Pediatric Annals

Editorial Free

Affordable Care

Stanford T. Shulman, MD

Pediatric dermatology cases, always very popular with our readership, are presented in this issue of Pediatric Annals, which is guest edited by Sarah L. Chamlin, MD, an outstanding pediatric dermatologist and member of our Editorial Board. Children with various dermatologic issues are certainly common in our offices, and I believe the cases presented here, with discussion and differential diagnoses, will be valuable.

Access to Medical Care

We are all aware that the roll-out of the Affordable Care Act (ie, Obamacare) has, to say the least, been problematic. As I write this, however, there has been a considerable amount of improvement in the ability of individuals to sign up for care compared to the initial disastrous performance of the website. However, I strongly believe it is important that we don’t lose sight of the major goal of this very complicated legislation — that is, to provide medical coverage for the almost 50 million Americans (22% of all adults) without insurance.

Several recent articles in the medical literature and in the lay press have highlighted individual tragic stories of the consequences of medical care delayed specifically because of lack of insurance. These tragedies put a human face to the estimate by Families USA, a healthcare advocacy group, that an American dies every 20 minutes because of lack of medical care, a statistic derived using methodology developed by the Institute of Medicine in an earlier study.1 A 2009 study in the American Journal of Public Health concluded that almost 45,000 adults (actually one every 12 minutes) die yearly in the U.S. because of the lack of medical coverage.2

An elegant article in the Nov. 14, 2013, New England Journal of Medicine by Michael D. Stillman, MD, and Monalisa M. Tailor, MD,3 described several of their patients who suffered serious inability to access medical care, indicating that the descriptors “shocked,” “saddened,” and “disheartened” didn’t quite capture their emotions as well as the word “appalled.” The patient they described in greatest detail, with metastatic colon cancer and a completely obstructed colon after more than a year of symptoms, had originally seen a primary care physician a year earlier who indicated that he could not be evaluated without insurance. This was despite the fact that both he and his wife worked full-time jobs without coverage and were ineligible for Kentucky Medicaid. The colonic malignancy spread widely and then completely obstructed the colon, prompting his visit to the emergency department, where he was finally diagnosed long after a cure was possible.

Similarly, Nicholas Kristof4 also described tragic patients in a recent New York Times article. He noted that although many Americans receive superb medical care, tens of millions without insurance receive marginal care at best, lacking access to many preventative and screening measures, among other deficiencies. This helps to explain why many other countries have longer life expectancies and much lower child mortality rates compared to the U.S.4

Although fortunately relatively few children lack total access to care in the U.S., the care of uninsured children is often compromised in a variety of ways. The American Academy of Pediatrics (AAP) has worked with federal and state policymakers to ensure that the Affordable Care Act’s health exchanges provide high-quality health benefits for children in the marketplace.

“This moves the U.S. closer to achieving the dream of every child having access to high quality coverage,” outgoing AAP president Thomas K. McInerny, MD, FAAP, said.

Full implementation of the Affordable Care Act has the promise of changing access to medical care in America for the benefit of average citizens in a positive way and continues to be a worthy goal despite its unfortunate launch.

This Month’s Stamps

The very colorful sheet of 10 stamps was issued by South Africa to celebrate the 19th World Transplant Games, held from July 28 to Aug. 4, 2013, in Durban, South Africa. The games are held every 2 years and this year were sponsored by the South African Transplant Sports Association, established in 1994 by a small group of organ recipients. Transplant recipients participated in 13 sporting events, with more than 1,500 athletes from 69 countries, including 298 from the U.K., 142 from the U.S., 136 from South Africa, and 110 from The Netherlands. One goal of the games is to promote public awareness for organ donations. Designed by South African stamp artist Peter Sibanda, the stamps portray lung, heart, kidney, and liver transplant recipients engaged in various sporting activities. Recall that the first successful heart transplant in the world was performed by Christian N. Barnard, MD, PhD, in South Africa.

Set of stamps issued by South Africa to celebrate the 19th World Transplant Games, held from July 28 to Aug. 4, 2013, in Durban, South Africa.Image courtesy of Stanford T. Shulman, MD.

Set of stamps issued by South Africa to celebrate the 19th World Transplant Games, held from July 28 to Aug. 4, 2013, in Durban, South Africa. Image courtesy of Stanford T. Shulman, MD.


  1. FamiliesUSA: The Voice for Health Care Consumers website. Available at: Accessed December 9, 2013.
  2. Wilper AP, Woolhandler S, Lasser KE, et al. Health insurance and mortality in U.S. adults. Am J Public Health. 2009;99(12):2289–2295. doi:10.2105/AJPH.2008.157685 [CrossRef]
  3. Stillman M, Tailor M. Dead man walking. N Engl J Med. 2013;369(20):1880–1881. doi:10.1056/NEJMp1312793 [CrossRef]
  4. Kristof ND. This is why we need Obamacare. New York Times. November 3, 2013: SR11.


Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD, is the Virginia H. Rogers Professor of Pediatric Infectious Diseases at Northwestern University Feinberg School of Medicine; and Chief of the Division of Infectious Disease at the Ann and Robert H. Lurie Children’s Hospital, Chicago, IL. Dr. Shulman is the recipient of the AAP 2011 Award for Lifetime Contribution to Infectious Disease Education.

An avid stamp collector, Dr. Shulman chooses relevant stamps from his personal collection to accompany his column each month.

Reach Dr. Shulman via email:


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