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Why I'm Voting for The Maverick and The MILF

Posted Oct 23 2008 10:25pm

Okay, people. Unadulterated opinion, coming right up. Because that's just the kind of day it's been. Or week. Or month, for that matter. But I digress.

The election is just around the corner, and it may surprise a few of you to see me all fired up about it - because I'm typically very politically blah. Middle-of-the-road, halfway apathetic, watching the whole thing unfold in front of me with casual disinterest. But not this year. And the reason for that is because so much of the race keeps going back to questions about healthcare and coverage.

Universal healthcare. Well, it sounds like an innocuous enough thing. On the surface, it says everybody gets healthcare. Reasonable, right? But that's not what it means. All the talking heads are spouting "everybody deserves healthcare, nobody should be refused care" and at the risk of sounding really harsh, I want to know exactly where it's stated that health care is a right. It's a privilege - and a damn nice one to have - but absolutely not one of the inalienable rights our founding fathers wrote about. See, it's like this.

Let's craft a tale of two Americans. (No, this isn't gonna be a Joe the Plumber story. Get over it.) Say Jimmy and Johnny go to school together. Jimmy pays attention in class, studies, and does well all the way up through high school. Johnny generally screws off, is lazy, cheats when he needs to and just slides through the system and lo and behold, graduates right there along with Jimmy. Jimmy goes off to college and works his butt off toward a career that's desirable to him. Johnny lives with his mom, works a minimum wage job for a month but quits because he doesn't like it, and finds ways to make excuses and mooch off the system and be subsidized by the government for his lack of gumption. (Subsidized by the taxes that Jimmy pays out of his hard earned money, I might add - but that's for another post.) Jimmy keeps working hard, and one day down the road drives an Audi and lives in a nice house in a nice neighborhood...because he earned it. Jimmy has a well-paying job with nice health benefits and a retirement plan...because he earned it. Johnny still lives with mom, rides his bike to the liquor store because his Pinto broke down, and pulls that government disability check...that he didn't really earn a cent of.
The point of all this is that This Is America, land of free enterprise and capitalism and do your best and to the victor go the spoils. If you want something, you go after it, you work and you put your heart and soul into it and you earn it. (That's the old American way. The new American way seems to be sitting on our collective lazy ass and waiting for our handouts, our just entitlements. Grrrrrr.) Jimmy has health insurance because he busted his ass to earn it. Johnny does not because he sat on his ass and didn't bother to try to earn it - but that doesn't stop him from whining "where's mine?"

Now before you go getting all spider-monkey on me, hold up. Am I saying that everybody without health insurance is a lazy worthless schmo? Hell no. Am I saying that if you don't have health insurance it's your fault? Not necessarily. But in some cases, yeah. But folks - I Am One of the Uninsured. Yup. I have a great-paying job - I traded a higher salary for the riskiness of no benefits, which was a good short-term decision for me - and for a short while I paid for my own insurance out of pocket. Is it ballsy to run around with no health insurance? You bet it is. Shouldn't an ER nurse know better? Yup, I probably should, and I probably should wear a helmet on the Harley, too. I make damn sure my kids are insured, but as for me, one accident or freak illness, and I'm financially toast. Bankrupt. Broke. I'm not blaming anybody for my lack of insurance, though - I just wanted to put it out there that this isn't a rant against the uninsured. Lots of people don't have access to health insurance because their employer doesn't provide it, because they have pre-existing conditions, any number of things beyond their control. My point was only that America works on a reward-for-effort basis, not a "well I deserve it so where's my check" basis. Healthcare is a privilege, not a right. And I may have gone a little overboard in painting that picture of entitlement.

So anyway, back to Universal Healthcare - Barack's slick plan guarantees healthcare for everybody, which in a utopian world is a dandy ideal. But...as so eloquently stated by Professor Raymond Lynch way back in the dizzle: "There's no such thing as a free lunch." There has to be a tradeoff somewhere, and what the Dems don't say out loud is that the sacrifice comes in the form of standard of care and the time it takes to get said care. It's inevitable. You have a finite amount of money in the healthcare system. A finite number of facilities and providers of care. If you spread that all out thinner and thinner, something's gonna suffer.

