The Health Care “Debate”

As I commented today on Nick’s blog, I haven’t seen any debate.  To be exact, I said I haven’t seen any goddamn debate.  All I’ve seen is a bunch of hysterical people, like the woman weeping her ugly eyes out saying “I want my America back!”  As Helen, of the immensely popular Margaret and Helen blog said, the America she wants back must be the one where a black man does not grow up to be President. All I’ve seen is debate being shouted down.   I’ve seen people openly carrying guns to an event where the President is scheduled to speak.  When did we start allowing that?  What I hear is, it’s legal.  I also saw a comment that said those people probably had snipers trained on their ignorant persons from the nanosecond they showed up.  I have no doubt that’s true.  Remind me to tell you sometime about when I lived in New Orleans and personally had the occasion to witness said snipers in place.  So let’s acknowledge that it’s legal.  But at the very, very least, it’s rude. 

Now that I’ve gotten that out of my system, let’s talk about the villains in the story.  You get to take your pick, but the rules are that you have to prioritize.  Your choices are:  doctors, insurance companies, the pharmaceutical companies, and the government.  Hint:  you don’t get to pick the government.  The government is what we rely on to protect us.  And you don’t get to pick who you want the government to protect you from.  You don’t get to say that Osama Bin Laden is fair game, but Bernie Madoff and his ilk isn’t. 

Of our three remaining choices, I’d say that doctors have the least blame.  Which is not to say”no blame”.  The second least blamable is the pharmaceutical industry.  Granted, they are raking in millions, but this isn’t about castigating capitalism.  Profit is not a four-letter word.  The pharmaceutical industry has come up with life-saving drugs, and research is expensive (after all, they have to pay doctors to do it).  That leaves us with the insurance companies, which bingo, you guessed, is my prime suspect.  Doctors agree with me.  But all three of these villains are trapped in a system which none of them can bail out of on their own. 

So here is Fakename’s prescription for “fixing” healthcare.  Make all insurance companies and pharmaceutical companies non-profit.  (Like that would ever happen lol. Especially since it might play havoc with your investments.) Pay for doctors to go to medical school–anyone who wants to go into that field should not be discouraged.  Too many idealistic people are changed for the worse by the reality that they will be 50 years old before they get out from under their student loans.  In fact, if you did just that one thing, pay for medical school education, it would make a huge difference.  Then doctors might retain some of their idealism, instead of bowing to the need to make as much money as possible.  In the U.S., doctors are rich (well, after age 50).  In other countries, not so much.  In other words, they don’t do it for the money. 

It sort of comes down to what you value.  Doctors are not miracle workers, they are craftsmen (and women).  They hold no more value to me to me than Jeff the Mechanic.  In fact, increasingly I find that I have to do most of the work for my own health care, and thankfully the Internet is my Second Opinion.  Now that I think about it, Jeff the Mechanic is worth more, since the Internet will never tell me what I need to know to replace a head gasket. 

My point, in case you were wondering, is that I am terminally angry with these people who are sabotaging reform, in the name of protecting their “individual freedom”.  They don’t even have a clue what they’re talking about.  I can deal with people disagreeing with me in a thoughtful way.  But I am done dealing with stupid, and the apologists for stupid.

The Good Doctor…Part 3

What finally made me give up my distrust and suspicion of doctors was Dr. F, who had been my doctor for 7 years.  He unfortunately left the practice to teach in the local medical school, and I can’t imagine anyone better to do that.  My loss is their gain. 

But I have some notable quotes from him.  I had been taking a particular blood pressure medicine for three years, and had to quit after having an anaphylactic reaction to fire ant stings (no, Evil Nick…don’t go there about the ammonia treatment!)  Sorry, private joke.  In any case, I was also coughing my head off and having trouble breathing, and it turns out, that was an allergic reaction to the medication itself.  I could have kicked myself once I found this out.  And Dr. F said: 

Any time you’re taking a medication and you start having some symptoms, always assume it’s the medication.  We give you drugs that we think will help, but sometimes we make you worse.  That was the last day I ever took a medication without researching it.  Thank you, Dr. F.

The Internet became my Second Opinion.   

There came a time when both he and other doctors wanted me to take various drugs and I said no.  The other doctors were like, Whatever, but Dr. F was very frustrated by this.  I said…here are the side effects and I’m not willing to put up with them.  The risk is greater than the benefit.  And, let me not beat you over the head with this, but it’s my life, not yours.  I mean, you can’t argue with that, right?  And he didn’t.  But he was a bit huffy.  I wanted to say, Look, You taught me to be this way! 

