The imperative for HCR

I am always going to have good health insurance. As an MD/PhD student, I am covered well by my home institution. As a resident, I will be covered by my employer. And as a future faculty member, I will have coverage. And I will always have work, because there certainly isn't a surplus of physicians. But to me, doing something about health care is so vitally important because how medicine is done in the future depends on reform. Right now, the practice of medicine (the science, techniques, decisions, etc) is, for better or worse is tied to institutional realities (profits, contracts with insurance, medicare reimbursements, kickbacks from pharma, etc). So forgetting the moral argument for making health care accessible for the uninsured, the very manner in which I as a future physician practice health care is threatened by inaction by our government. I have a HUGE stake in all of this. I want to practice medicine in a sustainable fashion. I want more end-of-life consultations (a.k.a. "death panels," which have been shown to lower costs), comparative effectiveness research, evidence-based medicine, value-based insurance pilot programs; I want an end to fax machines and paper medical records. In short, I want to be a part of the future movements that solve health care's problems, rather than exacerbate them. To me, as a future American physician, it's a form of patriotism.

And here, for me, is the moral argument. What has grated me the most during the HCR debacle is that the nihilists running Washington (I leave the president out of the nihilists camp, because I believe he actually gets the importance of HCR.) have some of the best and most expensive health care in the world. They say, "Let's take a breather, the American people are frustrated with how we are approaching this...Health care reform can wait." Yes, to those who have coverage, HCR can wait. Tomorrow, when a member of congress experiences chest pain - worried he might not be re-elected in the fall - he can go to a medical center of his choice and be worked up for a possible myocardial infarction (heart attack). When the barrage of medical bills arrive, the employer (we, the people, of whom 30 million plus lack any kind of insurance coverage) will pick up the tab. And so, the congressman returns to work, owing nothing for his care. A second job will not be necessary to pay for stenting the congressman's coronaries. Bankruptcy will not be necessary. The belt will not need tightening. In short, there will be no sacrifice required to treat the congressman's damaged heart. You see, I don't think lawmakers really understand what it's like to lack health insurance. I don't think they really get how bad it is, to be sitting in the emergency department or intensive care unit knowing that financial ruin looms. I don't think they get it. As a medical student, I have seen patients who don't have insurance, and their look is noticeably different from those blessed to have health insurance. They become consumed with trying to emerge from illness and bankruptcy. Just like you can spot homeless people in a crowd, you can spot uninsured patients in a hospital. The weight of their problems is palpable.

The Senate bill is far from perfect. But it's a vital first step. And I just don't think the privileged few who run Washington really get it. They seem totally devoid of empathy. I hope President Obama shows that he does and fights.