This pile of stones was a two-room house, with a dirt floor, tin roof, no running water, and no electricity. And it was my mother’s childhood home in Barnacranny, Galway, Ireland. My grandmother gave birth to 10 of her 12 children in this house (she delivered the last two in a hospital). Tragically, she was widowed while her youngest was still in diapers. Luckily, her children were all born healthy, and the family needed little medical care. My grandmother summoned a doctor when needed, but those visits often required careful bartering and budgeting. She once burst into tears when she saw that ALL her children had demolished a (luxury) box of oranges, leaving only one for their sister, who had been diagnosed with scurvy.
Healthy habits and medical care often receive credit for good health. We don’t talk about luck enough. Luck can be genetic or economic. I’ve sat in meetings where leadership (physician, hospital, pharma, insurer) say, out loud, “Well, they chose the plan with the lower premiums and the higher deductibles; they took a gamble they wouldn’t need healthcare. That’s not our responsibility.” Or, my favorite (not), “Well, if patients have to pay more, they’re more likely to be adherent because they’ll value their medication more.”
Dude (this daughter of Erin has lived in California longer than anywhere else): They choose the lower premiums because they need those dollars for childcare. Or their student loan payment. Or rent. Or their bus pass. Or oranges. If paying their out-of-pocket medication costs is a struggle, patients simply won’t take their medicines. Or they’ll skip doses to stretch that 30-day bottle to 60 days. A cruel fact of life is that not everyone is born equally lucky.
We hope that patients can stay behind science’s learning curve, but we must put in the work so that access to that science is not a matter of luck.
This morning, at a very young 87, my mum received her second COVID vaccine shot. How lucky am I? (Very.)
Happy St. Patrick’s Day. Lá Fhéile Pádraig sona daoibh.
