The chronicle of a lonely do-gooder family doctor who survived.

Monday, March 22, 2010

The Health Care Bill

Dear Tea-Bagger,

It's going to be alright.

I know you are scared.

The Cold War was very frightening and we thought Communists were going to kill us all, or at least destroy our freedom-loving way of life. I remember it too.

And I know you don't understand the health care bill. To be fair, it is very confusing and complicated. And the only information your side has given you amounts to "your money is going to kill unborn babies" "the government is going to unplug grandma from life support" and "we can't afford it." It's a shame that in an information-laden society, ignorance is so fashionable, but try to consider who has the most to gain by your ignorance?

I have spent the last 12 years on the front lines of the failing American health care system. Shit, I have seen dozens of people literally die from it. I spend my free time reading medical economics journals and watch lectures by health policy experts. I consider myself fairly well informed about the current state of things, which is to say, sometimes even I am overwhelmed and confused and frustrated. But I think you can trust me when I say, this is going to be a good thing.

And I say this as one of the people who is going to foot a large part of the bill for the rest of you.

No it's not got going to fix everything. Those who called even the option for citizens to band together and buy group insurance policies "Socialism" saw to that. But consider, for the first time, this bill acknowledges, codifies, and plans realistically around a principle that has already been in effect in this country for decades: in the richest country in the world, with the best hospitals, best medical schools, and best technology, we all deserve some kind of access.

Now, I understand, the libertarian streak in you wants to say "Well I pay for my access, everyone else needs to man up and pay for theirs." Yes. Yes, you are absolutely right. And this bill takes us much closer that idea than we've ever been.

You see, whether you like it or not, no one is turning uninsured pregnant women onto the street to deliver their babies in gutters. No one is going to let a man bleed to death in front of a hospital. And the check you write to your hospital or your doctor or your insurance company already includes the cost of not turning those folks away. Now, you can stand in front of my clinic and try to prevent those who can't pay me from walking in, but most of us who got in to health care choose to help people and we're not comfortable doing that.

Thanks to Smart Liberals at Elite Academic Institutions, we have a pretty good idea of what it costs to deliver this emergency, last chance medicine that you and I already pay for. What this bill does is creates a line item for this care, separates it out from the bill you are getting from your doctor, and then figures out a more rational system to pay for this where the uninsured pay more of their fair share. Yes, some of the freeloaders (and I am fully aware this includes some of you right leaning libertarians who don't carry insurance because you consider yourself healthy; until you show me your notarized affidavit announcing you will not seek any future medical care that you cannot afford, I'm going to lump you in with the freeloaders, okay) will be required to pay a bit more into the system they already benefit from. Some of the money will come from tanning parlors. And some will come from rich people like me who can afford it.

Again: This is money that rich people like me are already paying for the emergency care of the uninsured.

Ok, Mr. Rich Conservative who doesn't believe in welfare or helping people, can you at least acknowledge that a simple idea like this sounds like it could be in your own economic best interest? I mean, if nothing else, this bill says that you won't get stuck with the hidden costs of taking care of these welfare moms and illegal immigrants, now, instead of your hospital, your elected representatives can debate directly how much of your hard earned money these low-lifes deserve. This is exactly what happens every year in such right-wing strongholds as Canada.

But if you've made it this far, let me clue you in on a little secret. Doctors, those modern day pill peddling sorcerers, have actually figured out how to make caring for these people (the ones you are already paying for, the ones who now are going to foot more of the bill for themselves) cost less. In fact, most new therapies have to prove that they save money and prolong productive work life before they are approved or paid for. Every day, hundreds of untreated diabetics walk into the hospital and are newly started on kidney dialysis (on your dime); we would only need to prevent a few of those cases to provide insulin to all of the rest of them.

I will grant that your leaders, Mr. Tea Party, are correct that the key to reform is to drive down costs. I don't need to tell you that the status quo isn't an option. $1200 a month for a family of four? For insurance that does less and less. Let's put it in a way that you might understand: you haven't gotten a raise in ten years because of health care. And if we do nothing, you may never get a raise again, with all of your increased wages going to health care costs. So of course, even you recognize the need to do something.

It is impossible to know if this bill really will drive down costs; it seems likely at least, and there is a whole lot of Research from Smart People and Evidence from Other Countries (even some Friends and Allies) that this will happen. Consider though, that insurance companies currently have very little impetus to control costs and indeed in the three decades they've run things they haven't done so. Once you get sick enough (or old enough) to stop working, you are dumped onto a public system to foot the bill for your hemodialysis or your motorized wheelchair. And that's assuming they haven't already succeeded in denying coverage for your pre-existing condition. And guess what? This bill addresses all of these issues as well: preventing denials of coverage, or life time caps on medical coverage, or preventing them from dropping groups of enrollees simply because one of the members suffered a catastrophic medical problem. Insurance companies will, for the first time, be accountable for the cost and quality of the service they purportedly sell: health care.

But I acknowledge that we don't know for certain what's going to happen in the long term. And I hear you are scared. And I hear you don't want to change. And I hear you don't trust politicians. But I have found in life that the best way to cope with a scary problem is knowledge and an honest accounting of the situation. This bill, not perfect, and not comprehensive enough, takes a giant step forward. We'll keep working on this thing, together I hope.

And, as a country, if we let fear and division stand in the way of what's right -- at Gettysburg, in the Depression, at Normandy, in Selma -- where would we be?

Sincerely, and compassionately, and in good health,

Your Family Doctor



Note: I am referring to "freeloaders" "welfare moms" and "low lifes" facetiously above. My direct experience working with uninsured people for more than a decade is that almost uniformly they want to pay their way. They want the security of durable medical coverage and understand the value of it, they just lack the means to buy into the system that is currently available. This bill honors working people all over the country who've been screwed for far too long.