We have the potential to have the best health care system in the world

Every once in a while, I’m forced to engage the health care system in a more personal way. Yesterday was one of those days. First, one of my children (who shall remain nameless), decided to take a stroll in the mulch on Monday without any shoes. He managed to lodge an enormous splinter in his foot which I couldn’t get out. By the time I saw it that night, it was already starting to look like it might be a problem. On the same night, another child (who shall remain nameless) reported that he was having some pain and swelling in an area of his body (which shall also remain nameless).

Yesterday morning, my wife called the pediatrician, who scheduled a visit for the latter problem. For the former, we made an appointment with the dermatologist for the foot. Before lunch, they had cut out the offending piece of wood and placed a stitch. The nameless part of the body was examined at 3:45, and there was some concern that it might be serious. He was sent to the emergency department, and I was pinged to join them. We all arrived around 5:05pm. At 5:15, a doctor was in the room apologizing about the wait. They did an ultrasound, and the urologist drove up from another hospital to see us in the ED and go over the issue with us. He even drew us a picture. We were out before dinner, dropped off the prescription, and gave the first dose of meds before bed.

What I’m describing could easily be taken as the finest health care system in the world.

People think that you get care because you have insurance. But I can swear to you that no one in this process cared one whit who our carrier was. People think you get care like this because you have more money. Believe me when I tell you that we are far from the richest people in this community. We get care like this because of who we are and what we do. We’re in the system.

The first doctor I mentioned had no sick visits available. But they squeezed in one of our children because they know I’m a pediatrician and they know my wife’s a nurse practitioner. They also know us personally. You have to remember that about a fifth of Americans can’t get an appointment when they’re sick within a week, let alone that day. The dermatologist appointment (for a splinter!) was arranged with a close friend at the practice. When our child was referred to the ED, I’m sure a call was placed to the urologist telling him who my son’s dad was and that I worked in the health care system, precipitating a level of service that few will see.

I’m so grateful for what everyone did. Please understand that I’m not saying one bit of this was fake. Every doctor we saw was unbelievable fantastic and ridiculously skilled. I’m not saying that these providers aren’t just as kind and caring with every other patient. I’m sure they are. We received no scans, no procedures, and no medications that someone else wouldn’t get. We just got them served to us in an ideal fashion.

That’s access. It has nothing to do with insurance or wealth.

We have such potential. For all my complaints here, we have the best trained health care workforce in the world. Our facilities are top notch. Our technology is amazing, as are our medications. The problem is that the way it’s organized and distributed doesn’t work well at all. It’s like we took the world’s best and most complicated Lego set and let a small child put it together without the instructions.

The Affordable Care Act will likely make things better for millions of people. Insurance will give them access to the health care system in ways they didn’t have before. But it won’t give them what I described above. Insurance is necessary, but not sufficient. Tons of Americans are attracted to concierge care (and I can’t blame them) because they bought the insurance, and still don’t get the access they want. Unfortunately, concierge care still won’t give you the level of care that I try very hard not to take for granted.

We don’t have the best health care system in the world. But we could. I long for the day when we can start talking about getting that instead of whether we should give Medicaid to people making less than the poverty line.

Aaron E. Carroll is an associate professor of pediatrics, Indiana University School of Medicine and blogs at The Incidental Economist.

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  • hippie1367

    Shorter = FU poors, its who you know!

  • Anthony D

    When we have millions more entering the system AND a number of doctors
    retiring because of Obamacare (and some that are not have decided they
    will go to “cash only” and will not accept insurance due to the massive
    and cumbersome Obamacare law) you won’t be able to average one day for
    an appointment like you and I can now. Be ready for weeks if not months
    delays in appointment.

    And it MUST be that way. Adding millions of new patients but REDUCING the number of doctors and, well, you do the math.

    • southerndoc1

      “will not accept insurance due to the massive
      and cumbersome Obamacare law”
      I’m unclear as to what in Obamacare makes accepting insurance any more onerous than it already was: everything that’s driving docs crazy (EMRs, MU, P4P, PCMH, pre-auths, etc.) was put in place well before Obamacare was passed.

