A Tale of Two Glaucomas
My personal experiences as an Optometrist Technician in one of Pittsburgh's lowest-income suburbs, Aliquippa, and a medical mission in Honduras, reveal a sobering reality: the availability of healthcare does not guarantee its accessibility.
Image from inside the rural clinic in Honduras.
I remember two patients with advanced glaucoma: a man from the United States and a woman from Honduras. Despite having access to healthcare his entire life, the man hadn't had an eye exam in sixty years due to high costs. In contrast, the woman, from a remote Honduran village, had no eye care available until our medical team arrived. She walked for 4 hours to reach the clinic, where she would have to wait another 2 hours for her appointment. Their contrasting experiences highlight a disturbing paradox: even when treatment is available, financial barriers can prevent its use, even in the world's richest country. This realization, first encountered at 17, has had a lasting impact on me.
Government programs consistently fail redlined communities, a truth I've witnessed firsthand. For three years, I've served as an Optometrist Technician in Aliquippa, one of Pittsburgh's lowest-income suburbs. This experience has granted me an unfiltered view into the lives of those without the privilege of assured healthcare, where straightforward procedures can lead to months of debt. In a place like Aliquippa, where the average household earns just $32,400 and 30% of families live beneath the poverty threshold, it's sadly unsurprising to encounter older individuals experiencing comprehensive eye care for the first time.
When this is happening, it really makes me wonder how affordable is the Affordable Care Act in this landscape? Its name suggests relief, but the reality is far from it. With exorbitant premiums and deductibles, many in these economically challenged areas are left grappling with out-of-pocket expenses they simply can't afford. A doctor I worked alongside in the clinic mentioned that low income patients, “Push off their medical conditions, almost like they are gambling with their health, until it is too late and their vision will never return.” The choice to seek medical attention in a system burdened by soaring costs often forces individuals to weigh healthcare against basic needs like food. For those who opt for a doctor's visit, the initial expense can be just the beginning of a larger financial struggle, especially if medication is prescribed for their condition.
Medications are difficult to afford for a lot of Americans, according to the 2019 Kaiser Family Foundation Poll, nearly 1 in 4 Americans taking prescription drugs say it’s difficult to afford their medications. While Medicare may seem to help people who are low-income, patients are often struck when they reach the medication cap. This coverage gap, known colloquially as the “doughnut hole,” is especially prominent from August to December. During this period, many patients, unable to afford their medications out-of-pocket, become non-compliant, which jeopardizes their health even further. Witnessing these inequities, largely invisible to much of America, ignites both my frustration and my drive to fight for cheaper drug prices. Our nation's inability to address the needs of these communities is a glaring oversight.
The reality of the woman from Honduras and the man from the United States are destined to face a future of diminishing sight due to their advanced glaucoma. Not only is this a testament to the global challenge of healthcare access, but it serves as a reminder that in the richest country in the world, low-income patients face similar outcomes as those who live in low-income countries like Honduras.
While this similarity underscores a profound disparity in healthcare systems worldwide, it also highlights the urgent need for reforms that prioritize affordability and accessibility. In a world where geographical boundaries and economic status should not dictate the quality of healthcare, these parallel stories emphasize the critical need for a more equitable approach to medical care, ensuring that essential treatments are within reach for all, regardless of their financial means.