An unacceptable remedy for asthma

August 1, 2007

Building the case for providing free healthcare to children in the US.

An 11-year-old boy with a history of asthma is brought to a pediatric emergency department with a 24-hour history of wheezing. He has had no response to inhaled albuterol at home. The child is treated in the emergency department and is about to be discharged home. Then it is learned that he has a history of multiple hospitalizations for the treatment of asthma, including admissions to the pediatric intensive care unit, because of failure to comply with the recommended, prescribed medication regimen.

Consultation from the hospital social worker leads to the discovery that Child Protective Services has been very involved with the family because of medical neglect. In fact, this child's parents have now abandoned him to the care of an aunt and uncle; the parents' whereabouts are unknown. The aunt and uncle are well-meaning and would like to accept responsibility for the care of this boy and his brother, but they don't have access to his medical insurance card, and they don't have the money to pay for the medications that have been prescribed. The proposed solution to this problem? Hospitalization until appropriate care by a foster family can be arranged.

Now, let's replay this scenario in a setting in which health care is a presumed right for all children, and necessary, prescribed medications are provided without cost. That scenario wouldn't ad dress the irresponsibility of the parents, but it might well have prevented the current hospitalization and at least some of the prior admissions. And, knowing that the aunt and uncle would have access to needed medications, Child Protective Services would never have considered foster care as a solution for this child whose biological family was willing to care for him.

Michael Moore's recently re leased documentary, Sicko, provides a somewhat simplistic view of both the evils of the current US private insurance industry and the benefits of free and universal health care available in Canada and European countries. We know that the health care systems in those countries are not free of problems or critics, and it's unlikely that any new approach that moves in the direction of universal care will be perfect. Whatever the strategy, however, it should provide children with the medications they need without taking them away from their families.