      • Mengles

        How about even more added bureaucracy?

        • Judgeforyourself37

          If you mean that insurance companies can no longer cap your benefits, refuse to insure you due to your “preexisting conditions, or disallow your children to be insured under your plan, then that is “added bureaucracy.” Of course, if an insurance company must comply with the above restraints, everyone must carry insurance or some individuals would not buy insurance until they became ill. The best plan, which our president wanted in place, was Medicare for All. The Republican congress persons would not stand for that as many were “bought and paid for” by the insurance companies. They would not even agree to a Public Option. Thus, the ACA was the only plan that the GOP would allow. It was THEIR plan in 1993, to counter “HillaryCare.” It was even Romney’s plan for MA, although he eschewed this plan while running for president.
          Until we finally “get with the program” and have Medicare for All, this is as good as it gets.

          • GT

            You need to stop the lies, and stop blaming Republicans. Obama had a super-majority in Congress for his first two years. Even if not a single Republican was on-side, if he could have got all his fellow Democrats on side, he could have passed anything he wanted.

            We’re not all stupid and ill-informed, and it’s a mistake for you all to assume that we are.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Actually, it has everything to do with insurance and wealth. If you were a poor and uninsured homeless person, you would not have any great physicians on speed dial, so you would probably have to pull that splinter out with your teeth, and take a “watchful waiting” approach to pain and swelling in any part of the body.

  • http://www.medicalschoolhq.net/ Ryan Gray, MD

    “We don’t have the best health care in the world. But we could. I long for the day…”

    This article seems like it’s missing a whole section – How to stop longing, and actually start doing. It reads as if the medical community CAN do better, and is, but only for our own, which I don’t think is a good message.

    How about a follow-up article “How to go from potential to reality.”

  • EmilyAnon

    There have been so many comments here by doctors claiming it’s a myth that patients with VIP status get better care than average folk. Doesn’t seem like it with this OP’s story.

    • Guest

      The author is correct that “VIPs” have better access. As we know, this does not equate with better quality nor does it equate with being affordable. For my child I got to see the best surgeon in town in a relatively brief time frame, choose my anesthesiologist, and get a private room. My indecipherable hospital bill for a 1 hour surgery and 1 night stay in the hospital? 35K. Most of the fees were hospital fees and an $88 charge for every single medicine administered. Who knew a single infant dose of rectal tylenol cost $88? I’m getting a great deal at my local CVS – they only charge $10 for a bottle of 500!

  • guest

    We already have the best health care in the world, it’s just that not everyone can access it.

    We have top notch health care, it’s just the health insurance system that sucks.

  • christythomas

    I appreciate the honesty here: it was the family connections, the KNOWING of people, that gave them access. Last year, after years of perfect health, I encountered a series of problems. Because I am known in the community where I live (newspaper columnist and well-known pastor), I was immediately seen by competent specialists who treated me with a great deal of respect and who were very willing to take the time to listen to and honor the rather unusual decisions I made about my health situation. I seriously doubt that I would have received such treatment, despite my good health insurance, had I not been a minor public figure and influencer. I appreciated the privilege, and also know my experience is anything but normal or common.

  • Peter D. Ferguson

    I seriously wonder at the intelligence of the people commenting if they weren’t paid by this blogger to compliment the health care service.

    Whichever is the case, the poster says “because they know I’m a pediatrician and they know my wife’s a nurse practitioner. They also know us personally” is the reason as to why they got into another medical doctor who literally had no room.

    I don’t mean to insult people but if you have the comprehension abilities of a two year old, get off the internet. There’s enough stupidity without you adding to it.

    This “excellent” health care is a bunch of BS with a capital B. The American health care service is considered a joke by and large throughout the entire world for the simple fact it caters to the wealthy and those that have some clot while the average Joe has to wait hours in the emergency room or continually has their family doctor cancel and reschedule appointments as people who aren’t scheduled – like this ass – suddenly show up and need the spot.

    Really people, it’s not hard to read.

  • lissmth

    American health care produces far superior cancer survival rates than socialized systems. We lead the world in innovation and technology.