I attended a Santa Clara County Medical Association meeting tonight, and I couldn’t help but feel that the doctors were missing the forest for the trees. Jack Lewin, the CEO of the California Medical Association, gave a great talk about issues facing California physicians–ridiculously low levels of reimbursements from Medicare, MediCal, and the private insurance system, taking care of at-risk populations, suing the HMOs to force them to pay reasonable and fair amounts. I initially asked him a question about single-payer (surprise), but every other question that was asked had to do with administration. Business. Billing. “What can I do about Blue Shield sending a check to my patient?” “Who should I talk to about HealthNet losing my documentation?” On the subject of one health insurance billing system, three-quarters of the physicians knew the difference between billing as a “non-contractual” versus “contractual” patients for Blue Shield. They smiled at our medical student ignorance. “How silly of you to think you’re going into medical practice to help people! Don’t worry, you’ll end up sucked into this horrific system too!” I don’t want to work like that. Neither do my classmates. One leaned over and whispered, “Man, they know as much about billing and administration as we do about anatomy.” Imagine all the time they spent navigating the insurance system that could’ve been used seeing patients. Or reading more about the latest best-practices research. Or hell, spent with their families. The health care system is one that makes absolutely no sense. No one wants to be a part of it. And why should we have to?
After every question, I just wanted to shake them and scream “Single-payer!” (Yes, I have a slight flair for the dramatic.) And I’m not trying to be idealistic. I realize it’s not a golden bullet. I realize health care reform is politically difficult. I acknowledge it. Fully. But how can doctors continue to work on some sort of patchwork system–like suing the insurance companies, like the CMA did with the RICO lawsuit–but not fight for a long-term change? People seem like they’re willing to fight their own fights–but not fight for medicine as a whole, as well as their patients. It almost seemed as if the doctors were more willing to deal with the hassles of HMOs (which they cited as “the reason you never get to see your kids”), but aren’t willing to try another solution, even when it was staring them in the face.
Dr. Lewin made a great analogy of why doctors have to stick together. He gave an example of speaking to neurosurgeons last week, who didn’t care about struggling pediatricians or internists: once internists and general practitioners are replaced with nurses and techs, all physicians risk becoming obsolete.
But honestly, how much of this “doctors are barely getting by” mantra am I supposed to believe? I’m a medical student, and at the same time, still a member of the public. A lot of the questions discussed “How do we get patients to realize that doctors are hurting,” and “Universal health care does nothing to address low incomes for specialists.” The malpractice issue aside, who’s struggling out there? And I mean struggling. When you’re “struggling” to make car payments on the BMW or the 5-bedroom house, you don’t count. You can live a perfectly happy and satisfactory existence with a measly Honda and cheaper mortgage, can’t you? Isn’t it more the expectation of a certain level of income that’s the problem? Not the absolute income, but the level relative to one’s societal expectations as an all-important doctor? (Sidenote: would specialists and/or general practitioners not be willing to take a pay cut to have reduced administrative workload, increase the time they’re actually practicing medicine, and possibly increase the time with their families?) Maybe it’s my societal naivete of what it’s like to have children and mortgages and responsibilities greater than oneself?
“Political feasibility” and “tax increases” were cited as the reasons that single-payer wouldn’t fly. “The public would never support it.” “No one would be willing to pay for the tax increases.” I don’t buy either of them. The economics aren’t as bad as they seem–otherwise, how could any other nation be insuring everyone, have higher general health outcomes, and spend less? I’ll admit the political argument is a more worthy foe, but people also thought Women’s Suffrage was silly (“Women? Voting? HA!”), and even though Nixon opposed the Environmental Protection Act. The politically unfeasible can become common sense over the course of a decade. And I don’t buy the “marketplace freedom” argument, either. Your Holy Market would’ve had no problem if slavery still continued today.