physicians perspective on universal

A physician's perspective on universal health care

When I graduated from medical school, I joined my classmates in

reciting aloud the Oath of Hippocrates, vowing to help the sick in

uprightness and honor. (Note: not only the sick with health insurance

and access to medical care.) Like me, many of my colleagues entered

medicine with idealistic notions of wanting to help people and later,

during training, getting hit in the face with the reality of our

health care system.

The U.S. has arguably the best and most advanced medical care in the

world, that is, if you can afford it. On any given day, you can see

private jets landing near our nation's most prestigious hospitals,

bringing international patients looking for cures. But that's the

paradox: cutting edge care for some and none for others. And if you're

sick and poor and unemployed, well, good luck in getting the care you

need.

Health care has become big business, administrated by suits with an

eye on the bottom line and less about medicine and even less about the

patient (and blind to the patient who can not pay). Is it any surprise

that the U.S. spends more than twice as much on health care as other

developed countries, yet trails behind on such indicators as infant

mortality and life expectancy? We have a truly flawed system, bloated

by administrative costs, profit, and billing bureaucracy, and leaving

a significant portion of the U.S. population uninsured or

underinsured.

I completely support the adoption of a national health insurance like

most developed countries. I'm of the camp that believes health care is

a right, not a privilege of the paying. Yet, as someone in the

trenches, I also see some distinct challenges ahead in making this a

reality.

The adoption of universal health care will necessarily mean putting a

cap on our nation's spiraling health care costs. Physicians have, in

the current wildly permissive health care setting, grown reliant on

expensive technologies with little regard to cost:benefit ratios. We

are quick to jump on the latest, grooviest technological advancement,

before the economical impact on the greater medical system can be

weighed. Yet, patients, too, are partners in the American quest for

medical spending. There's a sense of entitlement to any possible

resource available. I wonder how patients will react to being told

that a certain resource can not be offered to them because of

system-wide limitations. I don't think necessarily well.

In the U.S., if a person dying of cancer with 6 months to live

develops kidney failure, they are offered dialysis if they want it. In

almost any other country, it wouldn't even be an option. Dialysis,

which acts as artificial kidneys, costs over $30,000 a year. Yet, we

are largely uncomfortable discussing how much life is worth, and even

more uncomfortable denying someone time.

There would also be repercussions on medical education and training.

When deciding on what kind of doctor I would be, I followed my heart:

general internal medicine is not glamorous or sexy (no ER or Grey's

Anatomy here), it doesn't bring in the big bucks, but it's what I

loved. I was fortunate that I could financially follow my heart. Many

medical students graduate with such enormous debt from their education

that they feel it necessary to pursue a career in one of the more

lucrative medical specialties instead of the primary care fields of

internal medicine, pediatrics and family medicine. We have a gluttony

of specialists and sub-specialists; the balance would have to shift to

train more generalists who can focus more on prevention and preventing

disease in the first place. Incentives and renumeration for working in

primary care should be considered.

Paradigm shifts are in order for universal health care to become

adopted, for both patient and physician. And while there will no doubt

be a certain amount of upheaval involved, it's becoming clearer and

clearer to me that this is the only sustainable solution to our health

care quagmire. Not to mention the only socially-responsible solution.

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