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.
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.
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 American electorate once again fascinates me. The ongoing discussion of health care coverage and delivery is schizophrenic at best. The most recent pools show a population in need of health care coverage but the same group most highly skeptical of the most recent attempt to improve their ability to access coverage. Furthermore those who are most in need, and treated the most poorly by the current system are still willing to hold onto the failed system. It is unfortunate but the same the tactics developed and used by the cigarette industry to convince us that cigarettes are safe are being used to undermine the ACA. Many are against the ACA without investigating the potential benefits.
The cable talking heads have succeeded beyond their wildest dreams. They have so muddled the facts that it seems no one has a grasp of the services that will be improved. The problem with that assumption is that it is far from being a fact. The data are there if we as consumers would only look beyond the imbeciles on cable T.V. The problem is that our attention is firmly planted on the imperfections and not the goals. We are not being true to the fundamentals of American cultural strength, the belief that we can do it if we want to. I can only suggest that the opponents do not want Americans to succeed. The success of American Corporates is not the same as the success of Americans.
The intellectual dishonesty of the talking heads and those in charge of the news media is disheartening. They have no regard for the uninsured. The consequence is that the people who need help the most have been convinced that there is no help to be had. The truth is not deceptive nor is it hidden. The ACA is good for Americans. The ACA aka Obama Care is good for American business and will be a success. Success will not be achieved overnight, but will be a long hard fight. The fight is against those who do not believe that government has any part to play in the delivery of services and those who do. The battle is against the deceitful. The battle is against the business lobby. The battle is primarily against the ignorance that parades in fine suits on 24 hour cable T.V.
Those of us objectively looking on need to not only look but need to shout down the liars and the dishonest. How do we inform those that need the information the most? I would suggest a grassroots election style campaign. We need to start by informing ourselves. Each of us needs to study the benefits and pitfalls of the law. Without in dept knowledge we cannot be effective advocates. Go advocate, it is our moral duty.
I am often struck by the disconnect in our political life about what our government spends money on. We hear the clamor for reduced spending and the false equivalency to a household budget. The intellectual dishonesty of the argument is clear if only we would look even superficially. The budget of the American State is primarily about moving money from the coasts to the rest of the country. It is about paying off the rich for their service to the entrenched political class. Who is actually getting our money? Look at your representatives in congress to find the answers.
Our political system is a construct where there are three branches of government with supposed equality of power. However, on close inspection it is clear where the real power lies. It lies with the body that controls the purse. The budget of the US federal government is controlled by the congress. They are the holders of the passbook, they alone can authorize the use of funds. The lie that the President of the United States, whomever he is, controls spending is a lie told to the uninformed. Unfortunately the majority of the electorate is among that group and hence getting to the real problem in American government is not possible.
If we recognized the facts of the economics of the federal system the discussion would not be so hollow. First, we have a state welfare system in which the richer states support the poorer ones. This is how the poor southern states got money for new infrastructure while the states in the northeast cannot afford to maintain their own. In principle the richer states helping the poorer to better the circumstances of their citizens is an admirable goal. If we examine the post civil war era called reconstruction we can see where the interests of the south, the primary beneficiary of the federal transfers, lies. The current aversion to anything that would help the working poor comes directly from the language of that era. This disdain for the working poor is not new, the purveyors have just regained power. The south lost the shooting war but has won the long-term economic struggle. My analysis is rough and you may say without merit, but I suggest you take a closer look.
The entrenched political class is the congress of the United States of American. They need to be term limited. No congress person should be able to serve longer than the President of the Republic. The current system disengages the congress from the people they should be representing. The people who get representation are those with the economic ability to buy time with their representative. The resource poor many are left to the vagaries of the market, while the insiders are protected. Term limiting congress persons would be a great place to start in fixing the debacle called American Government.
There is a time and place for everything and I think it is time for us to all look in the mirror. Our government has impaled herself on her own sword. The truth is that there is only one person to blame. No, it is not the President nor is it members of congress. You and I are to blame. We are the idiots that believe the garbage spewing from the despicable talking heads on radio and TV.
The continued pretense that there is always two sides to a story belies the continued mass delusion we live under. There is not two sides to every story. The imbeciles that continue to repeat that lie are in my view the worst thing that has every happened to our country. This pretense is used to confuse and demoralize the masses. This pretense allows the well dressed liars to continue to manipulate the low information voter. We all need to stop buying what the snake oil man is selling.
The current big lie is that Obamacare or the Affordable Care Act is going to bankrupt the country. The system as we have known it was doing that already. The honest among us will acknowledge that health care inflation was already running rampant. Obamacare has nothing to do with it. The honest among us will admit that there was always a problem and that Obamacare is an attempt to solve it. The most insidious lie of this whole fiasco is the that Obamacare is proposing something new. It is not. If we were paying attention to the health care debate of the mid to late 90’s we would recognize that this is exactly what was recommended by the right-wing think tanks. But the liars among us continue to deny and obfuscate.
The level of dishonesty is mind-blowing and disgusting. The people we expect to know more continue to disappoint. The dishonest continue to lie to the low information voter and said voter continues to send dishonest representatives to Washington. The deeper problem with our country is that the majority of the population lacks the willingness to do what is necessary to be considered a ‘informed citizenry’. Help us all.
The 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?