Big headlines should accompany every needless death in our state; July 7, 2014

News item: A Tennessee couple was arrested for endangerment Saturday after leaving their small child in a car with the windows rolled up. The article states that dozens of children die every year from this form of neglect.

Meanwhile, a 55-year-old woman who lives in Alabama's Covington County has diabetes and is unable to afford her insulin. She waits too long to seek care in an emergency room for her bladder infection because she lacks insurance. She goes into a coma after her sugar gets too high (a combination of her lack of insulin, infection, and the Alabama heat) and is found after a day when her daughter comes to check on her. The hospital in Florala has closed, so it takes another hour for her to get treatment, but it's too late. She dies.

No article is written about her.

Three a day. That is the estimate of how many people die prematurely in Alabama because of Gov. Robert Bentley's decision not to expand Medicaid. They don't die in a spectacular fashion. Pictures of them smeared with birthday cake are not shown on the evening news. Instead, for the most part they have the decency to die quietly. They delay care for their diabetes and hypertension and die of a heart attack quietly in their home. They choose food over life saving medicine and seek care for their elevated blood sugar in the emergency room of their local hospital, sometimes miscalculating and dying before they make it.
Thirty. That is how many hospitals are projected to close in Alabama in the next several years because of the number of uninsured. Some of these may have closed anyway, but with 191,000 people in the coverage gap many more will close. With 15% of Alabamians lacking reliable transportation, this is a death sentence to those with chronic illness and no car.
Forty-seventh out of fifty. That's where the state of Alabama ranks in America when chronic diseases such as diabetes are combined with other poor-health indicators. Alabamians suffer disproportionately from chronic illnesses, but also are more likely to die from preventable cancers, heart disease, and infant mortality. Our citizens are getting sicker over time, not healthier.
We are losing dozens of Alabamians to death every month because they are uninsured. I would like to see headlines on each of them. Perhaps: "Woman lacking Medicaid dies from high blood sugar" or "Man working two minimum wage jobs, neither of which provide health insurance, has heart attack, decides to stay home, dies."

Such headlines might help us appreciate the urgency of the situation.

Perhaps Alabama's media could keep track of the impact of inaction: "Since Gov. Bentley declined the Medicaid expansion, 420 Alabamians have needlessly died and 3 hospitals have closed." Those numbers, by the way, are current as of today.

Access to health care saves people's lives. Paying hospitals to care for the uninsured helps the hospitals remain open. We can bicker about the mechanism but right now the Affordable Care Act is the only mechanism we have.

(Dr. Perkins is Professor and Chair of Family Medicine at the University of South Alabama College of Medicine in Mobile. The opinions he expresses are his own.)

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