Graham takes issue with Dr. Reece’s bashing of the NY Times yesterday:
I think they [the American public] want their health care to work like I want my electricity does”“when I flick the switch, the light should go on. That is, if Medicare or a single-payer or whoever can keep the level of quality and choice the same but provide coverage to everybody, then we should all get it.
And who, may I ask, is going to pay for this health care nirvana? Graham, I’m really interested in seeing if your progressive views continue to be so steadfast after you finish medical school/residency and start practicing real-world medicine.
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I think we should also decide on medical treatments and guidelines by polling the general public. They certainly have no more expertise in healthcare policy tygan they do in medicine, after all.
We all know someone who has crappy or no coverage. And we feel sorry for them. And when they are family members, we REALLY feel sorry for them. I wish America did have some universal coverage. But I also want to make a living. So, don’t ask me.
I think that the fantasy of removing the need to buy/sell medical services and take the financial exchange out of it is visceral to the doctor-patient relationship on both sides. Many of us as doctors even more than as patients want a place where we can just nurture and take care of people without ever having to say no. We want the medical encounter to recreate the nurturance of the mother-child relationship of unconditional love and giving.
It is so strong that even I, a libertarian, once had fantasies of a libertarian practice free of government payment and also free of a business transaction. My libertarian version of this fantasy was a clinic in which people just drop whatever donation they feel moved to drop in a sloted box in the waiting room.
Now, 20 years out of med school, I see how incredibly naive any fantasy that such could work really was. It isn’t that people don’t value medical care the way they value their church or other organizaitons they support, rather, at a gut level, they just resent paying anything for it just as they would resent paying their mother for her affections. People’s ability to overcome these primitive fantasies and feel comfortable with their physicians riightful desire for just compensation in and exchange of value with the patient is dependent on achieving a certain level of personal maturity that many people simply never reach.
Even though many people go into medicine wanting to help everyone in need and would love to see a system in which healthcare could be doled out fairly and cheaply, it’s difficult not to be a capitalist when they look at their $200,000 in educational debt.
If you think we are not already paying for a national system your wrong, care provided to the poor or underinsured is paid for by higher prices, medicare and medicaide without any oversight. additionally people who do not get timely care due to costs often end up disabled, thus being paid for by all of us again. Maybe it is time to look at an organized single payer system.
Dr. Masewic (failed solo practice from oct 2006 blog)
currently working for disability determination services
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