THIS AGAIN?


Again I find myself looking at the Affordable Care Act, aka ObamaCare and wondering how did we get here? With a rapidly aging population and escalating costs some changes were inevitable. We spend more per patient but get worse results. I have heard and read many blaming the newly arrived sicker immigrants and the lazy minorities. Those attitudes represent the bias in the healthcare system were minority patients are often not treated with the respect they deserve and often get substandard care.  As a minority physician I saw this a Medical student and choice to do rotations in areas with significant minority populations. What I realized is that poor care is not a choice of commission, it is most often a result of omission. The truth is that most patients get great care, but the system often gets it wrong with minority patients. Having family members with great insurance and serious chronic medical issues puts the disparity in care front and center. Lack of insurance is not the most significant problem. The problem is bias. On countless occasions, care is significantly delayed for no apparent reason. As a physician I can make that statement with confidence, because I have experienced it on many occasions. That loud minority patient is not just loud, but loud because after giving the system the benefit of the doubt she or her family is still sitting waiting for urgently needed care. I usually do not announce that I am a physician and thus get to experience the treatment I often heard about but did not believe. I am here to affirm the assertion, if you are a minority patient you will get poor treatment.

Will any of the changes of ObamaCare make the care of minority patients any better? I am not sure, but at least outcomes are being closely tied to pay. Yes I went there. Tying objective criteria to payment is an excellent means of encouraging improved care. We might not want to accept that outlook, but if we expect our patients to take their medications as prescribed why shouldn’t payers expect us to provide evidence based care. If we would enforce some self-regulation we would not be here. For minority patients we are hoping that our care improves with the general expectation of higher standards. This is our hope for ObamaCare.

As a physician I wonder about the goals of Obamacare and lament the loss of freedom. I dread the arrival of the heavy hand of government regulation. The problem is that as physicians we have not been good stewards of our privilege. As a group we are reactive not proactive. Unfortunately we are once again reacting to the new paradigm. Many of these changes have been in the works for significantly longer than the discussion that  surrounds ObamaCare. Instead of organised self-regulation we now have government mandates. These mandates are not the answer, judicious self-regulation is the answer. We need to examine the new paradigm and workout a constructive path to achieving our goals.

No matter what our goals are, the constant absurd chatter about the evils of the law is a waste of precious time. I suggest a more constructive conversation would be to evaluate how we got here, look for the future challenges and proactively respond. We are problem solvers. Let us look closely at the issues and solve the problems before the government goes further in destroying the practice of medicine.

ENJOY YOUR EASTER.


Often life gets in the way of living and we get carried away with the emotional. The beauty is in the living not in the life. Our experiences are the sum total and the after life is irrelevant. That view of life is much disputed, but it is my view. The constant attempt of the religious to guilt us into prescribed behaviors is admirable only in that it has so thoroughly succeeded.

The complaints that will spring from my expression of this opinion is so perfectly conjured, by the religious, as to make even the most noncommittal give credit to those views. The oddity is that the same people who believe in the absolute power of scientific evidence in the care of patients ignore the validity of those rules to justify their beliefs.

As I tell the story I lost my religion in the sixth grade when a teacher seeing I was bored gave me a book about the solar system. Not far into reading about our tiny part of the universe the story of creation as proclaimed by Genesis lost all meaning. As a 9-year-old I was not sure about what I was reading, but the seeds were planted.

Those seeds grew into my love of science and evidence. I will allow you your belief structure as long as you do not attempt to guilt  me into compliance with your view of the universe. I will acknowledge the evidence and your freedom to do otherwise. I am comfortable with the knowledge that I am not in control of the universe. I am comfortable that your religious convictions do not give you any more understanding of the universe.

Religion is about ignoring the uncertainty and providing platitudes to explain the unexplained. I will stand with the evidence and follow it where it leads. I can live with the uncertainty and strive to find the evidence to answer the important questions.  Because I am looking for evidence does not make me any less of a person than you are. It makes me less ideological.

Enjoy your Easter, while I continue to look for the evidence.