John McClaughry -- an interesting read
October 07, 2014
McClaughry is always interesting to read. He researches his topics well, and always presents an interesting view of history. His latest thesis on "Health Care Mutual Aid", (September 30, 2014), was one of many ways he tries to discredit the "health care for all" movement and, in particular, the Accountable Care Act, or "Obamacare". He disagrees with me on the concept that health care is right for all Americans. He finds this to be an anathema and is quite sure it will lead to the ruin of our country. I, as a physician, see universal health care as an imperative and as our only way forward.
This latest treatise tries to compare health care in the 1930s to our current health care system. He seems to be advocating a "friendly societies" approach to health care. He refers to the Odd Fellows and the Loyal Order of Moose as potential providers of health care for those without means. He laments the institution of the American Medical Association as "hammering down their fraternal competitors."
I was taken aback by the suggestion that the system of certifying and licensing our medical facilities is somehow run by the AMA or that this system somehow favors those with a license over those that might want a license. It seems like he would like to see us revert back to the days when health care was unregulated and anyone that wanted to could claim to provide health care. Included in these health care providers were various "tonic" salesmen that peddled their unregulated wares across the country, making miraculous claims, then moving on to the next town. It is fun to collect some of these bottles or to read their ads but this was NOT medicine as we know it today.
To practice medicine today one needs to meet numerous qualifications and standards set out by governmental and non-governmental agencies. As a Family Physician I needed an MD and a 3-year ACGME accredited residency, (ACGME.org). I had to pass a 3-part USMLE licensing exam, (8 hours each), beginning in medical school and ending just after residency, (NBME.org). This qualified me to apply for a medical license. Then I had to get insured by a malpractice insurer. Then I had to apply to each health insurer to be qualified to accept payment from them for my services; Medicare, Medicaid, Blue Cross/ Blue Shield, Harvard Pilgrim, Cigna, etc. These hurdles apply to everyone that wants to provide health care. While each step is substantial and difficult to attain, it is not a conspiracy by the AMA to keep others out of the business. It is what we, as a society, have created as the standard of care. If this is "socialized medicine" then so be it. It is certainly better than the alternative.
As I read this "In My Opinion" piece I think of the many patients that would fall through the cracks in a system that relies on "Christians who abstain from illegal drugs, tobacco, and sex outside of marriage, and refrain from abusing legal drugs and alcohol." I think we both agree that a world in which these indiscretions never occur would be a wonderful place. Where we begin to diverge is what to do with those who do not comply with his utopian world.
It would seem John is an advocate of the "tough love" chorus. Those that do not comply with the above-mentioned qualifications would need to clean up their act or suffer the consequences. As a health care provider I take a completely different view. Void of opportunity, lacking hope, or mired in social upheaval the populous that John alludes to are not likely to suddenly see the light and begin to adhere to his utopian ideal, or else.
We live in the most prosperous country on earth yet we are reluctant to make access to health care a right of every citizen. We know that if we remove barriers to obtaining health care that people will live healthier lives and have less financial burden if they get sick. The likelihood of getting people to "abstain from illegal drugs, tobacco, and sex outside of marriage, and refrain from abusing legal drugs and alcohol" while being denied health care seems quite low. There are always exceptions, some people find religion and/or make miraculous turn-a rounds in their lifestyle or habits for various reasons but for the most part we see these "social determinants of health" as long term issues that don't get better with ultimatums.
The irony in all of this is that we end up paying for it even when we don't pay for it. The patient that can't afford their insulin for diabetes has a stroke because their blood sugar goes out of control. The patient that never checks their blood pressure because they could never afford the medications to treat hypertension has a heart attack. The patient that never gets a colonoscopy starts to have blood in their stool and ends up with a widely spread colon cancer. Every one of these patients will get care in this country. The problem is that the "horse is already out of the barn" type of health care is much more expensive than the "free kind."
We are a compassionate people, we Americans. We need to care for our citizens with no strings attached. If we do so we will find that we are healthier as a whole and that more opportunity is available to more people. When the playing field is leveled by providing guaranteed access to health care more people have the opportunity to achieve health, wealth, and happiness. Relieving the populous of the burden of financial ruin by illness will make us all more prosperous.