Why must health care be changed? Why should it be universal via single payer? I'll present a medical vignette and I'll then discuss various topics that compel me to act in the manner that I do on behalf of all patients.
The young mother was desperately trying to end her life taking her children with her. She was driving around, playing the music loudly, as her face reflected a storm of tears. She was planning to end it all via an auto accident, January 2008. When I first saw her, she could hardly contain her tears. As I carefully dissected her life with minimal words, she revealed her troubled life. She was deeply torn because her last boyfriend was having an affair with another woman. She added that the boyfriend was more of a lazy "parasite" that had always used her for sex, alcohol and money. Her self-esteem was so low that she had felt that all she deserved were "human leftovers."
On follow up, a week later, she reported that the anti-depressant was helping but was causing her headaches. I switched her anti-depressant (actually a vitamin placebo) for another vitamin. When she tried to pay for the second consult I said to her "You've already paid me by having given that homeless person in the cold a blanket." By saving this poor woman, I also saved her two kids. So how is society to pay physicians like me?
Commercial health care has no conscience and patients become simply numbers and profit. If health care wants to be a business, it should not be legally protected (socialized capitalism). The politicians have committed a grave crime against patients when they legally allowed Kaiser to be immune against malpractice via binding arbitration. If you knew what I know about Kaiser, it would send shivers up your spine.
I believe in capitalism with value and I'll cite the example of In-N-Out Burgers. At In-N-Out, you get quality, efficiency and a great value. If the food were bad or too cold, they'd gladly give you a new product or your money back. Medicine is exempt from value and patients are made to pay irrespective of quality or effectiveness.
We must address some fundamental flaws inherent in our medical system, the physician. Who are they? While in medical school and residency, I noted how crass and dehumanizing some students of medicine could be toward the poor and chronically ill. In regard to the latter subject, you should read the book, The House of God. Their background, i.e., private schools, privileged lives, made them strangely detached from the patient while more easily conforming to a profit driven system or unethical behavior. I have found more humanity in our jails and ghettos than in our medical schools.
For some reason, it was okay to let unsupervised medical students freely deliver children at Harbor-UCLA but not at Cedars-Sinai Medical Center, a private hospital. It was acceptable to use forceps on a poor child's head in order to develop the skill though the procedure was unnecessary.
The solution to many of the inherent problems in our health care system is to develop a single payer system where all citizens can freely choose a provider or hospital. The cost for caring for a patient at public hospitals is much higher than that in private hospitals. Many despots seem to gravitate toward our public hospitals. Do our patients need to be treated in the manner they often are? Why should the poor be freely accessible to medical students and unlicensed residents for training? Patients at public hospitals actually think, as quid pro quo, that they have to let "students practice" on them.
A universal health care system would reduce the risk of HIV and would allow our veterans to choose private care instead of the V.A. A single payer system would free up a lot of capital that could be invested directly on the patient and uninsured.
How do we enact a legal health care reform through the courts? There are two important tools that our constitution gives us. I can knock on any door or distribute pamphlets at any public place if based on religion or political action.
The duplicity of charges must be challenged in court. Professional codes of ethics exist that prohibit the astronomical fees the uninsured are made to pay. Patients must begin using the small claims courts to force reimbursement of fees if they are improperly diagnosed and treated. For the latter, I will freely offer my medical expertise.
The American Medical Association, historically, has been a patient foe. The AMA used to place cigarette ads on its journals in the 1960s.
If medical students and residents wish to continue to ignore the plight of the uninsured and poor, the patient is then entitled to charge them for educating them at great personal risk (death at times!).
Health care can be changed through law.
Luis Lomeli MD/Beta
