Solving Our Healthcare Crisis Would Truly Be an Independence Day!
By John Graham
July 4th, 2012
The maddening and never-ending debate over our nation’s healthcare casts a dark shadow over today’s 2012 Independence Day celebrations. Citizens stand by and wonder why Congress cannot work together to solve so pressing a problem: Men and women refused insurance coverage because of a preexisting illness; people losing their insurance when the company they work for tanks and they are forced to move from job to job; and now a 2,500 page Affordable Healthcare Act that may actually create more problems than it solves.
In his July 4, 2012 column David Brooks reports that the new law calls for the creation of 159 new federal offices, boards and councils (Houston Chronicle, B7). And he says, “in the first six months after passage alone, federal officials churned out an awesome 4,103 pages of regulations.” As we all know whatever the national government does
I have hesitated to address this issue because there is confusion on both sides as Nick Anderson’s cartoon in today’s Houston Chronicle suggests – both Obama and Romni saying “It’s NOT a tax” while our Supreme Court Justice John Roberts, Jr. says it is. How convoluted can things get? Politics gone amuck! No wonder the public doesn’t trust our government to solve even so fundamental an issue as the healthcare of our people.
The Delivery of Medicine has Changed
I was a physician before becoming a priest. As a doctor I saw the problem first hand – and I left the private practice of medicine twenty years ago. Today, when I return to my hometown, Shreveport, LA, where I practiced, physician friends come up to me and say, “How did you get God to call you into the priesthood?” Shaking their heads, they say, “John, you left at the right time, medicine is not the same anymore.”
What has changed? For the most part physicians have their hands tied behind their backs by insurance companies. Even the best companies tie their reimbursement to Medicare payment schedules, which continue to drop year after year. I have a surgeon friend in Oklahoma City who says it costs him more to try to do a minor procedure in his office than Medicare will reimburse. So, he has to go to the hospital which costs the government far more than it would have if they gave proper reimbursement for office surgery.
And, if Medicare refuses to pay because a procedure is considered “experimental” then private insurance will refuse payment. Physicians with a sick patient in the hospital may be told the insurance company is refusing payment because the patient has exceeded the allotment for his or her particular illness. The physician is forced to FAX the insurance company documents to prove the need for continued hospitalization. Even then, the clerk may refuse to continue coverage.
Diabolical, mind-boggling — a clerk a thousand miles away is dictating treatment of a patient the clerk has never seen. No wonder a majority of physicians today are looking forward to retirement from the practice of medicine. No wonder we already have an extreme shortage of physicians and it will only get progressively worse in the years ahead, especially in the small towns of America.
Misinformation is Given to the American Public
The sad part of all this is our physicians provide the finest medical care in the world. That’s why physicians the world-over want to do a Residency or Fellowship in our hospitals. And, that is why most foreign physicians want to remain in America after they complete their training. This is the best place on earth to practice medicine.
But, don’t try to convince Washington this is true. Decades ago I went on a tour of three medical centers in Europe. I visited a hospital in London where one hour into an eight hour surgery the anesthesiologist said, “Mr. Thompson (physicians are called Misters in England), the patient is doing well and Sister (nurse) will check her blood pressure and pulse every fifteen minutes. Ifit is all right with you, I’d like to go have a spot of tea.” I couldn’t believe what I was hearing. I thought he was joking. Then, the head surgeon said, “Oh yes, brilliant idea.” And, at that the anesthesiologist abandoned his patient and left the operating room. He did not return for an hour. I took a picture of the “anesthesiologist,” which in this case was a machine set on “automatic,” pumping oxygen and anesthetic agents into an intubated and unconscious patient.
A nurse left to check a patient’s blood pressure every fifteen minutes is appalling. No, terrifying. Can you imagine an anesthesiologist trying to defend himself in an American court of law if something went wrong? He would be wise to settle out of court. Abandonment of a helpless patient is clearly malpractice of the highest order. Dr. Conrad Murray learned this in his trial following the death of Michael Jackson.
I returned to America to see Senator Ted Kennedy of Massachusetts featured on national television evening news proclaiming we were “thirty years behind medical care in England.” Clearly, Ted Kennedy has never been in an operating room in England or in American for that matter. He had absolutely no basis for making such a statement and yet the Press gave him a platform to disseminate his misinformation upon our unsuspecting public. And, even worse in my opinion, American Medicine did not stand up and deny such claims, though clearly they misrepresent the facts.
What Senator Kennedy did not say was that England have a “two-tier” system. Anyone can get medical care in a government facility if they are willing to wait or they can go to a physician in private practice. When I visited the office of a physician in London he showed me a wall of drawers which contained index cards. He said, “Dr. Graham, which operation would you like to do today?” I said, “Excuse me, what do you mean?” He said, “Name an operation, any operation.” I said, “Okay, I would like to do a gall bladder operation.” He went over to the wall, pulled out two drawers, and said, “Take your pick.” I said, “What do you mean.” The surgeon said, “All these people are waiting to have surgery.” Again, I was shocked and said, “Do you mean they have been worked up and it is known they need the surgery?” He said, “Precisely.” I said, “In America they would be operated on tomorrow or before the week is out.” He said, “Yes, I know, and that is why we have a two-tier system in England. If these people tire of waiting, they go to a private doctor for the care they need.” Ted Kennedy did not mention this fact. The same is true of the Canadian health care system which is so highly touted in the Press. They also have a two-tier system for the delivery of medical care.
