The medical system in this country is broken. I accuse this nation of allowing the system's critical illness to fester and applaud Massachusetts and Governor Romney for shining a beacon on the problem through some kind of attempt at universal coverage. If that state represents Paul Revere, it's crying "Death is coming, Death is coming" rather than something about advancing British. In 1993, when First Lady Hillary Clinton's national health plan attempt was shut down by lobbyists, frequently bankruptcy inducing early graves should have been sidestepped by citizens in this country when some variation of the Clinton plan should have been launched.
Now, the rest of the nation represents "The Minutemen" called to arms to activate behind the Massachusetts rider. Indeed, the clock is ticking on a "health care system" that is imploding daily.
A failing bureaucracy and the absence of consistently effective Specialty Care are grave defects in our health care apparatus. These problems are like evil twins. Both problems are increasingly malignant and prop up one another. It's one if by land should you stand on any United States clinic floor to get outrageously over tested for a hangnail, two if you're an American inclined to hit the high seas to get a cheap cholecystectomy in India.
A key derangement in our medical system is the fact that capitalism is associated with health and the treatment of illness. From the standpoint of strategizing diagnosis and therapy, "making a buck" should have nothing to do with the provision of medical intervention- Oh, I'm sorry, except in the way the United States organizes medical and health care.
The roots of this flawed linking of capitalism with disease are extraordinarily complex. But let me take the physicians' standpoint here. Who died and decided they should become Mother Theresas? They like helping people. In fact, many love helping people. They also see millions "cashing in" on the American dream through various professions and/or entrepreneurial ventures and ask the simple question: "After all these expenses to achieve a medical education, after all the nights on call as coolly labor while an intern and resident, after attaining this highly prestigious position in this capitalism driven society, why can't we make a lot of money?" These M.D.'s also compare their lot with those rolling in doe, who have not invested the same time and effort to gain high incomes and wonder why they, American physicians, should be relegated to wage earners low down on the American ladder if they don't jump into the "capitalism game".
Specific comparisons? I'm not going to point a finger at certain chiropractors who treat ear infections, certain unscrupulous malpractice lawyers, certain nutrition business owners who sell products that "improve your focus" or certain HMO moguls. I'm just not going to single out individuals.
In a word, capitalism in medicine has generated a bureaucracy. This is based upon the application of a private practice model to medicine that is combined with a take-over orchestrated by HMO cowboys/sheep herders supplemented by governmental hyper-regulation, lawsuit threats at every corner and an explosion of frequently misappropriated technology. Thus, your doctor may have his own office as a solo practitioner, be part of a small group or even a large group, but he is hardly the equivalent of "Doc Jones" from the ‘50's who would make house calls and answer the phone himself.
This is not to say that "Doc Jones" was so marvelous. I am using this comparison to assess the erosion of care as linked to capitalism. Although the "good doc" of old may have had multiple gaps in his knowledge, one thing is by in large true: He was not a "high roller capitalist". Well, they also didn't have a multi-billion dollar nutritional supplement industry back then nor closets costing $300,000 also known as apartment dwellings where "docs" can live.
So when you call your medical doctor (let's make him a Specialist at this time), you have to navigate through hoops so familiar to all. There's Suzie answering the phone at night, then Joe, the Sloth, as slowly as possible, picking up phones outside of his two hour lunch break, then the woman who puts you on hold for 20 minutes to tell you that the next appointment is in two months but "if it's an emergency, go to the Emergency Room". You all know the drill. Then, after ascertaining that it is not an emergency based on your lay assessment that you seem to still be conscious and breathing, you hear Sandy telling you that the appointment you had for two months from now has to be rescheduled for three months from now, since the doctor will be out of the office that day.
Three months march by and let's say that your problem happens to be stable, although there are a couple of new wrinkles. (No smart-*** comments. I am not referring to the miracle of Botox). You get in the office only to find that there are multiple issues with your insurance. It covers X, not Y. You have misunderstood your deductible. "Doc" schedules a study at Z Cat Scan but you then get a call from Gloria at ZCS that their scanning place doesn't participate in your insurance. You go to ZZ Scanning Place instead and ZZSP sends you a bill because they never got the right insurance information from Sandy. And then you find that Sandy isn't even working at "doc's" office anymore.
What does all of this have to do with capitalism? Suzie, Joe, Sandy, Gloria, the scanning centers and "your doc" are all trying to earn greenbacks through the broken system that gets you that scan at the end of that third month. I say let's figure out other stuff for Suzie, Joe, Gloria and particularly Sandy to do in a new system of medical interventions, perhaps retrain them in needed areas where their skills might be effectively utilized to help the burgeoning population of aged and sick Americans. The imaging industry can be tackled in future reports.
And "your doc"? Get him focused (with or without nutritional supplements) on the work of practicing effective and streamlined specialty care. It turns out, that if you had been able to see "doc" as his patient day one of your problem, you would not even have needed the Cat Scan and your condition could have been cured in a week with a cheap antibiotic that had been developed 50 years ago. Not only that, all that money saved in your care if multiplied a million times as part of a gutting of the present bureaucracy, would help to cover the cost of medical insurance allowing for even Sandy to return to a medicine related job instead of her current role as an assistant marketeer for supplements that help you focus better.
Having said all this, and focusing on "focus", there remain, shall we say, "boutique" issues involving Specialty Care that involve things like LASIK. Add on certain applications of Botox to this "partially cosmetic" arena. This needs to be covered via another writing too.
But wrapping up the gist of this piece. It is the deterioration of Specialty Care in the midst of all of these great advances in medicine that needs to be immediately addressed via a national health care agenda that draws at least in coverage scope from the Massachusetts first call to arms.
When you are sick, you often need the interventions of a Specialist. In fact the sicker you are, the more likely you will need that Gastroenterologist or Neuro-Ophthalmologist or Oncologist.
No hocus pocus with aberrant focus on "health care" will solve that requirement to address the fact you have Non-Tropical Sprue and a homonymous hemianopsia in the setting of CNS Whipple's Disease complicated by Lymphoma that masqueraded as Secondary Progressive Multiple Sclerosis.
And you can't wait for Sandy and you don't need to go to the Emergency Room and you simply need to see your Specialist tomorrow.
And that Specialist needs to earn a good deal of money in this capitalist society. And his pay must be divorced from the current model of a capitalism linked "health care mess" that includes defective triage and wasteful medical decision making, driven to excess or inadequately performed within this country's poorly functioning medical care system.
Published On: December 18, 2007