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.


As a consumer and provider of health care services I am not impressed with the level of service I see. I am disturbed by the lack of empathy and the poor efficiency of the system. Providing health care services can be a very stressful occupation, but if we have chosen to be participants we should put our best face forward everyday. The empathy and sympathy we show are major components in conjunction with efficiency and competence in providing the care that is required and that our patients deserve.

The system as currently constituted allows for wide variance in the quality of the service that is delivered. This is a problem that is often overlooked and under appreciated. We get distracted by the politics of our work environment and neglect to critically assess our function in it. I see providing great care as delivering the correct service in a timely manner. I do not consider giving the patient options as a service to them. Patients want us to tell them what the best choice is and why it is so.

Very few patients are equipped with the knowledge to make great choices. We need to refocus our discussion to providing the evidence that support our recommendations. We need to provide our patients with the option that the best evidence supports. When there is no known best option then we need to use our medical judgment and provide clear direction.

Discussing the best option is great, but only makes a difference if that service can be provided in a timely efficient manner. As a service providers I have the impression that many of us are not as concerned about the efficiency of the service provision. This lack of attention to the details of delivery is poor form on our part. We may think that providing the correct service is the important factor and we would be correct. However, providing the correct service is only as good as how timely that service is provided. We need to deliver quality service with empathy and efficiency.

The current system we have will never be able to provide this type of service delivery as long as providers are not engaged fully. We complain about the rules and regulations that hinder us, but they are not the problem. The problem is us. Instead of saying how can I get my job done, we have defaulted to how am I going to make them see that this rule is bad for patient care. This attitude is detrimental to patient outcomes.

I do not have hope for any improvement in the system. The irony is that the more we protest and passive aggressively resist the more change we induce. Providers are so lost in the echo chamber of passive resistance that we cannot see the good or the bad in the current system. We have given over control to the money changers while we are fighting for the crumbs. We are distracted from the essentials of our service. Let us be reminded that we will be patients too.


The curious nature of the human animal is often a puzzle to me. My single psychology course in college has not prepared me. The current focus on the cost of health care is once such puzzle. As a young physician our cultures disdain for the earnings of doctors is a puzzling. How much is your life worth. Like most young physicians I will be paying my educational debts until I die. So the current trend in American political and social discussion about the value of health care and the cost of a doctor’s services rings hollow. Arguably the value you put on care needed to preserve your life is more than the cost of seeing a concert or going to a nice restaurant. I hope that is the case but it manifestly is not so.
It has become a national sport to complain about how much it cost to get heath care services. This question is lacking in dept and is intellectually dishonest.
We want the best care but are not willing to pay the cost. The cost is directly in proportion to the system we have continued to vote for. We vote people into office that believe that education is a commodity whose cost should be raised to what the market will bear. Once we get to that point we arrange loans to make the needed education attainable. The natural consequence is that the cost of the end product, care delivery, must of necessity increase.
As a physician my debts from education is more than the cost of most mortgage loans and added to that the cost of the eight postgraduate years of lost earnings. The debt burden is heavy and increasingly so. The immorality of telling me to earn less is not lost on me or anyone in my position. The only question from me is, when are you going to start seeing the whole picture?
When are we as a country going to stop asking me to starting earning less. Are you willing to pay off my educational debt? The answer to both questions remains a resounding no. Instead we are sticking to the tired and disproved option of moving care to lower cost providers which generally translate into less educated provider. This is a natural extension of the commodification of health care. As patients we want dedicated care, but we are not willing to pay for it. We would rather spend on a sport or food or anything else. Health care is not french fries. French fries cost nothing, because we as a country have decided to subsidize the production, distribution and sale of potatoes. We have decided to do the opposite for health care and expect a similar result. Until you pay off my first mortgage, please do not comment on how much I earn.