Friday, August 15, 2008

Guest post by Skylanda: Fifteen days of blogging for health care reform

I am a physician. To be more specific, I am a resident, in my second year of training in a rural family practice track. I live and breath health care, more hours than I live any other part of my life. Ask any resident, they will quite likely tell you something very similar.

Doctors battle out the flaws and foibles of the American health care system every day. No matter what their opinion on the solution, few will disagree that we indeed have a problem in this country. Some will tell you we need more free marketeering, less government interference; others lean to the far opposite side, demanding reform toward single payer coverage or even a government-run health care system that directly manages health care workers as its own employees. But find me a doctor in this country who thinks there is nothing direly wrong with health care in America today, and I will find you a chicken who hatches pink bunnies out of its eggs - that is, a rare bird indeed.

At the same time, few physicians are immune to some personal ensnarement of the health care crisis in America. We straddle two sides of the fence - we are providers, but we are also consumers, and our relative wealth provides only thin insulation from the same traps and pitfalls that plague the rest of the nation. Just out of college, in the midst of the turn-of-the-millennium tech bust, I took a job that required heavy manual labor on offshore construction rigs; I was uninsured, working on subcontracts among union crews of merchant marines, and I was without a hint of worker’s comp coverage - it was simply understood among us contractors that if we were ever injured offshore, the first call would be made to lawyers to start talking settlements, because there would be no other way to pay a medical bill proportionate to the risks to life and limb we took on those rigs. My older sister, meanwhile, waited out ten years without health insurance, during which time a minor (and treatable) skin condition blossomed into inflammation and scarring so severe that it impairs her ability to walk, write, even provide fingerprints required by new employers; by the time she obtained insurance, the condition had become entrenched and largely irreversible. Two years ago, my brother’s school-age child came down with a complicated case of leukemia less than a month after he returned from a year-long tour in Iraq with the National Guard; though her epic hospital stay was graciously covered by the combined taxpayer efforts of Tricare and Medicaid, he now has to closely balance his potential income with Medicaid limits lest his chronically ill and entirely uninsurable daughter lose her only source of insurance eligibility.

These are not sob stories and they are not meant to gain any particular sympathy for a few rough years in my family tree; these are entirely typical stories in America in 2008 (and I don‘t doubt that readers here could share a litany just like them). Few families outside of the shrinking and ever-more-distant elite cannot tell similar stories: grandparents hospitalized for conditions that could have been prevented by medications they were prescribed but could not afford, bankruptcies filed as a last-resort means of coping with unpayable medical bills, choices made between health care and food, health care and education, health care and mortgage payments.

Nor can one pretend any longer that the crisis in health care coverage and access is at all limited to the poorest corners of the social strata. There is nothing acceptable - morally, economically, or otherwise - about a wealthy, industrialized nation leaving any portion of the populace without access to care, but when such problems are limited to the most marginalized people, we can at least pretend that we are on our way to vanquishing the problem, chasing it into darker and darker corners, moving toward something better and brighter. This pretense has no business existing any longer. Extinguish the notion, right now, that we are not losing a fight, in this nation, in this very moment, to the burden of ever-growing numbers of the uninsured, the under-insured, the improperly insured, and people simply pushed so far to the margins that access to care comes only at the door of the emergency room - a door exponentially more expensive than that of your local five-star hotel. Some forty-something million of the former, some uncountable number of the latter, growing every day.

Echidne has graciously provided several of us guest bloggers a platform on which to speak during these next two weeks, and this is auspicious timing indeed. In my adopted state of New Mexico, the governor has called a special session to force the legislature to start addressing this issue of broadening health coverage; at the end of the month, Barak Obama will accept the nomination for the democratic presidential ticket, bringing new hope - and renewed cynicism - to the health care reform table and the litany of other progressive issues. During these two weeks, my contribution to Echidne’s blog will be a series of posts from this one insider’s perspective - and there are as many insider’s perspectives as there are doctors, nurses, hospital administrators, biotech developers, patients, and the like - on some of the key issues and developments that shape and hinder health care reform in America today.

Times are ripe indeed for a profound push toward reform, as they have been ripe and then fallen short before, time and again. But like an addict who quits their cigarettes fourteen times before the quitting takes, one of these times, reform will take hold. The shape of that reform, the effect it will have on the diversity of issues that shape health in America, its inclusive or exclusive nature - those remain to be seen. Stay tuned.

Cross-posted at my blog, Loose Chicks Sink Ships. Please note that all references to patients have been altered and/or fictionalized to protect the identity of those individuals.