In 2006 Peter Jennings hosted an ABC special called Health Care in Crisis. This had been created while he was slowly dying of lung cancer, which may explain why he and his editors completely missed the real story. The story he told was basically about the terrible unfairness of it all. Bottom line. Health care costs keep going up, and so many people can't afford to buy insurance. Companies are dropping health insurance for their employees and retirees, or going bankrupt trying to continue it. The people without insurance clog up the emergency rooms (in the US ER's can't refuse you service even if you can't pay) which of course causes hospitals to lose millions, forcing them to close their trauma centers and even ERs. The costs keep going up year after year as the baby boomers get into their 60's and ever more expensive medical technology and pharmacology responds to the multiple diseases of aging.
At the end of the hour no one really had any solutions for this, which is not surprising. What everyone did agree on was there had to be some way to provide health insurance for everyone, and good medical care for everyone. And then everyone would of course live happily ever after….in the land of Oz? No one had a clue just how to accomplish this however. The problem was well presented. The origins of the problem were pretty much neglected. We can only hope the solution(s) are at least a work in progress. There wasn't much evidence for this however.
Problem #1 is people think all medical care and the insurance to pay for it should be an entitlement. No matter how well they do or don't take care of themselves. They want medical care to be available to everyone according to their needs and regardless of income. Wait a minute! Haven't we heard that sort of thing before? Didn't it go something like “from each according to his ability, to each according to her needs” or words to that effect? Didn't we develop an enormous nuclear arsenal and a superpower military force to make certain that set of ideas/ideals would not ever make it into America. Hey, what do you think Senator Eugene McCarthy was fighting for anyway?
Imagine if auto insurance would pay not only for accidents, injuries and theft, but also routine maintenance and all repair bills too. (With a small deductible of course.) And they would pay even if you refused to ever change the oil, keep the tires properly inflated, use the correct grade of gasoline or fasten your seat belt. We would expect them to pay even if we had multiple accidents related to speeding, excessive drug or alcohol intake or failing to wear our prescription lens. As unreasonable as that sounds, it is just about what we are asking of our health insurance plans.
Problem #2. Even if we had all the money to pay for medical care for everyone, there just isn't enough to go around. Medical care I mean. There aren't enough doctors and nurses and techs and everything else we need to take care of everyone who needs it. The system only works now because millions of poor people are shut out, and have to get their care late in the course of any illness by waiting for hours (sometimes days) in emergency rooms that by law, can't turn them away even if they can't pay.
You've seen how crowded your doctor's office is now, and how long you have to wait to see a specialist or get an MRI. Here in the USA it is days or weeks. In England it is months or years, as it would be here if poor people had well financed equal access to medical care.
Problem #3. American doctors have become obscenely rich. And many or most of them that are rich, won't take care of poor people. That's why they are rich! With the poor reimbursement of Medicaid, it is a losing proposition for them to accept patients with that coverage. And Medical Corporations are not in business to purposefully lose money. Some doctors don't even accept Medicare!
OK, it's time to tell my story. I am named after my grandfather, Dr. Cleaves Bennett, who was a beloved general practitioner in a medium-small town in Illinois. He did simple surgery (tonsils and appendectomy), delivered babies, held the hands of stroke victims and came to the house to pronounce people dead and comfort the family. He worked 20 hour days during the flu pandemic of 1918. He delivered me to my mother who was over 40 at the time. He was thrilled of course that I was given his name.
He took care of anyone who needed it, and was paid by most, but not all of his patients in cash money. The rest would give him a sack of corn (really) or fresh vegetables or just embarrassed looks, mumbled apologies and bowed heads. And tears of gratitude of course. I for one think a mix of some cash money and some tears of gratitude makes for a pretty darned good living for a doctor. You may not be able to drive a Lexus and a BMW, and live tucked into 6,000 ft² in Beverly Hills, but I think it's gonna be a lot easier on you when you finally have to face the big guy upstairs.
My grandfather was not in it for the money. He was in it because he had a God-given ability to take care of sick people and that's what he did until he died of a heart attack from untreated hypertension. At the time he was only about 60 years of age. A lot of people came to his funeral. Over the years many of them encouraged me to become a doctor like my namesake. I have attempted to do just that. I am still a work in progress. I hope I have a few more years left to aspire to do the kind of good works that he did over a career and a lifetime.
Socialism doesn't work very well everywhere it's been tried. The National Health Service in England is always in chronic troubles. The wait for elective gall bladder surgery is measured in years. Rich people, many of them Arabs from oil rich countries, pay private doctors to see them whenever they need it, without waiting in long lines. The doctors who take care of everyone else are the real heros. Like the doctors of yesteryear, they work long hours for not very much money, but that doesn't matter all that much because they wouldn't have time to spend it anyway. The National Health service is made up of doctors and nurses who do it because they believe in it. Because it's their calling. Being able to heal and comfort the sick and dying is a privilege.
Similarly in Canada there are long waits for medical care, just not enough of anything, although the quality of what they do have is very high. Everyday thousands of Canadian nurses cross the border into the US where the pay is a lot better and the US dollar is worth about 15% more. Can you blame them?
Author: Cleaves M. Bennett MD FACP
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