Health care looms as key election issue

Lowcountry residents say it goes beyond insurance

As the 2008 presidential primaries get closer, The Post and Courier is taking a close look at some of the biggest issues as seen through the eyes of Lowcountry residents. This first installment looks at health care.

A year ago, Dr. Patrick Cawley treated a Colleton County man of modest means who was in his 40s, had high blood pressure and suffered a mild stroke.

The man was treated and discharged, with the only lingering symptom a little weakness in his right hand. Several weeks later, the man didn't — or couldn't afford to — pay the $25 or so per month to refill his high-blood pressure medicine. About seven months after that, he suffered a major stroke, one that left him paralyzed on his right side.

"On a personal note, it sort of breaks your heart. If they had a little more insurance or they had a little more resources, they would get their blood pressure medicine so they wouldn't have another stroke," said Cawley, the Medical University of South Carolina's chief medical officer.

The man is among the 47 million Americans without health care insurance. And while Cawley noted some might criticize the man for not properly caring for himself, "at the same time, he shouldn't have to make those basic choices."

Ensuring that every American has access to basic health care has loomed as the largest health care issue in the 2008 campaign, but those working in the field know it's not the only one. They would like to hear the candidates talk more about prevention, education and advocacy so people can better care for themselves.

Ann Carter, who works for the nonprofit Every Child Matters, has seen a problem firsthand with her father, who has held a regular job that provided him with health insurance. But even though diabetes runs in their family, he never talked with a doctor about preventing that, and he was diagnosed with diabetes about 14 years ago.

While he takes medicine to control his diabetes, that in turn has caused kidney and cardiovascular problems. At age 65, Robert Carter has had to postpone retirement and keep working to ensure that he remains covered. "His doctor is like 'Retire, retire, retire.' He's like, 'I can't right now,' " she said.

Ramona Smith is a nurse manager with MUSC's transitional care unit. The unit acts as a sort of safety net, and Smith treats patients who don't require hospitalization but still have serious health problems and have nowhere else to go.

"They may have no family. They may have burned their bridges. They may be undocumented workers," she said.

She praises her nursing staff for going the extra mile, whether by delivering medicine to Charleston's homeless shelter or buying clothes and underwear for a returning patient who lives under a bridge and often arrives at the hospital naked.

"I don't think we can find better health care than we have here in the United States," she said, "but I do believe there's a health care crisis because there are too many people who don't have insurance."

While Smith and her colleagues provide good care, it often comes too late, after a patient's illness has worsened and caused a problem too serious to ignore.

"The safety net is there, but it's always an urgent thing. It's not the wellness/prevention model I'd like to see. There should be places where you can go and get a physical," Smith said.

The Rev. Jeannette Jordan of The Church House of Ministries outside Summerville used to work in a hospital and has turned her church into a kind of health care center in its own right. It provides monthly screenings for its 150 members, about one-fourth of whom don't have insurance. They step on the scale, get their blood pressure and blood sugar checked. Each member has a file.

During one of those screenings, she found a parishioner whose blood pressure was 192 over 127, so high that she needed to be taken to the hospital at once.

"She had no previous knowledge that she had high blood pressure." She didn't fit the high risk profile at all: She was thin, educated and her husband was a retired Air Force officer who had good health insurance. Jordan said the woman was somehow released with high blood pressure medication until Jordan checked in and urged her to return to a doctor, who said her high blood pressure was noted a year earlier though she didn't get the message.

"You have to be aggressive," Jordan said. "She said, 'You know pastor, you all saved my life. The doctor told me I was a walking time bomb.'"

Another parishioner had an infection on his toe. He initially was told to treat it with Vaseline and then another cream, neither of which helped. Jordan urged him to check into a hospital and to resist any effort to amputate the toe until doctors tried aggressive antibiotic therapy. Doctors scheduled him for surgery anyway, but he held his ground thanks to Jordan, who worked in a hospital for 15 years.

"He still has his toe today," she said, "but his toe would have been gone if he didn't know somebody who knew the system."

Jordan said any health care reform should emphasize ways to educate people about their health and how the system works.

"We have to make sure great effort and dollars will go to education at a grass roots level for communities at risk," she said. "People need to know what to ask. They need to be informed. If not, the whole nation will suffer."

Michael Jernigan, chief executive officer of Select Health of South Carolina, which has its headquarters in North Charleston, said the health care debate should focus on solutions.

His company works with about 77,000 South Carolinians who qualify for Medicaid but who choose to have their benefits coordinated through the private sector, not government. His company has staff that educates members about their benefits, provides nursing advice around the clock and goes into the community to teach people about asthma and other illnesses.

"The state saves money through our program. We saved the state $3 million in 2005," Jernigan said. "To me, what it confirms more than anything else is our program emphasizes that preventative care can pay off."

Lorna Beck works as a quality improvement and compliance officer with Franklin C. Fetter Family Health Center, a federally funded clinic. She also has established a nonprofit to help get the word out about healthy lifestyles.

She met a woman at a health fair who had been diagnosed with a brain tumor but who couldn't get it operated on because she didn't have the money.

"The last time I heard she had been hospitalized but the hospital was not going to perform the surgery. That's not uncommon," she said. "We see people without insurance every day, and then there are many institutions where they can't get specialty care because they don't have insurance to provide that. There's nothing beyond us. As a health care provider, your hands are tied. You feel very sorry for the patient, but there's nothing you can do beyond your scope and practice."

Cawley said he wants the next president to make sure that every American has access to basic health care, although he acknowledges the definition of "basic" itself could lead to a testy political fight. Does that include generic drugs or brand names? Is preventative care a basic right or should it be a luxury? Should they be able to see a specialist?

"That muddies the entire debate," he said. About nine out of 10 of the uninsured could be greatly helped simply with access to a clinician, generic medicine and the ability to see a specialist under certain circumstances. The other one in 10, though, often requires much more expensive drugs and evaluation.

"We get so wrapped up in that last 10 percent," he said. "The last 10 percent are the hard ones to solve. It's the expensive care."

On the Web

Candidates speak out on health care

Reach Robert Behre at 937-5771 or rbehre@postandcourier.com.