Know how I know this?? Because in America, we do have a little form of universal healthcare. It's called EMTALA, or the Emergency Medical Treatment and Active Labor Act, passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986. In plain-speak, it's the law that says no emergency room anywhere can turn away a patient for any reason without medically screening that patient to make sure they don't have an emergent problem. And this affects me and my colleagues in Emergency Medicine every single day. And if you've ever been a patient in an emergency room, chances are it's affected you too. It works like this:

Lots of people go to the ER for rational reasons. They have chest pain and think they might be having a heart attack. They break a bone. They're bleeding profusely. They're having stroke symptoms. Lots of things. And these things are just what the ER is for. But there are also lots of people who go to the ER for other reasons, like sniffles, toothaches, sunburns, ingrown toenails, abdominal pain they have had for 8 months, and so on and so forth. Stuff you and I would see our primary doctor for. But lots of these folks don't have primary care doctors, because they don't have insurance, whatever the reason, and they know that the one place they can go for treatment is the emergency room - because they can't be turned away no matter how many bills they don't pay (before you say I'm discriminating against people who have unpaid medical bills hanging over their heads, stop right there. I'm one of those too.). So they go to the emergency room, even though their complaint is not emergent in nature, because it's their only option. It happens, all the time, and I'm sure it's a shitty position to find yourself in. There are also plenty of people who go to the ER when they need their narcotic fix, when they need a little bit of attention, or for whatever reason they have, because they know they can't be turned away no matter how much they abuse the system.


So in there amongst all the legitimate ER patients are sprinkled the folks with clinic complaints who just can't get in to a primary doctor due to lack of insurance, and the people who aren't emergent at all and just work the system. You've got a large pool of patients to take care of with the same limited resources - and despite our best efforts the system just gets clogged up with all the non-emergent stuff. That isn't to say we can't take care of strep throat in the ER for a family without insurance, because we sure can and we're happy to. But imagine all the rooms in the ER are filled with patients, some truly sick and some not-so-sick - and you come in with an arm that's broken in two places and you're in pain - you have to wait longer than you would have had to wait if the ER were just occupied by the real need-the-ER patients.


Not only do you wait longer for care, but once you're finally in a room the staff is so overworked and overstressed from scrambling around with no lunch breaks and no pee breaks, that the care you receive might be less than warm and fuzzy.


Blow that up on a grander scale, and that's what we'll see with Universal Healthcare. Only worse, because the government will be running it. Bottlenecks at the entry points of the healthcare system. Government officials making decisions about what's good policy or not, what's necessary or not, what's emergent or not, and jeez don't you want DOCTORS to be making some of those decisions? If government is getting MORE involved in the administration of healthcare (and any of my colleagues can vouch for the screwed-up-ness of that, i.e. JCAHO), then the actual providers of medical care are going to grow progressively more disillusioned, disenfranchised - and they're gonna fly for greener pastures. (Jeez, Barack, what happens when all of a sudden the doctors and nurses are disappearing in droves?? How much longer are people going to have to wait for the care you promised them now that there are only half as many people to take care of them??)

Now the McCain-Palin camp is angling for a system wherein the free enterprise system is preserved as regards health insurance - which means, especially once opened up to interstate commerce, that the insurance companies are going to have to become more accountable or they're going to lose business. They're going to have to price competitively, sharpen pencils and actually provide good benefits, or the customers will go elsewhere. That can only be a good thing, in my opinion - as someone who used to work on the other side of the health insurance equation, I can say that there's plenty of sharpening to be done. So no, your coverage won't be free or absolutely guaranteed - but you will still have the option to choose what's best for you and your family. You'll still have the option to purchase more comprehensive insurance if you think you need it, rather than being told you need the same insurance as everyone else in the country so here's your card, take a number, have a seat, now serving 006. They're working toward getting rid of the pre-existing condition hurdle that right now keeps so many folks from being able to get good coverage - so in my mind that's a win-win situation.

I haven't even touched on the basic philosophical argument behind Obama's plan: take the best-coverage options away, and spread all that coverage around to everybody. Instead of letting those healthcare dollars be spent by those who have earned the right to spend them, to decide where to spend them... put all that money in a pot and then divide it equally so we can all be entitled to the same care. It's an awful lot like "from each according to his ability, to each according to his need." Sound familiar? Scares the piss out of me.

So back to the main focus of this post, at least as you're led to believe by the title that precedes all the rambling:

Why am I voting for the Maverick and the MILF?

As a patient: While I choose, right now, to not carry health insurance, when the day comes that I do decide to insure my sorry ass, I want to be able to have options and different levels of coverage (and consequently cost) that I can choose from. I don't want to be put in a bucket with the lowest common denominator and forced to accept substandard care because the healthcare dollars got spread too thin.

As a healthcare provider: Because I've seen the effects of guaranteed health care, in the microcosm of the ER, and how the resultant dilution of resources consistently works against the truly sick and encourages misuse and abuse. And I damn sure don't want the government's fumblefingers in my day-to-day job more than they already are.

And from a completely non-healthcare standpoint: Yeah, you'll have to wait for the rest of that spiel. There are plenty of other reasons, but I'm tired.
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