Allow me to make a confession. I was being naive thinking that I had any hope in hell of managing to come up with a coherent analysis of today's Health Care Reform summit in time to have it up any time today. In fact I'm not sure if it will be ready before next week. But never let it be said that I don’t come through with at least a little something for my loyal readers.
Today's article comes from a comment that one of my readers at Daily Kos made in the comment section of my look at Obama's suggestions for Health Care Reform. He opined that he felt it was inappropriate for Doctors to ever have an investor interest in providing extra services. I said something to him in my reply, that the more I thought about it today seems more and more true.
I said, "What's more I'd like to see us return to a very old fashioned notion that there are simply some jobs you take expecting to not get rich. Medicine used to be one of those."
And I kept thinking of that, over and over again, especially every time today during the Health Care Reform summit that one of the Republicans would carry on about doctors getting paid through Medicare and Medicaid a lower percentage than what they get paid via insurance companies.
The more I think it over the more I think that I’m right, and that I’ve hit upon a problem that is an important part of why Health care in this country is so horribly broken.
ONCE UPON A TIME...
Here's the thing, once upon a time, generally speaking the talent for being a medical practitioner, doctor, nurse, what have you, was considered a gift. People generally were aware that the ability to take in and retain such complex knowledge and be able to act on it, under incredible pressure was not something everyone had. Most people felt that while in a way it set them apart, it also gave them a duty to their fellow human beings. Kind of a, "Of those to whom much is given, much will be demanded," mentality. Generally speaking the ideal was that a doctor would often have well off clients who could afford to pay in full, and they subsidized the doctor spending some time treating those patients who could not afford to pay much if anything.
This worked well enough although imperfectly to be certain. There were always those doctors who didn’t give half a shit for anything other than making money, and thanks to The Great Depression the number of people who needed medical help but could not pay was enormous.
It was in part because of the Depression that ideas like Medicare and Medicaid came into being. The idea at least in conception was that rather than leave people dependent on charities, which are not immune from the ups and downs of the economy, and during lean times might have to cut back on the help they give, or on individual doctors who could easily get overwhelmed and simply decide to stop seeing hardship cases, better to create a program that would guarantee that doctors, nurses, technicians, etc would get paid something. It might not be much, but it would still be more than nothing, and might serve as in incentive for more doctors to see impoverished patients.
I like to think that this suited most, if not all doctors (and by the way from here on out I’m going to be using "doctor" as a generic term since it’s quicker and easier to use than Health Care Professional over and over again) and that the majority were happy to be able to treat people in need and not have to worry quite so much about being able to make a living.
THINGS CHANGE AND NOT FOR THE BETTER...
But then something insidious in this country happened. We had a steady and persistent decay in our core values. Like most things it did not happen in a day, or a week, not even a year or a decade. But bit by bit, we lost sight of the idea of service to our fellow human beings, being one of the highest callings one could have. Slowly it started to seem that making money and serving oneself became the highest calling. The ideas behind that ethos seemed to coalesce and become codified during the '80's. Everything about that decade seemed to be people trying to justify greed and selfishness. That's what Gordon Gecko's speech in wall Street is about, and that at it's core is what "Trickle Down" Economics is about. It's not actually an economic theory. What it is, is an attempt by people to rationalize and justify greed. "Well it’s okay that we have all this and keep getting more, because just by doing what serves us, just by doing what feels good, it’s benefiting those below us, so we’re actually helping them."
The next factor in this moral warping involved envy. People in parts of society that were not usually easy paths to riches saw how much comfort and what nice things those with lots of money had, and they wanted it too. You know what? I can empathize. I really can. This is something I don't talk about much but when it's relevant and important to understanding the story I do not withhold the truth about my life and experiences from my readers. When I was young my father worked in the timber industry in the Pacific Northwest, and during the late seventies early eighties it was still a boom time. We were working class, but he was involved in both production and management, roughly the equivalent of middle management, and he was paid very very well. My mother did not have to work outside the home. There was nothing we did not have. Doctor visits? Not a problem. Nice cars? No difficulty. A nice house, good food, clothing. The only time I didn't get something was because my parents didn't want me to have it. Whether or not we could afford it was not an issue. And then over night the bottom dropped out of the timber industry. If my father had savings they were not much, why save when things were going to go on forever like they always had. Suddenly we were just one bad moment away from being not merely poor, but destitute. We lost our house, we moved back to the town where he had grown up and moved in with his parents. Suddenly every purchase had to be carefully monitored, food, clothing, doctor visits, all had to be viewed with an eye towards money and if we would be able to pay for it.
And do you know something? I hate it. You see I was just old enough to understand the ease that having money brought to our lives, and to understand how difficult things became because of not having it.
So I do not demonize people who looked at those who lead lives of ease and comfort and wanted to have a piece of it. To just not have to work quite so hard to have a decent life.
WHICH BRINGS US TO TODAY...
And so a little at a time over many years, the Health Care landscape changed. More and more doctors specialized, the general practitioners became fewer and fewer, because specialization was seen and not wrongly so as where the big money was. Meanwhile the general practitioners that were left wanted more, so they started to change the way they did things, many of them. They started to see more and more patients, and often rather than really handling cases themselves simply determined what relevant specialist they could refer them too, often a specialist that they had made a deal with to receive a gratuity for every patient referred to them. Often times it was a flat fee per patient, sometimes it would be a percentage of what the specialist received from the patient. Ultimately though health care, increasingly became a volume business.
The acquisition of a large number of hospitals by large corporations did not help matters, more and more the focus went from changing to changed. It became about almost nothing but the bottom line. This has led us to today. Giant insurance companies boast record profits. Profits which they in part achieved by raising rates astronomically, and then by canceling policies out from under those who dare to actually make use of the service they've been paying for. And when called to account for such practices they shuck and jive and say, "oh well, it only looks like we're making money, in truth we're almost poor ourselves. Why we’re practically down to our last million."
And in the midst of all this we hear about how doctors are refusing to see Medicare and Medicaid patients, because essentially they don’t get paid as well billing the government as when they see patients who have private insurance.
To put it very simply if we are going to have any hope at all, of fixing this incredibly broken health care system and the country it sits within, we are all of us going to have to make some changes.
IT'S TIME FOR A CHANGE FOR THE BETTER...
It is time for doctors who enter the medical profession because they want to help people, not because they want to get rich, to go back to being the standard, instead of being an exception. It is time for us as a society to make the well being of our citizens and those who care for them more important than the well being of multinational corporations and the CEO's that run them. It is time for us to begin the move back towards the idea that some professions you choose, not for the money, but for the chance to do something good for your fellow man. We need to return to a mindset where doctors look at the money they make from those who have public insurance and feel grateful that it's presence means they are able to treat those who most desperately need their help, without having to be wholly dependent on their own resources for the wherewithal to do so. Basically to look at Medicare and Medicaid as a gift that helps make it possible for them to serve their community, not as a burden preventing them from making the big money.
To be certain this change alone will not fix what is broken within Health Care, nor within our nation as a whole. But I think that it would be an important first step, and would help to make all the myriad of subsequent steps that must be taken possible.
Keep The Faith My Brothers And Sisters!
(This article originally appeared at The One About...)