[Ed. Note: We received today's post from Timothy Shaw, M.D. F.A.C.S. as a comment in response to a post, " Health Care and Disparity in a 'Post-Racial' Era ."]
Photo by Eva the Weaver
Twenty years ago, upon entering private medical practice for the first time it took me about a month to realize that the United States needed “Health Care Reform.” After serving the previous fifteen years in the US Army Medical Corps, I started my first civilian medical job. I was asked to come to a hospital by another surgeon to perform an ear operation on a 3 year old boy at the same time as he would be performing an eye operation. This would save the child from two anesthetics on two different days. Since I had never worked at that hospital, and apparently in order to set me straight from the start, one of the head doctors at this hospital, came up to me in the preoperative holding area, and boldly shoved the child’s chart in my face, pointed to the child’s insurance (Medicaid (Welfare)) and shamelessly told me, “if all you are going to do, is to bring this “****” in here, then we don’t need you to come here.” The poor little guy sitting in the corner with his Mom, was smiling at us with his cute partially toothless grin, and coke-bottle glasses. He didn’t realize what one of his doctors called him because of his health insurance coverage.
Again, several months later I was called to a different hospital (one that I normally did not work at either) in the same city by an operating nurse who asked if I took Medicaid “welfare patients.” She asked me if I would come to their operating room to take a coin out of a 2 year old child’s esophagus. She informed me that their hospital doctors in my specialty did not take welfare patients and they were looking for someone to do the operation as the child had choked on a coin. “Apparently someone forgot to screen this child’s insurance before he came to the operating room.” I canceled my clinic patients and drove across town, performed an esophagoscopy and removed the coin.
Obviously, the doctors in these above scenarios did not support “the Public Option” (Medicaid).
What had happened to our Health Care System? What had changed? Where was the honor that we had in the Army Medical Corps? We treated everyone from Generals to Privates and their families with the same respect. In accordance with Geneva Conventions, we even treated enemy soldiers during the Iraq War in our Combat Support Hospitals with the same care that we treated our own.
In a significant measure the United States Private Health System had changed into “Big Business.” In some measure the humanitarian emphasis had eroded.
Although spurning the pharmaceutical industry as “conflict of interest” entities, not suitable for proper patient care, surprisingly, doctors saw no apparent conflict of interest in merging with the Health Insurance Industry. Doctors and the Health Insurance Business became so closely aligned that their DNA intertwined to form a new species. This powerful new combined-arms team became the forme fruste of our new United States Health Care Industry. Doctors armed with new found business tactics, and the Health Insurance Industry armed with the legitimacy of the Doctor’s legal authority to limit health care to patients became the de facto United States Health Care System.
The business meeting replaced the medical conference to discuss “patient care” issues. To cope with the ever burgeoning bureaucracy, more and more doctors went into administration. More doctors have their MBA’s then carry black bags and make house calls. Mergers, Acquisitions, Expansions, Contracts, Covered Lives, Marketing Strategy, Demographics, Competition Threat Forecasts, Actuarial Science, and Health Insurance became the focus of many doctors. Time was spent on avoiding insurance business risk, trying to avoid the high risk patients, finding the better payer groups, etc. Hospitals became less hospitable. Doctor’s began to discharge patients so rapidly, that in the mid 1980’s the majority of States passed consumer protection laws (”Drive By Delivery Laws”) to protect mothers/newborns from being discharged from the hospital too soon.
Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates.
Expenditures in the United States on health care surpassed $2.2 trillion in 2007, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.
Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 45.7 million completely uninsured and millions more inadequately covered. Spain has a constitutional law guaranteeing health care for all of its citizens. The United States is the only industrialized nation that does not have a single payer government national health plan covering all of its citizens.
More Americans die of lack of health insurance than terrorism, homicide, drunk driving and HIV combined. Lack of health insurance kills 45,000 American adults a year, according to a new study published in the American Journal of Public Health. One out of three Americans under age 65 had no private or public health insurance for some or all of 2007-2008. Even with health insurance, many Americans are a medical crisis away from bankruptcy. Research shows 62 percent of all bankruptcies in 2007 were medical, a share up 50 percent since 2001. Most of the medically bankrupt had health insurance. American Manufacturing is down, but not American Manufacturing of poor people. In Canada, where they have a single payer government managed health insurance system, bankruptcy filings due to medical bills are precisely zero (0).
Contrary to myth, the United States does not have the world’s best health care. We’re No. 1 in health care spending, but No. 50 in life expectancy, just before Albania. In Japan, people live four years longer than Americans. Canadians live three years longer. Forty-three countries have better infant mortality rates.
