Health care help just out of reach

Editor's note: This is one in an occasional series by columnist Issac J. Bailey examining health care and insurance issues and how they affect the lives of patients and their families.

On May 28, James Pope of Conway was 20 minutes away from the relief he had been seeking from a throat condition he's struggled with for more than a decade.

He was sitting in the office of Dr. Lucinda Halstead, a head and neck surgeon at the Medical University of South Carolina. Halstead was preparing to stick a snaking camera back down Pope's nose, as she'd done just minutes earlier to get a good look at two vascular polyps on his vocal chords, a condition she mostly sees in cigarette-smoke-inhaling bar singers.

The polyps are likely noncancerous. But Halstead was at least the second doctor who recommended they be removed; the first made that recommendation almost four years ago.

"They would get bigger, which might cause airway obstruction, eventually making it hard to breathe," Halstead told Pope.

She was readying her laser surgery equipment, then called in the nurse to assist.

"Ten to 15 minutes to numb him up, five minutes to do the procedure," she said.

The surgery would have cost Pope almost $2,000.

"Wait," Pope told her. "I can't afford it right now."

He has no health insurance and hasn't been able to work since he began battling a skin and throat condition whose root causes were only recently identified.

How it all happened

The uninsured are up to three times as likely to delay seeking medical care than the insured, according to Families USA and other medical research. And those delays are costly to those with insurance, who pay an estimated extra $1,100 every year to help offset the costs the uninsured accrue in emergency rooms and other medical facilities for illnesses that could have been prevented or been less expensive to manage had they received earlier treatment.

Successfully accessing the health care system can be complicated for those with insurance. It can be even more daunting for those like Pope and the 20 percent of South Carolinians who have no insurance, particularly when they have to navigate the legal system while seeking medical attention. The 2010 Affordable Health Care Act will provide a new option for many of those residents beginning Aug. 1, but Pope isn't certain he will be able to take advantage of the new high-risk pools designed to help those with pre-existing conditions.

Federal officials are using $5 billion to make insurance on the individual market as affordable for the sick as it is for the healthy, said Jennifer Tolbert, a health policy expert for the Kaiser Family Foundation. Under the law, insurers in 2014 will no longer be allowed to deny coverage based upon a pre-existing condition. The high-risk pools serve as a bridge until that provision of the new law becomes active.

"The premiums are set for a standard population, which means they are set as though they are not sick," she said.

According to Families USA, more than a third of the state's residents go without insurance for parts of the year. Most of those in the portion of the uninsured population who are not working are family caregivers, disabled or have a chronic illness, such as Pope's.

According to medical and court documents, he suffers from a painful skin condition that began in 1996 after he began working as a car detailer at Hadwin-White Buick in Conway, where his job was to use a variety of cleaning products to keep cars looking new for potential sale. At its height, the condition affected more than a third of his body.

The skin condition has kept Pope out of work since 2007 and in his single-wide mobile home to avoid too much sunlight, particularly during hot summer days, when it worsens. His skin burns when he showers.

"It hurts to drink or eat," Pope said of the times when the conditions makes his throat swell. "And that happens a lot this time of year. I gargle salt water or get something from the drug store, like Gold Bond."

He left the company in 2003 and became a detailer at another area dealer, but was fired because he was advised not to work with the cleaning products, according to a termination letter.

Hadwin-White declined comment about Pope's medical claims.

His efforts to continue his lawsuit have been complicated by an inability to get and keep a lawyer. Some told Pope they had conflicts of interest with Hadwin-White officials. One was angered when Pope refused to deny his medical condition during a potential settlement hearing, he said.

The doctor who has been trying to solve Pope's condition for several years said there's reason to believe his condition is related to his work detailing cars, though it is always difficult to be certain.

"He didn't have the problem, he started working there and started having the problem," said Robert Bibb, a Myrtle Beach dermatologist. "But it's like a needle-in-a-haystack search."

In a 2006 deposition in the case, Bibb testified: "These are very powerful detergents that he's been using here, and detergents take off the natural oil of your skin and any of us probably using these or exposed to these on a constant basis without protection will get irritated skin."

Over the past decade, he has frequently awakened to sheets spotted with blood from when his skin broke out while he slept. The condition flares and subsides but is ever-present and covers 35 percent of Pope's skin during the outbreaks, according to medical and legal records.

The polyps in his throat make his voice raspy, sometimes making it difficult to understand what he's saying.

"It got so severe he could hardly function," Bibb said. "It makes your life miserable. We had to get James away from the work. He was a mess. We tried for years to get him disability."

The source of injury

Without insurance, Pope's visits to doctors have been haphazard. His older brother has helped pay for Pope's visits to Bibb and others. His income consists of that help and his wife's disability checks. They've been able to come up with enough money for a $97 visit here, a $100 visit there, a few hundred dollars for medicine and more than $6,000 for lawyers over the past several years.

For the past few months, Pope's brother has taken him to a handful of doctors to try to get a handle on his condition.

Dr. Daniel Rosner of Myrtle Beach recommended Pope have throat surgery in 2006. But Pope wasn't able to see Rosner again until April. Pope's file had been placed in storage because of the four years between visits.

The uninsured don't receive timely treatment and are up to four times less likely to have a regular source of care than the insured, according to findings by Families USA.

Finding the precise combination of chemicals that causes an allergic reaction in certain people can be an endless search. After about 10 years of tests, Bibb tested the specific products Pope worked with as a car detailer and was able to pinpoint the ingredient that has been antagonizing Pope.

The combinations that must be tested could number in the thousands, which is why it took Bibb, who consulted with other specialists, years to determine that Pope is allergic to propylene glycol, found in soaps, shampoos, as well as the cleaning products. Pope's infrequent and inconsistent trips to Bibb's office - because he had trouble paying - also delayed the process.

Labels on the products Pope used as a detailer recommend the use of "chemically resistant gloves" if there is repeated or prolonged contact with skin. Pope said he worked without gloves until he began complaining about the worsening skin reaction, then was given a "pair of gloves that were too small."

"[The chemicals] would eat the meat off your hand if you didn't wash it off soon enough," Pope said.

The problem, Bibb said, is that once someone is "sensitized" to a chemical it can be transferred into other parts of his life. Pope will have to read ingredient labels on everyday products to avoid the chemical.

Not everyone exposed to such chemicals will respond the same or have allergic reactions, Bibb said in the deposition.

"Whatever he got exposed to over there, he might be exposed to now," he said.

"Obviously you are better since you are away from all of the cleaning products," Bibb told Pope during a recent visit for which he didn't charge Pope.

Discounts aren't enough

Still, the two polyps that developed the same time his skin began flaring remain on his vocal chords.

During his visit to Halstead in May, she explained that concentrated energy from a laser would be absorbed by the blood vessels, shrinking the polyps and leaving little to no scarring.

"These things are going to look different but they'll still be there but will continue to decline," she said. "We might have to go back in, and there's a small chance of making his voice worse."

MUSC offers a 50 percent discount to uninsured patients, meaning Pope would have to pay $1,760 of the $3,528 cost to have the polyps taken out to remove any chance that they can cause him long-term damage.

If he's eligible for the high-risk insurance pools that will be available Aug. 1, he would likely have to pay roughly $500 a month and have a $2,500 deductible, something Pope said he couldn't afford.

"She said she could do [the surgery] right here in the office," Pope said. "But I don't have that kind of money."