The other memorable thing he did was, he told me about a movie called, if I’m not mistaken, The Doctor.  It stars William Hurt as a doctor who himself develops  a medical problem and has to depend on a doctor who is just like him.  Namely, cold and impersonal.  Dr. F told me they showed that movie to him and his classmates in medical school.  It’s a very old movie now, maybe 17 years old?  But the fact that they showed it in medical school shows how things really have changed. 

At least the doctors who got the message now have permission to treat the practice of medicine as something that has to do with people.  It’s not just a chemistry problem.

The Good Doctor–Part 2

The main thing that started to change my mind about doctors is that my best friend is a doctor.  At least I still think of him as my best friend, although it’s been years since we’ve lived in the same city.  The last time I saw him in person was a year and a half ago, but I think “best friends” is kind of like a state of mind.  It’s a person who knows the very best and worst of you and vice versa, and you love each other anyway.  We met at a time when both of us were going through very traumatic periods, and that too forges a bond that is unlikely to be broken. 

So my friend, who for the purposes of this blog will be known as LC, started medical school in his thirties, in the early 1980’s, after having had another career.  At the time, I was a manager for McDonald’s and worked mostly nights.  LC was married and had three daughters, one of whom was still a tiny baby.  That was not an atmosphere that was conducive to studying.  So he took to coming to “my” McDonald’s to study, often late into the night.  This McDonald’s was right down the street from his house, and it was very slow in the evening.  He would often be the only customer in the restaurant, and he would drink endless cups of coffee and study.

When I met LC it was his first week of medical school.  He often says I went through med school with him. Seeing what he went through began to change my perception.  If doctors become focused on the money once they go into practice, it’s not a mystery.  I don’t have the facts at hand, but my guess is that it takes 20 years to pay off your student loans to go to med school.  So by the time your money is your own, and you’re free and clear, it’s almost time to retire. 

People don’t really go into medicine to make money.  They do it, no kidding, because they want to help people.  If money was the issue, they could just go work for Citigroup and package securitized financial instruments.  (Oh wait…I guess that won’t work out too well any more.)  Plus, you have to have not just the desire but the aptitude. 

So as we think, along with Barack Obama, about how to fix health care, let’s think about the way we educate doctors.  The cost is astronomical.  The schedule is punishing and brutal.  The two most hated words in medicine have to be “on call”.  If you’re on call for a weekend, that doesn’t mean that someone might call you on the phone on Sunday, like it does in my world. It means that you will go into the hospital on Friday night and emerge on Monday morning, sleeping maybe 10 minutes at a time if you’re lucky, with one ear open for the phone to ring. 

Amazingly enough, there are doctors who think this is a good system.  That it builds character or something.  I think they just want new doctors to suffer like they did.  But I ask you, do you want to be the patient whose emergency at 4:00 A.M. on Sunday morning is being dealt with by a doctor who last slept for 10 minutes on Friday night?  Hello.  Doctors themselves should know this.  They are not superhuman.  Pick a study, any study, and it will tell you that lack of sleep impairs judgement. 

So why is it still done this way?  It’s money.  Why should hospitals pay two people (interns or residents) when they can pay just one?  Not to mention, they pay almost nothing, barely above minimum wage. 

So my second recommendation after reforming the insurance industry is reform the way doctors are educated.  Let’s try to stop punishing them.  Let’s not put our fate in the hands of people who slept for 10 minutes, and lets not put our fate into the hands of the few who managed to survive the punishment.  It could be that some of those who didn’t make it are smarter than those who did.

The Good Doctor–Part 1

Yesterday when posting about how to fix health care, I pointed a finger at the insurance industry.  The other three major players are doctors, hospitals, and the pharmaceutical industry.  While I’m not through pointing fingers, I’ll only be pointing a very small weak finger at doctors. 

Sure, you can expect doctors, as represented by the AMA, to vigorously fight anything they perceive as being “socialized medicine”.  They’ll say it’s because they fear that patients will suffer.  And I reply:  what do you think is happening now?  The insurance industry is now dictating what treatments you can provide, what medications you can give, how long your patient can stay in the hospital.  You aren’t in charge.  The insurance industry is making the decisions based solely on money.  I’m all for returning the decision-making to doctors.

But there is a hidden agenda here too.  Doctors get freaked out about the term “socialized medicine”.  The meaning of the term itself has been lost in the hysteria, like the term “gay marriage”.  If you ask any doctor, Do you think every person should have access to health care?, I can’t imagine any of them saying no.   Okay, then.  What would you call “socialized medicine”?  The hidden agenda is that doctors are afraid they’re all going to be put on a salary that will be far beneath what they hope to earn.  That “socialized medicine” will turn them into worker bees no better than Joe the Plumber. 