Our Health Care System is unjust. It is unjust in part for some of the following reasons:
Much of the medical research in our country is supported with public tax money through the National Institute of Health Grants. At present, this benefits only those lucky enough to have “good health insurance.”
Many of our hospitals were founded by the hard work of ALL citizens, not just corporate health care institutions. In the late 1800’s Catholic nuns from St. Louis hitched their horses to wagons and rode into the North West Territories armed with a Mission Statement from God to “cure the sick, care for the poor, comfort the dying” and built our first hospitals. They built these hospitals for ALL citizens, not just the patients with “good” insurance.
Our health care system is unjust because patients of minority background get less care and inadequate care compared to white patients, based on evidence published in numerous medical studies. The same arguments which justified slavery as an institution in the 1860’s are used today to justify our current for-profit health care and health care insurance industries “we don’t want government telling us what to do; we can’t change our lifestyle and our way of life; we don’t want interference with our benefits; we don’t want you to interfere with our economy, the jobs of the health insurance industry.” These statements are made notwithstanding the basic injustice perpetrated on others by our current health care system.
Our Health Care System is unjust because patients are discriminated against based on their ability to pay. Some doctors and dentists will not see “No insurance / Self Pay ” or Medicaid patients, even though their degrees were issued by publicly funded medical and dental schools.
Our Health Care System is unjust because Doctors charge different patients different prices for the same service based on their insurance or employer. If one would go to a gas station and be told that you have to pay $6 a gallon of gas but that your neighbor has to pay $3 because of who you work for there would be civil war. But this is how health care is billed. Often the person without insurance is charged more for the same service.
It is unjust because patients do not have the liberty to pick their own doctor. Every time their employer switches health insurances as a business decision, the employees often have to switch doctors. This is an inefficient system, particularly for those with chronic diseases, such as cancer, asthma, etc.
Our healthcare system is unjust because of cost. A man showed me his mother’s hospital bill when she delivered him in 1937. For 5 days in the hospital, room, meals, nursing care and the delivery - $175. Today if you go to a clinic to get earwax removed by a doctor taking only two minutes - it costs almost twice that !!
It is unjust because, although many of the discoveries of medicine were not the work of American Medical/Insurance Industry, the discoveries are then used to create private profit for our present Health Care System. For example, when the Austrian Pathologist Karl Landsteiner won the Nobel Peace Prize for his 1903 discovery of the ABO Blood Groups which made blood transfusions safe, saving billions of lives, he gave his discovery to humankind, not a patent lawyer.
Our healthcare system is unjust for the reason that people without health insurance just as likely had fathers and grandfathers who laid on the sands of Normandy and Iwo Jima, and whose sons and daughters are serving and dying in the service of our country today.
Our health system is unjust because of huge profit taking. Health insurance executives don’t worry about going bankrupt from getting sick. Forbes reports that two large Health Care Corporation CEO’s made $121 million and $57 million respectively in the last five years. While The Medical /Insurance Industry, and Pharmaceutical industries make billions in private profits, our citizens are lining up at a county fair, in neglected health, with their teeth rotting from their heads, just to be seen once at a free medical/dental clinic set up in a barn with freshly swept farm animal stalls.
Health Care is an essential human service which should be part of a public trust, not sold as a for-profit commodity. It has the same essentiality as Clean Air, Clean Water, Roads, Rivers, Police and Fire Protection and should be afforded the stature of Public control.
I’ve often wondered why educated people and our leaders cannot see the injustice of our healthcare system. In a historical context however, it is inconceivable to think that the man who wrote “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness,” could see his slaves working in his fields as he looked out his window.
To right the injustices perpetrated by the British against his countrymen, Thomas Jefferson would write the words which lent justification and strength to his fellow patriots to fight the world’s most powerful army and navy. However, Jefferson’s quill had not the power to convince his countrymen to right an injustice perpetrated by themselves against another people. This would be a conflagration for another time, another generation.
Let us encourage our congresswomen and men to have the moral courage to pass legislation long overdue, to create equality in health care. They should establish a national healthcare insurance plan as a civil right of American citizenship. Let’s abandon our current “Lobbyocracy” and create a true “Democracy.” They should forgo the influence of lobbyist’s money, and “establish justice and promote the general welfare” by creating a health care system that serves and cares for the people.
Some say that we don’t want a Canadian or British style healthcare system. I say let’s make America’s healthcare system look like the United States space program compared to Britain’s or Canada’s! If we put our nation’s collective will together Americans can do anything. Let us create a publicly funded national health insurance plan to restore to every American their dutiful respect and “unalienable rights.”
Thomas Jefferson’s last words in the Declaration of Independence ring true today: “And for the support of this declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our lives, our fortunes and our sacred honor.”
Timothy Shaw, M.D. F.A.C.S.