DOCTOR, TAKE A STAND.


The debate around health care in our fair country as heated up again. The strange thing about the process is that the majority of the people commenting already have great insurance. They can afford to pay for great health care. The ACA is flawed and all should admit it, but it is not the cause of the chronic underperformance of our system. We have a closed unresponsive system that is constrained by an ill-informed electorate.

We need to exposed the entire system, both strengths and flaws, to the public. Doctors need to be in charge of care decisions and also need to be cognizant of the economic realities. Patients need to have realistic expectations, which should be set by their doctors.

Doctors need to stop listening to the ill-informed lobbyists. Those lobbyists are not working on our behalf, they are working for other economic interests. Doctors need to stand up and start voting our economic interests because the lobbyist are voting for their own. The interests of the lobbyist only rarely intersect with our own.

Let us take a stand together. Let us take a stand firstly for our patients and secondly for our own self interests.

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.

ACCESS TO HEALTH CARE IS A BASIC HUMAN RIGHT.


2012-12-28-0242The current consternation in our country about the provision of health insurance for the entire population is somewhat baffling. The selfishness that says that ones lack of insurance is always your fault is truly inhumane. Maybe I am the selfish one because I want to get paid for my services. The dilemma we have is that most of us don’t understand the care delivery system and more problematic is that we don’t understand the concept of insurance. Neither is easy to explain in our 30-second 24-hour news cycle. The paradox of not wanting to spend hundreds of dollars to save hundreds of thousands is lost on the general population. More precisely, ‘a penny of prevention is worth a pound of cure’. It seems that the few that understand either gain from the broken system or are powerless to change it.

The conditions that lead to lack of insurance are varied and are sometimes self-inflicted. In spite of this, it is our responsibility to care for each other. After my last weekend on call I have come to the conclusion that access to health care including insurance is a basic human right. Some may disagree, but I say you are 100 percent wrong. My other conclusion is that I am not the selfish one. Sadly, that leaves you. Yes, I know I have no right, but I have seen too much to disregard the obvious and pervasive selfishness and disregard shown to the weakest among us. We claim equality for all but are quick to disregard the suffering of others so we can continue to consume more than we need. The obesity epidemic is the prime example. We buy more, consume more and throw out more food than we need many times over. At the same time we claim concern for the hungry. We however are oblivious to our own part in their deprivation. We, and that includes me, don’t really care about the others. We want to be seen to care without putting in the work.

For those that are now labeling me ‘one of those liberals’. Yes I am a proud Liberal. Yes I am a proud Capitalist. Yes I am a proud Libertarian. Yes selfishness is good, but greed is not. The selfishness of Capitalism looks to preserve individual advantage and caring for the weak is a part of that process. The problem is that most people are not informed enough to even look out for their own advantage. The low information citizen is easily manipulated into thoughts and actions that are not in their interest. The sadness I feel is enough to make me not care, but the truth is that some of us are not capable of not caring. We are the ones attempting to keep society balanced. Sadly in spite of the obvious we are still convinced that the majority of the population is caring and empathetic. I beg respectfully to disagree. Few people are truly heroic and even fewer are willing to tell the truth when they are the only ones who believe it. This is where we are. Our selfishness is self-centered, poorly directed and lacking in insight. This lack of insight will be the death of us all as a species.

What will we leave behind when evolution no longer has any use for our poor survival instincts? Are you planning on making a change this year?