An emergency room. In a cubicle, a sixty year old housewife complains of slurred speech and being unable to walk. She has history of hypertension, but can’t afford her medications. Her health care insurance provides coverage for catastrophic illness, but regular doctor visits and medications require high co-pays. In another cubicle, a man, also sexagenarian, complains of sudden weakness in the right (dominant) hand. He is a busy chef who owns his own restaurant; he has never seen a doctor or felt inclined to purchase health care insurance. His blood pressure was very high and needed powerful i.v. medications to control it, so that a clot-buster drug could be safely administered. Both had strokes, caused by clots blocking their brain arteries. Both patients had high blood pressure throughout their hospital stay, requiring anti-hypertensive medications to prevent another stroke or damage to other organs. Both were unable to work for months.
These strokes could have been prevented. I concur with Jeffrey Brenner’s opinion that “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise.” I know this is true because my job description (stroke neurologist) is to amend the negligence of our health-care system.
Easy interventions like dietary salt restriction can lead to modest but real declines in blood pressure, while cheap medications, such as the mild diuretic hydrochlorothiazide, may decrease the risk of stroke by almost 40%.
Hypertension is very common. As the graph shows, it becomes more prevalent with advancing age.
There is an almost linear relationship between blood pressure increments and the likelihood of having a stroke. As the graph below shows, stroke risk is cumulative and additional risk factors offer many opportunities to curb the risk.
In spite of this, many people with cardiovascular risk factors don’t have access to health care. For instance, blacks have higher prevalence of hypertension and related end-organ damage than whites (42% versus 28.8%, respectively), yet they are less likely to have health insurance (1 in 5 blacks were uninsured in 2008 —according to a CDC’s recent Morbidity and Mortality report—, while 14.1% of whites lacked health care access). Mexican-Americans are not as prone to hypertension, but almost 1 in 4 adult Mexican-Americans have the disease and 2/3 of them don’t attain good blood pressure control. To make matters worse, 2 out of 5 people identified as “Hispanics” were uninsured in 2008.
Universal access to health care is needed to end these inequalities.
It is in the best interest of every country that its population remains healthy. This is hardly an ideological postulate. A recent proposal to extend health care to all Vermonters begins with the argument that a large proportion of the population was ineligible for conscription in the army because of poor health.
Ayn Rand, the pythoness of the bradyphrenic, wrote in her Atlas Shrugged:
There is an old rule of physics: if you have too many people riding in the wagon, and not enough people pulling the wagon, the wagon stops.
To this bagatelle of wisdom, I would add: “the wagon may not move either if the ones pulling are obese, have hemiparesis or an ejection fraction of 10%.”