White Coat Underground

I got a little cranky earlier during a facebook discussion, then heard the voice of a friend in the back of my head saying, “Blog it! Blog that shit!”

And I was about to, when the hospital called with a minor crisis, and then I realized it was the probably one of the last nice days of they year, so I went to the pool with the family, then my wife made a yummy dinner…you get the idea. Anyway, here’s the deal. I was reading this piece in the Times about a woman with a complex disease who died at least in part because of our Byzantine health care system. It was a familiar story.

And it’s not just a compelling anecdote—this is every day. I’m just one physician and I regularly see horrors like this. The conservative/libertarian philosophy that encourages this sort of system is sick—immoral, unjust, and sick. It’s hard for me to understand how otherwise moral-appearing people cannot see that medical care, like air, food, water, roads, and schools is not “just another commodity”. I admit I just don’t get it. This ultra-libertarian view of health care is a form of social insanity.

There is no justification for failing to create a just system–none. The cost is trivial compared to the cost of doing nothing. Ours current system is rife with irrational rationing and wasteful spending on profit-driven middle-men.

Health care is not just another industry where unfettered competition and “red in tooth and claw” capitalism benefits all. The profit motive kills. It kills trust, it kills people.
Ultimately, all the bluster and hot air expended defending the status quo because of cost, ideology, or whatever is immoral bullshit.

Comments

#1 symball
September 14, 2009

As a proud European I simply cannot understand what the fuss is about in the US over healthcare. So much money is wasted on unnecessary testing and treatment in the US where the more comprehensive policies are squeezed for whatever they will pay for, yet those with limited or no health insurance are effectively left to die- or simply bankrupted.

I would be really interested to know if this is a real issue on ‘main street’ or whether it is simply another issue for the rabid right wing to froth over in their attempts to make themselves heard.
#2 Ray M
September 14, 2009

I absolutely and completely agree with you. I was born and raised in the UK, and it still feels alien to me when I have to dig out my credit card every time I visit the doctor. Indeed, when I first discovered that health care here was run on a for-profit basis, my head spun as I tried to understand how anyone could possibly imagine that such a system could ever work in the (average) patient’s favour, let alone how those without such “insurance” could survive.

Like you, I simply cannot begin to understand how anyone with even a partly-formed sense of common decency could not only be against reform, but actively oppose it so vehemently, especially when they tend to be the very people who stand to benefit the most from such reform. The only explanation that makes any sense is that these people are either complete sociopaths, or they are utterly brainwashed.

As for the politicians who are making such strenuous stands against reform, they ought to be ashamed of themselves not only for their outright partisanship, but more especially for their extreme hypocrisy in denying to their constituents what they themselves have.
#3 Something Polish
September 14, 2009

As a proud European I simply cannot understand what the fuss is about in the US over healthcare.

Are you familiar with the phenomenon some economists like to call “The Bobbi Flekman Principle”?

I would be really interested to know if this is a real issue on ‘main street’ or whether it is simply another issue for the rabid right wing to froth over in their attempts to make themselves heard.

It’s an issue for the rabid right wing to froth over to the extent that BigAss Insurance and HugeAss Pharma funnel gobs of money through reliable agents to generate the froth. See also: “The Bobbi Flekman Principle.”
#4 Dan J
September 14, 2009

The conservative voters (not the lobbyists or politicians&emdash;we know who butters their bread) refuses to believe the facts, and will not even look at the data in most cases. When they believe every word that Limbaugh, Hannity and Glenn Beck (*shudder*) throw at them, what are we supposed to do to get through?

I’m still going to hold every one of the politicos personally responsible for the damage if a single-payer option isn’t introduced at some level.
#5 Mary
September 14, 2009

Well, as a libertarian with many ideas for healthcare reform, I’ve been looking for a reason to stop reading you, Pal. I think I just found it. Because I disagree with you I am, “immoral, unjust, and sick.” Really?

FTR: My husband is a surgeon who favors a single payer plan, so it’s not like I haven’t been exposed to all sides.
#6 LanceR, JSG
September 14, 2009

And the winner of the FauxOutrage trophy this week is… Mary!

@PalMD: The conservative/libertarian philosophy that encourages this sort of system is sick—immoral, unjust, and sick

@Mary: Because I disagree with you I am, “immoral, unjust, and sick.”

Way to go, Mary! Come back next week when we have our “Fake Tears Cry-off”!
#7 Bob O'H
September 14, 2009

Mary – rather than giving up on PalMD, how about explaining how the libertarian approach is moral. Like Pal, I don’t get it either, so I’m interested in seeing the rationale.

If you do explain, just ignore the people who shout back.
#8 rob
September 14, 2009

i agree.

healthcare should be provided by the government as one of the basic human rights. it fits nicely with the “life, liberty and pursuit of happiness” thing. i am not saying the government should provide everyone with a learjet or football team. but a government of the people, by the people and for the people ought to consider the wellness of it’s people.

but i am confused by the people who oppose healthcare.

anyone who opposes care to comment here why you oppose?
#9 Denice Walter
September 14, 2009

Many Americans yearn for a “libertarian paradise”- well, we actually *had* one-over 100 years ago.Before income taxes**,unions,and labor laws:if you drive north along the Hudson River, we will see many lovely mansions and sprawling estates, owned by families whose names are familiar(Rockefellar, Vanderbilt,Gould,Livingston,Mills, Roosevelt).The average person did not live in a mansion, cared for assiduously by servants- they *were* servants, or farmers.In 1800,there were even slaves in NY state.(** guide at Vanderbilt mansion:”Who can tell me when this ‘Gilded Age’ ended?”Answer-”1913- when income tax was inaugerated”.Some of those whose laws began the dismantling of this system *were* Roosevelts and Mills’).
#10 Philip H
September 14, 2009

Pal,
Get the AMA to say this, and maybe someone will listen. Short of that – gather up all your horror stories and write a book. Go on Oprah. Since no one else is, if you don’t step into the gap, it will never close.

