My best friend from college, a Conservative, a Republican, and also an incredibly nice and very reasonable guy, wrote to me to ask my opinion about health care reform as he is "trying to keep an open mind." Here was his email:
So - being a doctor and a liberal - what is your opinion about the current health care debate? I kind of can read between the lines, but in an attempt to have an open mind and better educate myself, I want to hear it from the "horse's mouth." :-)
I have been doing a lot of thinking about the moral imperative of health care reform, so...
...this is what I wrote in response.
I appreciate your email. There isn't much dialogue that's happening right now, and what's happening is people are dividing themselves up into "for" and "against" camps - which is really kind of a tragedy, because for an issue this nuanced I really believe that most reasonable people ought to be saying, "There's parts of this that I agree with - and there are other parts of this about which I'm a little skeptical."
As a general rule: I favor health care reform, and I favor it through a single payer system - which puts me well to the left of the Obama administration, and to the left of the bill that is bound to emerge from Congress. The question is why, so here's why:
Last Saturday night, I was the physician for a 20-year-old kid who presented with diabetic ketoacidosis - a life-threatening "diabetic crisis." Nice kid - "yes sir" this, "no sir" that. He had a nice job coming out of high school - and then lost that job, didn't have a dime to his name, and couldn't afford his insulin. So: we admitted him to the intensive care unit, started three IV lines, pumped fluids through two of them and insulin through the third, checked his glucose every two hours and his labs every four, and by the following day he was as good as new. By the way, this was the second time that I had met this kid; this exact scenario played itself out the first time I met him in April.
See, here is the dirty little secret: we already (sort of) have universal health care. We absolutely (sort of) do. What I mean by that is: when a kid like this shows up in our ER, we don't tell him, "tough, you don't have health insurance, so we're going to have to let you die." No, we treat him, and we save the kid's life. Now ask yourself this: when was the last time you saw a hospital go out of business? Have you EVER seen that happen? Hospitals aren't closing by the dozens every week, and it's because hospitals are subsidizing their costs through the payer sources that they do have. THAT'S why your health insurance costs are outpacing inflation: every year, you're subsidizing more and more uninsured patients. And my argument is: it's much, much, much more efficient to ask you to subsidize this kid with a couple of bottles of insulin every month, than it is to ask you to subsidize the insane costs of two (and counting) admissions to the hospital ICU. Then, multiply that example by example after example after example just like that, that I see every doggone day - and you understand why I begin to dream about a system that would almost inevitably be more efficient.
It's much more than a question of efficiency for me, though. I don't talk often about religion often but for me, all of this speaks to the fundamentals of what it means to me to be a Christian: Christ, I believe, would ask us to take care of one another when we are sick; He would ask us to look after one another in our most difficult hours, and He would certainly not imagine that we would cast judgment on who was worthy of care and who was not, based upon one's ability to pay. Even for those who are non-believers, these concepts - taking care of one another when we are sick, looking after one another in our most difficult hour - cut to the heart of what it means to me to be a good person, and all of this cuts to the heart of why I really wanted to become a doctor. And it's why I've decided to plunge myself into the heart of the debate now.
I'm a little surprised that more people haven't taken the ideas embodied particularly in that last paragraph, and run with them in this health care reform debate.
(As an aside: I originally posted this as a comment in an excellent diary on the early morning Recommended List, and several suggested that I make this into a diary. I hope no one minds.)
Everyone that opposes current efforts at health care reform should join me for rounds one day, and see what it is to tell someone that they have a serious illness - an illness for which they will have limited options, an illness which may well make them bankrupt, with or without health insurance.
I am proud to have always worked in hospitals that offer care of patients regardless of their ability to pay - as a resident, fellow, and now as a young attending. Yet even in these settings, I worry every day that the care we offer will bankrupt those we are trying to serve.
To me, this health care debate is fundamentally a question of how we choose to care for one another, to look after one another, to give to one another, to be good to one another. Indeed, it is nothing less than a question of what it means to be a good person - and this is a time for us all to ask what kind of persons we want to be.