29 June 2009

Congress : Return Health Care to the People

Health care should be a profession, not a business.

By Dr. Stephen R. Keister / The Rag Blog / June 29, 2009

The American, if he has a spark of national feeling, will be humiliated by the very prospect of a foreigner's visit to Congress -- these, for the most part, illiterate hacks whose fancy vests are spotted with gravy, and whose speeches, hypocritical, unctuous, and slovenly are spotted with the gravy of political patronage, these persons are a reflection on the democratic process rather than of it; they expose it in its underwear.

-- Mary McCarthy
The “health care debate” has become more and more peripheral to the basic meaning of health care, i.e. caring for the ill and those suffering from chronic disease. The politicians confabulate, confuse, and deceive in their personal interests or in the interests of their financial patrons.

The entire matter is quite simple and would health care costs could be reduced by 30-40% if our elected representatives would adhere to a plan 30 years in developing, a plan not of "socialized medicine,” but a plan developed to be administered by physicians to their patient base. This is a plan far different from the frantic attempts to improvise while paying homage to the insurance and pharmaceutical industries currently being considered in the Congress.

The plan proposed by Physicians for a National Health Program is all inclusive, provides care without the dictates and maneuvers of the health insurance industry, and returns health care to the people and their physicians, as is common in the vast majority of nations of the civilized world. Here is a plan for universal care without government interference, and without rationing care for the profits of the large corporations as currently occurs in the United States.

In the July 2009 issue of Vanity Fair there is an excellent article by Dr. Joseph Stiglitz entitled “Wall Street's Toxic Message” in which the author points out that when the current crises is over, the reputation of American style capitalism will have taken a beating -- not least because of the gap between what Washington practices and what it preaches. The article is illustrated with a cartoon, pertaining to Wall Street, but also indicative of the current health insurance cartel. The cartoon updates the four horsemen of The Apocalypse: Mendacity, Greed, Arrogance, Stupidity.

Dean Baker, in a Truthout Perspective article titled “Spreading the Wealth Around to the Insurance Industry and Friends,” starts with a telling statement: "This is the time when the excrement starts hitting the fan. The lobbyists are in overdrive, rounding up members of Congress just like the cowboys of the Old West would bring in the herd."

Not only are the insurance companies morally corrupt in their dealings with our "representatives" but they are equally duplicitous in their dealings with their clients, the sick, and the dying. David S. Hilzenrath writes in the Washington Post that "Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.” Yet the public hears little or nothing of this in the mainstream media.

One major problem of the current debate is the fact that the American public does not understand the issues involved. There is dismay about the lack of health care; however, the public at-large somehow does not get it. There was a demonstration this past week in Washington promoting health care for all which, as I understand, brought out 20,000 protesters. Considering the enormity of the problem one would have wished for at least 200,000.

Sara Robinson of Campaign for America's Future, in an article entitled "We've Been Trapped inside a Bad Health Care System So Long, We Don't Even Know How Much Were Missing" points out that "sometimes, when you're up to your chin in alligators, it's hard to focus on the fact that there's a big broad, alligator-free world waiting somewhere out there, beyond the edge of the swamp."

Perhaps I am overly obsessed with the corruption attendant to the present debate; however, nearly 88 years ago I was born into a household involved in local politics. My father was a totally honest man who attempted to face down the system, and ended up broken by the inherent evil of the political patronage game. He learned that, even on a local level, one either pays homage to those interests where money is power, or one best not play at all. Finally, my father bent and chose not to participate at all. Also see Amy Goodman’s "Congre$$, Heal Thyself.”

We tend to dwell on the profits made by the insurance, pharmaceutical, and health appliance industries; however, there is another facet to the overall high health costs in the United States and this is well illustrated in an article titled “Life is Expensive” in the May 30 Economist, in which the author cites the telling case of a middle-aged man. The man, who had good insurance, developed chest pains and went straight to a cardiologist who put him though a bunch of tests including a CT Scan amd an angiogram which caused serious complications and landed him in the hospital for a while.

He ran up a bill of $150,000, the studies were negative and the chest pains vanished. Some months later the pain reappeared and he talked to a physician trained in preventative medicine who asked about lifestyle changes. The patient mentioned that he had taken up gardening and had been weeding. The physician, on examination, established that the patient had strained a chest muscle while weed whacking and that was the cause of the pain.

Unfortunately episodes akin to this are much too common in the United States today. We over-utilize medical procedures rather than obtaining a careful history and examining a patient. Many doctors are overburdened with too many patients, while other physicians, unfortunately, do not take time with the patient, because, sadly, time is money. This is a culture developed in the past 30 years with the change, due to the influence of the insurance industry, that has turned a profession into a business.

There are other factors too, such as fear of medico-legal law suits, largely an unfounded fear, but used as a rationalization by physicians for doing any and all tests and X-rays, needed or not, for self protection. I practiced rheumatology for 40 years and spent time talking and communicating with my patients -- a largely foreign practice today -- and with rapport, honesty, and understanding I avoided all the legal complications I was warned about. When I started my practice an old wise physician pointed out to me that the way to avoid medico-legal problems is to establish an honest personal relationship with your patient. Personal communication, even by telephone, beats the patient being brushed aside only to talk to a nurse or PA, and might allay some fears for both patient and physician.

Another problem is the indoctrination of the public into believing that the utilization of “procedures” has something to do with “good medicine." The culture demands that every cough deserves an immediate chest X-ray. Every bump on a child's head requires a MRI or CT Scan ($2500). Every twisted knee needs a MRI and surgical intervention. (Try hard enough and there is always a willing orthopedist.) We in this country have twice as many births by caesarian section as in any other Western nation. Why? As a matter of convenience for the mother, or indeed, a greater fee for the obstetrician?

There is a great need for many more primary care physicians in the United States: internists, pediatricians, family physicians. These are in short supply because of the relatively low income and long hours involved, on top of the horrid expense of a medical education. On thhe other side of the coin are the "specialists" in cardiovascular surgery, ophthamology, orthopedics and urology, who make 10-20 times the income of the primary care doctors. I recently read a commentary by a cardiovascular surgeon who justified the income because "we save lives.” Perhaps this should be displayed on a flashing neon sign! “WE SAVE LIVES.” As I recall ALL physicians are trained to treat disease, alleviate suffering, give comfort, and in doing so save lives.

One would hope that Congress, while developing a health care plan, might spend some time talking to primary care physicians, largely represented by Physicians for a National Health Program, rather than talking to the CEOs and lobbyists of the insurance and pharmaceutical industries and their hangers on such as the AMA and AARP.

Unfortunately, when I look at Congress I am reminded of Will Rogers comment: "The country has come to feel the same when Congress is in session as when the baby gets hold of a hammer."

[Dr. Stephen R. Keister, a retired physician who is active in health care reform, lives in Erie, PA. His previous articles on The Rag Blog can be found here.]


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