Another source of misinformation: we are constantly being told American Medicine does not measure up. Although we spend the highest percentage of our National Gross Product of any nation on medical care we are said to be way down the list, a dismal 37th among 191 nations of the world by some measures. But, is it proper to compare the diverse and large population of America with that of Sweden and Denmark? Think about it. Many smaller countries have a homogenous socio-economic population and provide universal health care to all its citizens.
American has a very different situation made up, as we are, of people groups from all over the world many with very different ways of seeing things. Most feel they are entitled to medical care even if they are unwilling to pay for an insurance policy. These show up in the emergency rooms of our hospitals not having taken care of themselves and our national government demands hospitals refuse care to no one. Not having received the benefits of preventative medicine office visits would have provided, they often show up with problems.
Decades ago I was in practice in Shreveport where free medical care was provided to all citizens of Louisiana. This was part of the famous governor Huey “Kingfish” Long’s “Chicken in every pot” campaign to become governor of the state. Governor Long created five Charity hospitals – one in each of the four corners of the state and another in the largest city, New Orleans. Care was free to anyone in the state. But, all too often, even when care was provided without charge, citizens showed up at the last minute having not received the benefit of regular medical checkups. Pregnant women would appear at the emergency room doors, the baby “crowning,” and had not come in for prenatal visits. We often saw individuals using home remedies which were devastating. Pregnant women often ate cakes of clay which caused iron deficiency anemia. There are many more examples I could give, but the point I want to make is you cannot compare the quality of care in America to that of a nation like Sweden. That is like comparing apples and oranges and it is misinformation at the worse.
Not only is misinformation a problem, lack of information is another problem. How seldom in these political debates do we hear anything about how many physicians give of their services at no charge? Personally, when I was in private practice of medicine, I estimate 30% of my service was without charge. When I did charge and a patient could not pay, I wrote it off my “receivables.” I never in 25 years sent a single patient to a bill collector. And, I was not alone. Countless other physicians quietly and without fan fare have done the same thing for decades. And, how often are physicians acknowledged when they give of their time to local and foreign missions? Doctors Without Borders and Operation Smiles are but two of hundreds of organizations that offer physician and nursing servies to our world at no charge. In fact, these physicians and nurses pay their own way to the places they go to serve. They do this because they believe medicine is a calling — and they believe they are called to serve humankind. For many, there is no greater joy than to serve those who otherwise would receive no medical care. Not only do physicians, nurses and staff people offer services through these organizations, countless religious organizations across America have medical mission outreach programs to foreign lands. These activities need to be recognized, honored and appreciated.
Having said that, I must acknowledge in America many of our people are underserved or many go unserved. In many cases this is due to a lack of awareness of what is available. All too often, individuals who avoid medical services that are available ultimately arrive in the hospital emergency room where they become a burden on society. If they had attended to preventive medical services and knowledge that is readily available they may well have prevented progression of their disease. I am thinking of those who go to a fast-food store and purchase triple-decker hamburger with bacon and cheese. In many cases, they buy these same burgers for their young children — teachign them bad habits early in life. Socio-economics plays a role in not receiving preventive medicine care, but the patient has a responsibility too. And, that is seldom mentioned as part of the problem, which it clearly is. And, culture has a role to play as well. The story I mentioned about pregnant women eating clay cookies and acquiring iron-deficiency anemia is but one example of the adverse influence of one’s culture. Lack of information and missinformation can be deadly. What I am saying is that religious and civic leaders in our communities need to take responsibility for teaching those in their sphere of influence how to better take care of themselves. As they say, “an ounce of prevention is worth a pound of medical care.” I commend the African-American preachers for the role they have taken in educating their people. Many of these pastors hold medical clinics in their churches and have classes teaching the danger of obesity and how to recognize and treat high blood pressure. I take my hat off to them and their good work should be recognized. Community and media leaders who practice a healthy lifestyle themselves can make a great difference in this generation and the next.
Are there Any Solutions?
I believe if our politicians would put aside political posturing and work together, there are viable solutions to our health care delivery problem. I am afraid “penalizing” or “taxing” those who don’t have insurance policies is not going to work. Too many people will still not be covered and the burden on Medicaid in our states may become catastrophic for state and local government. They will opt out. Even more frightening, the host of federal regulations being placed on major corporations and small businesses may well cause them to no longer provide healthcare coverage for their employees.
For one thing, in the article I mentioned above, David Brooks talks about a bill being proposed by James C Capretta and Robert E. Moffit. These lawmakers seem to take a different approach. Instead of penalizing/taxing those who do not have insurance, they propose a tax credit to be used to purchase insurance. Like in the Affordable Healthcare Act, insurance companies cannot refuse coverage for individuals with pre-existing illnesses and would not be permitted to increase premiums if a policyholder gets sick. Individuals would be allowed to take the policy from job to job because they purchased the policy (not their employer) and the insurance company would not be able to cancel the policy even if they move to another state. The authors also propose gradually increasing the retirement age to help alleviate the burden. As people are now living longer that seems to be reasonable.
I do not want to say the Capretta and Moffit bill meets every need but I do believe it is a good starting place. If Democrats and Republicans in Washington care about this nation, it is time they lay aside their polarization into two camps and come together. If they do, like all the major problems this nation has faced for the past 236 years, we will surely be able to solve this one. Now wouldn’t that be cause for an Independence Day celebration?