1.20.2011

Celebrating an Immoral System: Some More Teaparty Nonsense

I'm moved to submit this post for two reasons: 1) the immoral Right wing grandstanding that 'symbolically' repealed the Health Care Reform bill yesterday, and 2) the hidden impact this could have on people within our little discussion circle who struggle with chronic conditions that are poorly understood and largely ignored by our proud capitalist health care system.

I am a doctor. I don't play one on TV. I have been a trauma surgeon for over 2 decades. I have been involved in health care systems efforts for most of that time. I am an expert on the delivery of healthcare. I have great respect for many of my colleagues who do their best to provide comfort and care. And I have no doubt that ours is an immoral system based upon one's ability to pay or the portability of one's healthcare coverage. The poor get care, but it's care from people like me. At the end of the line when injured or too sick to not come to the ED. No prevention, no wellness, no early detection of disease. The immoral Right wingers celebrate a system that learned through science that early detection of disease and good management saved lives, yet is governed by a payment system that penalizes those who access those same services. They call it actuarial tables to limit risk, but I know it prevents our nation from realizing the benefits of our best medical science. We spend more than 2x times on care in the US compared to the next highest nation, yet rank 32nd (tie) in life expectancy and 40th (tie) in infant mortality. [World Health Organization, “World Health Statistics Mortality and Burden of Disease ", 2008]. Yes, there are many factors that cause this but ignoring prevention while dispensing erection pills in baskets isn't helping. Republican 'law makers' (wow there's an irony...) are really good at catch phrases - I wish they were half as good at actual leadership but hey. So Mr Speaker - when you trot out 'Job killing Health Care Legislation', those of us who actually know about such things know that the real job killer is the fact that we don't get value for our health care dollar and nothing kills a new job like being saddled with the burden of a pre-existing condition that makes it impossible to change coverage.

What's worse, we are spending this much even though we are largely ignoring huge segments of health care need. There are many places one could point to that illustrate why I use such a strong word as immoral. But a short description of our 'mental health services' works all too well.

Every night I cover the ED, any number of poor souls is brought in by EMS. They are homeless. Many are mentally ill. They have no advocates. They can access no benefits. Mental health resources have been slashed in the last few years as the States have struggled to make do with less. The mentally ill disappear into the shadows. Hospitals hate admitting the mentally ill because it almost invariably means that they will eat a huge bill and the length of stays are very long since there are few places to send them post discharge. With the costs associated and the fact that hospitals are graded by length of stays (affects payments) it doesn't take long to understand how a hospital in LA used a van to dump homeless mentally ill patients in another area where some other hospital would have to take care of them the next time. It's a dreadful and immoral game of musical chairs. And no hospital wants to be left standing when the music stops. A system based upon payment for expensive and glitzy procedures has little to spare on unpopular chronic problems.

So those in need are swept under the carpet. The average Joe doesn't have to concern themselves with their plight unless offended by some poor guy muttering to himself on a street corner in the throws of untreated schizophrenia. No, this is much better than a national health system where we'd all have some skin in the game to figure out how to provide care to all Americans. I believe Oregon has not executed any criminal for aggravated murder in the last 14 years - in the last 14 months I know of at least three mentally ill persons who died at the hands of the Portland criminal justice system. Now, don't get all offended for the Portland police. I'm not blaming them. Our national unwillingness to face the music puts them in a no win situation. But it is sad that schizophrenia and mania are ending on our streets because the police , ill equipped and untrained to address mental illness (why should they be the only ones when the rest of the system has washed its hands) are being forced to deal with mental illness with a gun.

Yeah a lot of the usual do gooders rant about the horror of it all, but there are no initiatives on the ballot to address any of it. They just want the police to be more gentle - or quieter about it I suppose. High profile shootings make it harder to ignore the problem. Though I am impressed with how even then, nothing really gets better.

This is just one example of the problems we face. The right and moral thing to do is to band together as a nation to address these challenges. Or stop pretending that we care.

3 comments:

Michael Lockridge said...

It is sad, and I don't see a solution. I had a hand in caring for the mentally ill in our community. I worked in the jail, where a lot of them washed up. I wore a badge.

I received my greatest honors in the mental health unit. I tried to treat them with respect as human beings. On their part they honored that by behaving as well as they could on my watch.

Now I am retired. I just called to cancel my health insurance, provided through our retirement program. The county continued to make a very good contribution, but the burden of paying for it from month to month had been hard for our share.

At the turn of the new year the rates went up 16.4%. I did not anticipate a similar increase in my pension income. I pulled the plug. As of next month I am among the great uninsured.

If I thought I could have such an impact I would encourage a general insurance rebellion. Everyone cancel their policies. Load the emergency rooms with patients who are no longer insured. Break the back of the broken system. Revolution.

There would, sadly, be many deaths. In revolutions there often are. However, a disaster may be necessary to compel a solution.

Whatever. I plan to muddle on. We have a plan, and this is not a choice made without thought. It is sad that it is a choice that must be made at all.

Harry C Pharisee said...

There is too much of a problem to ignore some politicians' willful disregard of their own species. We can't necessarily put them out of a job so perhaps Michael is right to a degree.

I'd like to think of our local government's program, in conjunction with the biggest healthcare provider in the area, as an incendiary pamphlet in the hands of political fascists.

Free prescriptions and healthcare for the needy (irrespective of welfare benefits).

Of course there will be a limit, and who knows what they'll do when they get there. But someone had the balls to approach the provider. And though I'm sure it was in their interests more or less, they still said yes.

Jared said...

I think that the problem comes from a poor understanding of governmental structure and policy. This, combined with fear-inciting buzz words like "socialism" and "communism" without even the most basic idea of what these are, and that insurance, on a fundamental level, is "socialistic," and, more importantly, fire departments, police forces, public schools (even private schools) are communistic, cause a large degree of our governmental woes.

From a failure to understand climate change to a failure to comprehend medical care (17% here, 11% or less in most "socialised medicine" countries) to an inability to comprehend world politics in the modern era, it seems we are often struck only by catch phrases, euphemisms, and rhetoric lacking substance. It is for this reason that I could not become involved in politics, well, that and I enjoy not having projectiles traverse the various lobes of my brain. Toy soldiers with delusions of persecution scare me, not because I'm afraid they will try to shoot someone, but because they actively dream of such things. Strangely enough, most "crazy people" don't...who's really crazy?