Politics and Health

Skip this post if you're tired of hearing about American politics particularly the ongoing discussion of health care funding.

I’m a bad blogger. It’s just that things here have been busyish, and I feel like there’s been so much to say that it’s been hard to sit down and just start writing, because then I’ll have to choose what to talk about, and inevitably some important / interesting stuff will be left out.

First, a few words about American politics: it is very tempting for me to completely ignore it. I’m not at home. It’s not my problem right now. I don’t have to seek out information on what’s going on; (because so many of my friends are actively thinking and talking about what’s going on, posting comments and articles on facebook, blogs etc.) but it also wouldn’t be hard for me to ignore it either. In residency I pretty much did that. Taking care of my patients, my team and myself was all I could worry about. I didn’t have the time or emotional energy to invest in worrying about our national health policy, or much other than how I would vote in elections for congress, the senate, and the presidency. But while things have been busy here, I’m still working a normalish work week - in the 40 hour range - and the emotional burden of patient care is much less as I am not directly responsible for any patients. Don’t get me wrong, I still care about these patients and I want to make sure they get the best possible care they can with the resources available, while raising the overall standard of care and trying to get better/ more resources. But I don’t come home and have nightmares or trouble sleeping because of worry that I forgot to order something or missed something the way I did in residency. I come home and look things up if it occurs to me that I should have thought of something else, or if there’s something I want to be able to explain better the next day, but the connection is different. So I have some time an emotional energy to devote to something else, and as a relatively well educated, thoughtful citizen, perhaps the current American political situation should be one of the things I choose.

The incredible amount of time and energy being put into talking about the republican challengers for Obama is distressing to me. The election is more than a year away still, and I think the earlier and earlier start of campaigning for the presidency is both distracting from the very real issues and problems we should be talking about, and skews this discourse when it does happen. The candidates themselves are distressing as well - it seems there is no end in sight to the dominance of the extreme christian right’s focus on ‘conservative values’ and trying to force all Americans to live by them. I would be so delighted to see an “old-school,” small government, civil liberties preserving republican have an actual chance at the nomination that I might forgive them for dominating the discourse for the next 16 months. There are so many real, important problems we could be fixing in that time - of course health care funding being the one nearest and dearest to my heart. In some ways, I’m glad we are finally talking about this in the budget negotiations. However, the direction the debate has taken is also distressing. Cutting funding even further for medicare and medicaid, and especially the proposal to cut GME (Graduate medical education) funding is an incredibly backwards approach to the problem. And I don’t understand why the democrats continually allow the republicans to set the tone and topics available for discussion. Yes, American health care is the most expensive in the world (and not the best quality for all patients) Should we be able to do more with the same amount of money? Absolutely. Should we be able to do the same amount with less money? Absolutely. Should we be talking about whether we want to do more (cover everyone with basic, decent quality care) or the same amount for less? Absolutely. Should we be talking about cuts in corporate welfare for big pharma and maybe malpractice reform, and definitely how much money the people at the top of HMOs and insurance plans are making? Absolutely. Should we be talking about who and how much we pay for various services and what they actually cost and are worth? Absolutely. Should we be cutting funding across the board, most of which goes to pay for the poorest patients, and much of which goes to primary care doctors, nurses, and ‘safety net hospitals’? No.

This is a nuanced, complicate issue and it should be approached as such. Apparently none of the people I elected have the guts to stand up and say that, though, which makes me sad. Residency doesn’t cost hospitals money, it saves them money they would otherwise pay staff physicians to do the same work. Does that mean we can cut GME money without repercussions? No - hospitals with residency programs tend to be those same ‘safety net’ hospitals that are taking care of (often very sick) uninsured or underinsured patients. That money isn’t going into the pockets of the hospital administrators or attending doctors, its going to help pay for high quality care for people who need it. Residents learn from taking care of these patients, everyone wins.

I can’t claim to know how to fix our system. I don’t know how to answer the questions I asked above. After spending 3 years intimately enmeshed in the American health care system and having this year to step back and look at the (bigger) picture and think about how my experiences relate to the bigger issues, all I know is that things are really, really broken, and that this is a complicated, nuanced issue that will take lots of critical thinking, problem solving, compromise from all parties, time, and trial and error to fix. However, it is clear that our leaders beating each other over the head with the cudgels of “you’re wasting money” and “you hate poor people” isn’t helping anything.

Umm, that turned into quite a few words. I think I shall post this with the promise to write another post soon that will have less rant and more cools stories about what’s been going on recently in Laos.