And Blog here. Often.
#11 Philip H.
September 14, 2009

Well, as a libertarian with many ideas for healthcare reform, I’ve been looking for a reason to stop reading you, Pal. I think I just found it. Because I disagree with you I am, “immoral, unjust, and sick.” Really?

No Mary, you are trying to make a general disagreement with the philosophy you identify with into an ad homenim attack. Interesting try . . . Pal (and many others of us) don’t agree with the Libertarian approach that says this is a market issue that government has no business messing in. By remaining largely outside of how healthcare is delivered and paid for (except through Medicare and Medicade), government has allowed a significant market failure to impact around 47 to 50 Million Americans. Since the market refuses to correct this failure, government action to correct the situation is the only other avenue left.

And that doesn’t even begin to get at the moral issue of 47 Million Americans having to pay substantial market penalties to access the health care system since they are uninsured.

FTR: My husband is a surgeon who favors a single payer plan, so it’s not like I haven’t been exposed to all sides.

Posted by: Mary | September 14, 2009 11:24 AM

Interesting Appeal To Authority. We’d like to hear what he has to say independently if you don’t mind.
#12 Rowan
September 14, 2009

Here is yet another story of someone denied coverage who has died. Crystal Sutton, the woman who story became the basis for the movie Norma Rae, died on Friday from meningioma.

Now granted, people will argue that it being a rare cancer she would have died anyway so what does it matter that early in the treatment her insurance company denied coverage for the necessary meds for two months?

It matters because of quality of life.

I am one of the 47 million uninsured, as well as unemployed. Due to pre-existing conditions I have been denied private insurance. The two employers I had in the past five years did not offer health insurance as a benefit at all as they couldn’t afford the costs.

Why don’t people understand the issue of not having health insurance available for everyone? or the benefits of preventive medicine for everyone? or the relief of not having to stress about whether or not you will receive treatment for an ailment?
#13 Patient
September 14, 2009

Interesting statistics in that Times article; some 18,000 people dying every year due to lack of health insurance coverage. Sad. Another statistic that is also quite sad is the one for medical errors; some 98,000 people dying every year due to some mistake by a doctor or health care professional, this figure rises to about 200,000 people per year if one looks at a study done about those that are receiving government care–medicare and medicaid.

And it’s not just a compelling anecdote—this is every year. I’m just one patient and I regularly have expericenced the horrors of medical errors, fortunately without the dire consequences.

The philosophy of having overworked interns, residents and nurses with little sleep doing vitally important care, and the medical establishment that encourages this sort of system is sick—immoral, unjust, and sick. It’s hard for me to understand how otherwise moral-appearing doctors cannot see that this kind of poor medical care, unlike providing food, water, roads, and schools is not “a gauntlet for testing people”. I admit I just don’t get it. This ultra-stupid requirement of continuing to force people to stay up 48 hours straight and then try to stick a needle in my arm is a form of social insanity.

There is no justification for failing to create a system of training doctors and employing nurses that keeps everyone sharp and able to do their work without errors. Truck drivers in this country are limited to working 10 hours, and no longer, by law— because it’s DANGEROUS to everyone when someone is working without sleep. The cost of putting on extra employees to meet the demand is trivial compared to the cost of doing nothing and endangering people’s lives. Our current system is rife with irrational traditions, a “medical guild” mentality and wasteful spending on error prevention schemes that don’t work and cause death rather than prevent it.

If one wants to start preventing unnecessary deaths, then perhaps they should clean up their own backyard first, before looking to blame insurance companies for ALL of the injustices in the world.
#14 Dan
September 15, 2009

John Green of YouTube’s vlogbrothers gets it exactly right.
#15 Bexley
September 15, 2009

@ patient

I’m pretty sure that those figures are not solely deaths from medical errors they are from all iatrogenesis. They include deaths from complications from surgery and adverse reactions to drugs.

Why does that matter? Because it will include deaths from risky procedures and drugs that the patient and doctor agreed upon because it was better than doing nothing.

For example if a patient has cancer that will inevitably kill him then having surgery which has a 10% chance of curing him and 60% chance of him dying from complications may not look so bad. Yet if he dies during surgery then he’ll be included in your figure of 98,000 despite the fact that if he hadn’t had the surgery his cancer would have killed him anyway.

Thats why you have to be careful just looking at that headline figure without looking at what it actually represents.
#16 Patient
September 17, 2009

@bexley

The same could be said of the original 18,000 figure of people that die due to lack of insurance. “Lies, damn lies, and statistics” are not exclusive to the Left, the Right or the Center.
#17 Julius
September 17, 2009

Ah, yes, patient@16. When criticised, pull the old “but the other side is just as bad” gambit. So beloved of creationists, climate change denialists, and the right in general (usually when it’s specifically the right that’s simply outright wrong).

You actually make a good point IMO, the comparison with truck drivers seems quite apt, but using it to defend insurance companies seems strange. One might even argue that a free-market approach, especially coupled with the broken US system, may make it worse, as it puts more pressure on doctors to work harder to earn a living, pressure on hospitals to cut costs by working the doctors harder, etc. But of course some or all of those pressures also exist in other systems – I know it’s quite bad in Germany.