I used to not like or trust doctors.  That was grounded in real-life experience.  I worked my way through college working part-time in a hospital as a “ward clerk”–what in other hospitals was called a unit secretary.  The job included greeting visitors, entering admission information into the nurse’s station computer, transcribing doctor’s orders–meaning that you sent requests to various departments for tests and actually ordered medications from the pharmacy as well (this all had to be signed off on by a nurse), and running errands for the nurses, which sometimes included taking specimens to the lab or picking up reports, things of that nature. 

But at that time (I graduated from college in 1973) there was a strict attitude of  reverence for doctors that I thought was unearned.  I understood that then, as today, there are laws that govern who has to have the final say, and that is the doctor.  But doctors are human too, and some of them took that responsibility to mean that they were gods.  So there were those who had all the personality and social skills of  Tasmanian Devils.  One of the things they did not teach in medical school was the concept of drawing more flies with honey.   So here is my favorite anecdote from that time: 

I was working on the Neuro floor, and one of the neurosurgeons came breezing in with an entourage of interns or residents (neurosurgeons were the worst with the god-complex thing).  He handed me his suit jacket and ordered me to hang it up for him, then breezed down the hall with his flock. 

I folded his jacket in half, and laid it over the back of a chair.  When he returned to the nurse’s station and saw his jacket, he said WHAT IS THIS!!!  Don’t you know how to hang a jacket?  You must not know anything about a man!  (Note:  I was pretty cute in those days.  I now recognize this as a totally nerd version of flirting.) He proceeded to take his jacket, unfold it and drape it over the chair.  THIS, he said, is how you hang a jacket!  During that whole demonstration you could hear a pin drop.  When he was done, I said, “Well, since I apparently can’t do it right, next time I think you need to hang your jacket yourself.”  As soon as I said it, I was like, I am so fired.  You could actually hear the gasps from the nurses.  And then he started laughing.    Somewhere in there, behind the arrogant exterior, was a guy who had a sense of humor; a guy, I think, who had a facade to keep up like the Wizard of Oz. 

At the time though, that incident (news of which spread around the hospital like wildfire–I was a hero!) did not change my view of doctors.  Two things happened to cause that, which will be part of The Good Doctor–Part 2.

I can say though, that that arrogance is mostly a thing of the past.

How to Fix Health Care…Part 1

From December 15th through the 31st, Barack Obama is asking Americans to come up with ideas on how to fix the health care system.  Here’s the report about that from the Washington Post.  http://www.washingtonpost.com/wp-dyn/content/article/2008/12/05/AR2008120503322.html?hpid=topnews

Here’s what’s astonishing about that.  They’re not starting out with a question, such as “Do we have a problem?”  They’re starting out with a statement.  “We have a problem, what do we do?”

Here’s what’s even more astonishing:  our President-elect is giving us homework!  He’s suggesting that during the holidays, as people get together and have more time to think, that maybe this could be a topic to discuss.  This seems to me to be no less than an attempt to engage people in their own government.  After decades of top-down government, culminating in the 8-year long monarchy we’ve just endured, this is practically a revolution.  Sign me up. 

So I’m wading in.  And it won’t take long.  What’s wrong with the health care system is the profit motive.  I’m not opposed to profit.  I’m employed in the business world.  What we do is sell stuff, and charge as much for as we can without shooting ourselves in the feet.  In other words, you can price yourself out of business.  But health care is not a commodity like computers or shoes or cell phones. 

The whole health care system should be not-for-profit.  The argument is, if you make the system non-profit, then no one will do it any more and then where would we be?  Not true.  Not-for-profit doesn’t mean you can’t make any money at it. 

The big players in the health care system are doctors, hospitals, pharmaceutical companies, and insurance companies.  If you don’t pay the people in those fields well, then it would probably be true that fewer would go into those fields.  Plus, all of them have to have a way to have some sort of reserve, whether it’s just for the occasional rainy day or to do research or to pay for catastrophic occurrences.

But when you make huge profits and split them up amongst yourselves, rather than putting it into research or treatment, that’s thievery.  There is a lot of finger-pointing amongst the groups I named above, and let me jump in there too.  The villain, in more ways than you can count, is the insurance industry.  All you have to do to verify that is this:  pay health insurance premiums your whole life, then make a claim. 

Actually I’m simplifying, because that has not been my exact experience.  But for the most part, once you need them, the insurance company’s job is to try to find a way not to pay you.  Because that’s how they make money.  Denying your claims, making it difficult, and hoping you’ll die before they have to pay.     

The solution is simple:  take profit out of the equation.  And how to do that?  No need to reinvent the wheel.  Countries throughout the world are operating workable and compassionate health care systems.  Use their model.