In Practice: Reflections from NPs and PAs

Megan Tetlow, PA-C, is from Fort Myers, Florida, now working in Sheffield, England, as part of the National Physician Associate Expansion Program. She practices in gynecologic oncology and is a guest blogger for In Practice.

I’m an American physician assistant living and working for the government-funded National Health Service (NHS) in the U.K. I also write for this blog about the differences between the U.S. and U.K. health systems. I have thus far been moderately successful at avoiding political discussions in the public sphere. But the recent passage of the American Health Care Act by the U.S. House of Representatives has me changing my tune. Let me explain why.

Scrolling through social media, I saw a GoFundMe page from a family struggling to cope financially in light of an unexpected diagnosis — a heart-wrenching story of a young mom diagnosed with cancer while pregnant. Now she (and her spouse) face the financial and emotional complications of undergoing primary chemotherapy and radiation while caring for a newborn and two other young children. Any parent can tell you how difficult it is to care for a newborn, much less doing so while undergoing cancer treatments … and taking care of other children … and not taking too much time off work lest you lose your job and, with it, your employer-sponsored health insurance and main source of paying medical bills. The most disturbing part of this story is how shockingly prevalent it appeared to be. I realized we live in a world where a working American family must rely on the charitable donations of strangers to have a chance of survival.

When British health care providers talk to me about health care in the U.S., their great fear is of patients needing care that they won’t receive because they can’t afford it. I explain private insurance and Medicaid and how many practices treat patients regardless of their ability to pay. But the truth is, there are millions of families who make too much to qualify for Medicaid but not enough to afford top-tier private insurance. And even if you have good insurance, you’ll likely have to pay a large amount out of pocket in addition to your sizable monthly premiums, should you ever actually need to use it. For instance, my mother broke her shoulder last year, and despite good employer-sponsored private insurance, she paid $8,000 out of pocket for the required surgery.

Unfortunately, these problems will only increase if the American Health Care Act is passed by the Senate. For example, the home state of the patient described above could choose to make cancer a pre-existing condition. If that happened, she could expect her insurance premiums to skyrocket. Even more troubling, under this new act, the patient’s pregnancy itself could potentially be classified as a pre-existing condition.

It has always bothered me that in the U.S. health system, one diagnosis or hospitalization can equate to economic ruin for a patient. However, it was not until I became a health care provider and resident in another country and in another health culture that I acquired a different perspective. I no longer believe that these situations are unfortunate—rather, they are inevitable. But they should be avoidable, and and I find them no longer tolerable.

I also find it intolerable that a health care bill opposed by the American Medical Association, American Academy of Family Physicians, American Nursing Association, and other professional medical organizations could be presented to Congress as a serious plan, let alone passed by the House.

I had always thought that as a health care provider, it was my duty to do the best I could for my patients, within the restraints of the system. I worked hard to help patients who couldn’t afford treatment to get linked up with charity groups or patient assistance. I filled out Medicaid applications and sent appeal letters to insurance companies. But I didn’t fight to change the system. Now, I believe that as health care providers, we must go a step further and become patient advocates, fighting bad health care policies as vigilantly as we fight disease. Our patients deserve it.