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 He became depressed and withdrawn, and eventually his wife left him.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. For this man, illness had caused the loss of his health insurance, and now lack of health insurance and adequate medical care was allowing his disease to progress unchecked. It was undoubtedly shortening his lifespan, and was creating a situation in which we as taxpayers will all pay the enormous costs of providing care for him as he becomes so severely disabled that he requires hospitalization, heart surgery, and perhaps dialysis. Yet, we as a nation have not been willing to pay the upfront costs that could help this man and so many others to get the care that could help prevent or slow disease complications and extend functional years of life.

Who are we as a people? How have we allowed it to become the norm that our citizens go hungry, sleep on the street, and do not have access to basic medical care? Nations vastly poorer than ours choose to treat health care as a basic human right and thus provide health care for all citizens.

We each know deep down that a sudden twist of fate could land us in a devastating situation like my patient Mr. Richards. The Reverend Martin Luther King, Jr., once said, "Of all forms of inequality, injustice in health care is the most shocking and inhumane." Paradoxically, in our country health insurance seems largely to be reserved for the healthy.

We are coming to an historic moment, when we finally have a president who is willing to put all of his weight behind passing comprehensive health care reform. The outcome though, is not guaranteed. Most worrisome is the backlash against the option of a public health care plan. The so-called “public option” would help to loosen the stranglehold that the private insurance industry has on our health care system. It would offer meaningful competition to for-profit insurers, would help to reduce costs for medical care, and would provide comprehensive insurance similar to Medicare.

Now is the time to let our voices be heard: Comprehensive health care reform with a public health insurance option is not just what we want, but what we demand.
Dr. Komaromy is a former medical director of Albuquerque Health Care for the Homeless.
Copyright © 2009 by the New Mexico Editorial Forum. 9/09