Pornography & Health Care Reform

The public’s discussion of health care reform (really more accurately insurance reform) has not been particularly sexy, but it sure has been pornographic. Not in the legs wide open, insert tumescent phallus sort of way, but in a disgusting, dirty, “I can’t believe they did that” sort of way.  There’s a difference. Blue movies and Penthouse Forum serve a purpose. Town hall meetings about reform, where guns are checked at the door, are as disgusting a display of Americana as one can ever imagine. I am certain we have lost any sensibility we may have ever had. The recent presidential address to congress is a perfect example of the crassness we witness. Rep Joe Wilson’s “you lie” outburst is evidence that the GOP is a manifesto of fat, dirty, old men. They have lost relevance and are respected only by the Limbaughs and Hannitys of the world.

I have been in clinical medicine, counting my drug days, more than 40 years. I have an opinion of health care and how it should be managed. Many won’t agree with me, but they are ill-advised, wrong, or probably stupid. I’ll try to straighten everyone out here.

Here are some truisms:

1. Nothing is free. As Debbie & I discussed this recently she pointed that out. She’s spot on. We all are responsible in some monetary fashion for our health care. For those unemployed, 30 year old men who can’t work because they have back pain, too fucking bad. If you’re going to sell oxycontins to your cousin/girlfriend, put a little aside to pay a monthly insurance premium. Otherwise, I could care less if you have a tummy ache.
2. On the other hand, there is a segment of the population who are truly unfortunate and have health issues. Those with devastating neurological illnesses, have suffered major trauma, or the children. None of it is your fault, and there needs to be a safety net. No one should go bankrupt taking care of themselves or their loved ones.
3. Insurance companies by default are bad. Speaking of pornographic, add another X to XXX-rated.
4. Medical device companies and the pharmaceutical industry are not nearly as demonic as many wish to think. Lots of people want to pick these companies out as responsible for the ills of medical care. This is misdirected vehemence. But for the good of these companies (mostly American), we would not have many of the medical advances we enjoy. Give them a break.
5. People need to be responsible for their own health. It’s not up to me, Anthem, your church, your mother, the school, or the police to make you make right decisions about diet, exercise, abstinence from goofy sex, alcohol, tobacco, or riding a red-neck 4-wheeler without a helmet. Get a grip, take some personal responsibility, quit watching Judge Judy, and be productive. Otherwise, fuck you.
6. Making doctors be responsible for health care reform is a Sisyphean challenge. To wit, a patient I see in the office every day: A 40 year old anxious female with unusual chest pain concerned she has a heart problem, referred by her frustrated primary care doctor. In any other parallel universe I’d pat her on the shoulder, tell her to take a Tylenol, and get control of her anxiety disorder. But, I’m torn. If I don’t DO something: the primary MD won’t refer me any more patients, the patient will go to another quack doctor, and I will be perceived as a bad cardiologist. So, it’s very easy for me to order a $2000 stress test to prove to her, and everyone within a 3-county radius that her heart pain is in fact due to her Lortab inhaling husband.  In this scenario, I pocket the money, and don’t look back. That’s real waste, fraud, and abuse. I’m party to it, but if I don’t play, I’m shit. Stupid system, stupid expectations by patients, referring doctors, and society. Fuck it. I’ll retire a rich man partly because of her. I'm glad I'll be in another line of business when the rest of society catches on to this ridiculous economy.
7. Fat people, people who smoke, drink too much, people who don’t exercise, miss their office appointments, who don’t take their prescribed medications, and stupid people who can’t read beyond a 4^th grade level are Darwin’s children. It’s not my fault. It isn’t yours either.
8. There has to be insurance coverage for the 47 million uninsured. There just has to be. If that means the government expands Medicare, Medicaid, or provides for  insurance cooperatives, so be it. Fuck Aetna, Anthem, and any other insurance company. They need to be competitive.
9. I don’t know much about the Canadian health care system, or any other country’s health care, but I understand one concern is that there is a long “waiting period” for some procedures and operations. Americans are a fast-food society and want EVERYTHING right now, either their greasy Big Mac, or their bypass surgery. Americans expect drive-thru health care. Fuck ‘em. It’s probably not good medicine anyway. Taking a wait & see attitude on many illnsses is often a good thing. Just because you have a 90% blockage in a heart artery doesn’t mean you need a stent yesterday. Take your medicines, lose weight, quit smoking, then come back to me if you still have chest pain. Otherwise, fuck you. On the other hand, if I have a big old mass growing on my right nut, I want it ripped out right now. Some things can’t wait. We need a system that knows the difference when somnabulence is correct and alacrity is in order.
10. We’ve all read where we need not health care, but health maintenance. And for the most part this is true. Healthy people are cheaper. Insurance companies learned long ago that the cheapest patients are dead patients however. In effect, we are all going to die of something. The cheapest care is keeping one healthy for as long as possible, but when your time is up…it’s done. We spend 50% of our health care dollar on the last 6 months of life. That is pornographic. We need required living wills,  and doctors, nurse, attorneys, and family members need to respect this. Grandad (like me) is going to die. Don’t prolong it. Don’t spend $100,000 on ICU care on a demented 90 year-old. He doesn’t want it. (despite my earlier post).

I could say more. But if just a little of the above is taken to heart, we will have plenty of dollars to revamp the system, and have money leftover for making finally a good mass-transit system in this country.