Letter to the Editor: Wait Times Don't End for Uninsured

Editor: Our national health care reform debate proves the adage, “A lie can travel halfway around the world while the truth is putting on its shoes.” One of the worst untruths is that countries with universal health care ration care and patients die waiting. U.S. patients, in fact, wait the longest while suffering and dying at the highest rates. Wealthy and well-insured patients go to the front of the line, sending to the back many who suffer needlessly or die waiting. We must factor in these unfortunate patients in an unbiased analysis of U.S. health care. We can then see that system performance overall is abysmal. The Commonwealth Fund publishes comparative analyses of health care system performance every several years, finding in 2014 that the United States ranked last among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives despite having the most expensive health care system. (https://tinyurl.com/yprswtn6.) This is troubling. We are last in access to care, equity, and fairness because the United States is the only nation that believes private health insurers have our best interest at heart. EPs know corporate interests see us primarily as widget-turners and revenue producers. But it is the outright denial of access to care that shocks me. “Americans were the most likely to say they had access problems because of cost. Thirty-seven percent said they did not get needed care, fill a prescription, or visit a doctor or clinic when they had a medical problem because of cost.” (Commonwealth Fund. https://tinyurl.com/5a6zw5b9.) Only four percent and six percent of patients in the United Kingdom and Sweden had these concerns, respectively. Wait times are infinite because the 37 percent of Americans noted above were not able to access needed care at all. The wait time is permanent for many uninsured or underinsured Americans. It never ends. Keep this in mind as we read the Commonwealth Fund report on timeliness: “It is a common mistake to associate universal or near-universal coverage with long waiting times for specialized care. The U.K. has short waiting times for basic medical care and non-emergency access to services after hours. The U.K. also has improved waiting times to see a specialist and now rates fourth on this dimension with the U.S. ranking third. Patients in the Netherlands, Germany, France, and Switzerland have rapid access to elective or non-emergency surgery compared with patients in the U.S.” (Commonwealth Fund. https://tinyurl.com/5a6zw5b9.) It is a mistake to associate universal care with delays in care, seeing a specialist, or elective surgeries. Canada does have wait times for specialized elective care, but our Canadian EM colleagues assure us that emergency care and procedures are done in a safe and timely manner. If universal coverage was the cause of waits, U.S. Medicare patients would be looking at serious delays. It is often cited that Canadians wait for elective knee or hip replacements, but U.S. patients also wait, often putting off joint replacements for years. And remember that the wait is infinite for 37 percent of U.S. patients without good insurance. Brad Cotton, MD Washington Courthouse, OH

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