All Congress members should agree on one point: system is unsustainable

A physician recently shared a story with me. He spoke of a woman without health insurance who presents to the emergency department with uterine fibroids. He knows this woman: she is a “frequent flier” who often returns to the emergency department when the fibroids deteriorate to the point where she needs to obtain a blood transfusion. So, the woman is admitted and the blood transfusion is performed but the fibroids remain.

The appropriate treatment would be a hysterectomy or a partial hysterectomy. However, because she is uninsured, she waits until she requires a blood transfusion, shows up in the emergency department, is transfused, and is discharged after her emergency medical condition has been stabilized. The patient is frustrated because she knows that she is not getting the care that she needs. The physician expresses frustration because he knows what is clinically indicated in this case but his hands are tied because the hospital has admission guidelines that must be satisfied.

The present system rations her care, whether we want to admit that or not. So, the safety net for this patient remains the Emergency Medical Treatment and Active Labor Act, EMTALA, which ensures that people do not die in the street and are able to present to the emergency department for care to stabilize an emergency medical condition.

This story is simply illustrative; I am sure that during the month of August, all members heard stories like this from providers and constituents who have been patients. The healthcare system is simply broken; yet, I am hopeful because there is the potential for greatness. The question arises: Where do we go now? I have had time to reflect on this question during the month of August. After holding several town hall meetings and talking with constituents, I am more optimistic than ever that we simply must achieve something that has not been achieved in the history of the United States: enacting comprehensive health insurance reform through a system that has been redesigned to effectively rein in the rapidly spiraling cost of healthcare.

We have been on this journey for decades. The here-and-now represents a critical moment. We are on the precipice of passing a comprehensive health insurance reform bill. Will we plow forward to get a good bill done? Not just any bill, but a good bill that achieves these laudable goals of promoting access, quality, and reducing costs? Or, will we let this opportunity slip, saying that we can do this some other time? The story that the physician related to me, along with thousands of other similar stories, suggest that the latter is simply not an option.

We know that there is a need. We have 46 million uninsured persons in this country; this estimate does not include persons who are underinsured and thus one accident away from medical bankruptcy. We know that physicians are not being compensated in a manner that recognizes and incentivizes those who provide high-quality healthcare. We know that there is fraud that can be wrung from the industry: the U.S. Department of Justice just announced the largest healthcare fraud settlement in history — $2.3 billion related to a whistleblower claim in which physicians were paid by a pharmaceutical company, not for providing high-quality healthcare services — but instead, for writing prescriptions.

I believe all members agree on one principle: the current system is unsustainable. We simply must enact comprehensive health insurance reform. It is September and it is time to get energized to come together to get this done.

McDermott is a member of the House Ways and Means Committee.