Friday, August 4, 2017

King George and the Health Care Revolt

Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance.  (

More stress for patients and another example of wanton practices by insurers ahead.

Here we are, several weeks after Independence day 2017. Physicians have always been proponents of independence and free will.

It is time for all physicians to declare their own Declaration of Independence. There has been a change by physicians from murmur to rumble. The situation is much like that of 1775 where endless argument with King George led to a revolution.

Men do not go to war unless diplomacy fails, and diplomacy has failed to resolve the failure of our health system with talk.

Just like politicians physicians have their own 'base' . Those individuals who talk amongst themselves under the fray of their representatives, not in formal organizational discussions.  The 'base' know that their ideas become diluted, distorted and compromised by politicians and organizations. Then there is the niche that simply do not belong to organizations. Implicit in this choice there is little accomplished by supporting them.  Some belong only to their specialty society which improves their access to continuing medical education and a means to socialize with immediate peers.

During the past decade numerous paramedical organizations have spontaneously emerged, often pioneered by one or two physician leaders, at first relatively unknown to the majority of physicians.  Although overshadowed by well funded established medical and subspecialty societies private contributions have kept these new organizations alive.  Most important to their growth has been the increased regulatory environment and ennui of congress.

Health reform: It’s time for Congress to grow up and do their jobs

Health – /helTH/ – The state of being free from illness or injury
Care – /ker/ – The provision of what is necessary for the health, welfare, and protection of someone or something.
System – /’sistÉ™m/ – A set of things working together as parts of a mechanism or an interconnecting network.
It’s not keeping us Healthy, it doesn’t seem to Care, and it’s certainly no kind of System. What we’re got is more about hostile parties protecting their turf and income than a system that’s working together. The docs fight the insurance companies to get things covered; the patients fight the hospitals over inflated, inscrutable bills; the insurance companies fight the pharmaceutical companies over the eye-popping prices of new drugs. The people least suited to fight end up losing the most — that’d be the “patients.”
Meanwhile: The peeps we’ve hired to fix this mess are too busy trying to make each other look bad — which, by the way, is like shootin’ fish in a barrel these days, amirite? — to pass some kind of legislation to even begin to help fix this fine mess. Ever get hired to do a job that you don’t do for 2 or 4 or 8 or 20 years? Didja keep that job? Mind: boggled.
I will now specifically criticize the approach of both parties. Those of you with strong loyalties may want to skip the next (Democratic) or following (Republican) paragraphs, lest you be exposed to a worldview that’s not aligned with your own. But for the few of you left who are still capable of seeing two sides of an issue, start here:
Democrats: Obamacare has problems. The insurance marketplaces in many places are collapsing, and premiums are going thru the roof. Even people who have “insurance” often have huge deductibles that they can’t afford. In short: just having “insurance” isn’t the same as “having access to health care.” Obamacare didn’t do a thing to rein in the biggest problem: health care costs too much, and too many people (sorry, “market stakeholders”) are chewing up huge slices of the pie without contributing anything useful to helping patients. I know you’re feeling hurt that you lost the last election, but can you please grow up, talk to the other side, and come up with some common ground to start to address the problems?
Republicans: The free market, alone, cannot save health care. The barriers to entry are too huge (it’s hard to become a doctor, harder to open up a company to manufacture medicines, and even harder to open up a hospital) — which means competition is artificially stunted, and won’t pop up automatically to reduce prices. Also, emergency departments are required, by law, to offer care to people who cannot pay; that’s morally the right thing, and don’t even think about removing this safety net. Health care choices are also difficult and fraught, and often made under the duress of pain and worry. People cannot be expected to call around to different ambulance companies to check their prices when they’re experiencing crushing chest pain. You have to admit: Health care is unique, and you can’t depend on free market principles, alone, to fix it. The solution is going to include regulations and guidelines and (gasp) some guarantees of coverage, and might even require ways to rein in insurance companies, hospital, doctor, and pharmaceutical profits. I know you’re feeling giddy that you won the last election, but can you please grow up, talk to the other side, and come up with some common ground to start to address the problems?
It’s not easy, I know, but at this point, it’s clear that members of both parties aren’t keeping their eyes on the ball. Your job isn’t about re-election, and payback, and “If you play with Susie than you can’t be my friend anymore.”
The foundation of that system and our profession is the doctor-patient relationship. But this sacred and uniquely human interaction does not exist in isolation.  It occurs in a complex, fragmented framework of physicians, nurses and other healthcare providers, hospitals, third-party payers, pharmaceutical and medical device companies, federal and state policymakers, lawyers, and more.
In other words, if you’re in medicine, you’re in politics.

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