Do you care?

I start tonight by stating that I sat for a total of 30 minutes today, on my couch, and it felt great to rest. I never had much of a chance to sit today, and given that a friend of mine is studying sitting time, and has concluded in her work that time on one's derriere is directly linked to earlier death, I am not unhappy about that.

This may represent a slight change of tone, but I need to know who out there is really paying attention to what is going on right now. This op-ed is important, and summarizes many of my own thoughts. http://www.nytimes.com/2009/08/13/opinion/13gawande.html?_r=1&pagewanted=2 I heard Atul Gawande speak last night at my hospital and I was impressed that he is a man who truly understands the issues at hand and what needs to be done to begin to fix this mess.

This is so important, this issue of health care reform. Everyone deserves to be able to be insured. And everyone deserves a fair system with a common goal of doing good by the people.

But I need to ask Dr. Gawande, our president and all of you- do the 50 million or so people without insurance deserve this benefit without doing anything for it? Yes, the emergency room has become the new primary care physician-but why is no one talking about welfare reform? What about a national job bank and a six month limit on handout money for unemployment? How about a bill for those non emergent emergency room visits sent to the patient who has chosen not to be insured? And if collection agencies collect the money, people will have to come up with it, and if 25% of them did, we'd begin to chip away at this mess.

As a physician, I am thrilled by the thought of everyone being treated equally, but I am also worried that in America, we are so fixed on fair coverage, and not thinking rationally about ownership. Do we really need to pay for folks who are capable of work but unemployed? At what point do people need to have some onus for their well-being?

I was shocked this week to find out that a man won a lawsuit for the "damage" done to his wife by the Tobacco industry after she smoked 2 packs a day. I am no fan of big tobacco, but it's so very American to reward the smoker for damages! I liken the smoker to many of the uninsured in America. Of course the exceptions are those who are truly disabled mentally or physically and uninsured. (And yes, the smoker was 72, and lived through an era of lies and false advertising which despicably continues in 2009). Still, I cannot tell you how many patients walk into my office with 2 working arms, 2 working legs, often a college education and have been "out of work" for 2 years. I have been alive in prosperous and awful financial times. I have never gone a day without work when I wanted a job since I was 14 years old. I know that we have 9 plus percent unemployment and that some of that is layoffs. But somewhere in the past 80 years, the spirit of the 1930's New Deal was lost in a lazy haze. What happened to "Ask not what your country can do for you..."?

I am not turning a blind eye to those in need- I just want everyone involved in owning the problem. Everyone wants Big Insurance to fork over their secret stash of billions to fix this. And they do owe America more than record profits in these times. But the papers are also full of ideas of how to cut my salary. I'll gladly do so when I know that I am not in the only profession penalized for other people's circumstances. Where is the talk about tort reform? Where, in these discussions, are those snake lawyers making millions off my decisions which they later deem "mistakes?" And where are the millions awarded to people for bad lawyers? People behind bars because they weren't defended properly. People who got little or no money (myself included) when they suffered accidents. One multimillion dollar lawsuit against a lawyer would change the entire health care system in America. Put the lawyers under this microscope, give them checklists and pay them for performance. Embarrass them publicly in the papers for their "mistakes." And if you argue that health is more serious than prison time, or justice served, think through that one for a minute.

(As an aside, I work in a prison several months a year- and the health care delivery there is unique: Everyone behind bars is "insured" and not one prisoner pays the bill.)

So if you care, form strong opinions of your own. Disagree with all of this? I welcome that. Please, just make informed decisions about this crisis. Think about what's important to you. And if you're a hard worker, and always have been, I applaud you and believe wholeheartedly that we need to make insurance cheaper for you. Millions more people who are resting on their laurels can pitch in to help pay for that. They can work hard, even in non-profit government run jobs which help society- perhaps jobs in health care delivery, and accessibility, jobs aimed at keeping them out of the emergency room- and from sitting around.