect on our motivation. Why we are in our job, how did we feel when we first started. No doubt we were full of enthusiasm and excitement. Maybe we wanted to help people, relieve suffering, make a difference or find our inner joy and happiness. Whatever it was that drove us on, that ignited our passion, make sure it is still burning strong. If the flames have some what died, then find ways to rekindle the embers till the passion for caring for others once again burns bright.

Inner values and a healthy culture so together.

Why does it matter? Because what we do and the way we do it can profoundly affect someones life.  We may not be able to bring back someones loved one that has died, or prevent someones child being sick or cure someone of an incurable disease, but we can make sure we give them kindness and compassion. It may only be small things, the way we say “Hello” on a reception desk, holding an older persons hand while they under go a test, sitting talking about the weather with a mother sat by her babies incubator, fetching a cup of tea for a son waiting for his father to come out or surgery or sometimes just saying ‘sorry’ that your appointment is late. But these small acts can mean so much to a person, to a family that is suffering, that are worried, that are looking to us to help. We may never know the effect of out kindness and how we have helped others but we will in our hearts know that we are doing our best.

Thankfully there are many working hard to show real kindness and compassion everyday, both in small ways and in making large scale changes. By working closely with patients and listening and sharing ideas they are improving services to reflect not only good evidence based care, but kindness to others and compassion especially to those in society that are most vulnerable. Medically we give our best, some saving lives everyday, however we cannot forget to show kindness and compassion. When we do it improves the culture, improves care, it helps staff feel appreciated and valued and patients feel cared for and safe. It means feedback for our services that builds a good reputation and gives staff praise for all their hard work but more than that it will bring us inner joy and happiness knowing we made a difference and we helped those who depended on us in times of distress to have a journey a little more bearable. Yes, kindness and compassion matters to us all.




High rate of healthcare visits before suicide attempts

Original post from Medical News Today 


Most people who attempt suicide make some type of healthcare visit in the weeks or months before the attempt, reports a study in the May issue of Medical Care, published by Wolters Kluwer.

The study also identifies racial/ethnic differences that may help to target suicide prevention efforts in the doctor’s office and other health care settings. The lead author was Brian K. Ahmedani, PhD, LMSW, of Henry Ford Health System, Detroit, Mich.

Health Visits May Provide Chances for Suicide Prevention

Using data from the NIMH-funded Mental Health Research Network, the researchers identified nearly 22,400 individuals who made suicide attempts between 2009 and 2011. They analyzed healthcare visits before the attempt, with an eye on the possibilities for identifying people at risk for suicide.

The study focused on racial/ethnic differences in the types and timing of visits, including any documented mental health issues or substance abuse. Information on race/ethnicity was available for 78 percent of patients.

Overall, 38 percent of patients made some type of healthcare visit within a week before attempting suicide. The visit came within a month before the suicide attempt in 64 percent of patients, and within a year in nearly 95 percent. The percentage of visits with mental health or substance abuse diagnoses was about 25 percent within a week, 44 percent within a month, and 73 percent within a year before the attempt.

The study found significant racial/ethnic differences: 41 percent of white patients made any type of health visit within a week before the suicide attempt, compared to 35 percent for those in other groups. Nearly 27 percent of white patients made a mental health visit in the preceding week, compared to less than 20 percent for most other racial/ethnic groups.

Asian-Americans were the least likely to make any type of visit within a year before attempting suicide. Hawaiian/Pacific Islanders had the highest rate of hospital admissions and emergency department visits before a suicide attempt, but the lowest rate of mental health or substance abuse diagnoses.

“Overall, visits were most common in primary care and outpatient general medical settings,” Dr. Ahmedani and coauthors write. Rates of visits for mental health specialty care ranged from nearly 60 percent for white to 40 percent for Asian patients.

More than one million people attempt suicide each year in the United States. The recently published National Strategy for Suicide Prevention concluded that healthcare is one of the best places to prevent suicide.

“This research provides essential information to aid suicide prevention efforts in health care systems,” according to Dr. Ahmedani and coauthors. They discuss the implications for targeting suicide prevention efforts by race/ethnicity – including the need for “culturally competent mental illness detection and treatment” in minority groups.

Most previous prevention efforts have focused on emergency and mental health settings, rather than doctor’s offices and other primary care settings, the researchers note. They conclude, “This study supports the promotion of suicide prevention within general outpatient settings, where most people visit before suicide attempt.”


Article: “Racial/Ethnic Differences in Health Care Visits Made Before Suicide Attempt Across the United States” (doi: 10.1097/MLR.0000000000000335)

Wolters Kluwer Health  ……….’