By Miriam Komaromy, MD

When I walked into the exam room, a thin, pale, middle aged man was sitting patiently in a chair waiting for me. Mr. Richards (not his real name) politely explained that he needed medicine for his heart, and gave me a list of the medications he was supposed to be taking. I asked about his living situation, and he told me he had been living in shelters for the past two years.

As he responded to my questions I learned this man was an engineer who had been employed by a prominent technology firm. When he had developed diabetes in his late 30s he quickly developed severe complications, including damage to his vision, and later heart trouble. He could no longer perform his work duties. He lost his job and then his health insurance. He became depressed and withdrawn, and eventually his wife left him. His health care bills bankrupted him and he lost his home. He had applied for disability benefits, but was turned down.

As this man’s story unfolded I felt my stomach clench with anxiety for what would happen to him. Unfortunately I had very little to offer. As a physician who has worked all of my adult life caring for low-income and uninsured patients, I have so often been in a position to apply a band-aid—in this case, arranging for him to receive a month’s worth of his medicine free of charge—but not a solution to the huge problems that face my patients on a daily basis. In order to get in to see a health care provider at my clinic he had stood in line for over an hour in the heat on two successive days, waiting to find out if we would have an available appointment. Tonight he would walk a long distance alone on the street, vulnerable because of his poor eyesight, and would sleep on a cot in a shelter.

I was struck all over again by the cruelty of a so-called health care “system” that offers health insurance only to those who are employed.

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