Does anyone really want health care for all? I promise this is not a political rant. Americans, of any political persuasion, should not be misled by the implications of health care for all: It does not mean medical care for all. Providing a card stating you have health insurance is only a nominal solution, provided by politicians, who are looking for a superficial fix. Our problems are more complex than such a bandage can heal. I use the terms “health care” and “sick care” interchangeably because our current system seems to have little to do with health. Physicians are trained in medical schools, not health care schools. A person in need of healing is referred to as a “patient” in medicine. In health care, this person is a “consumer,” “customer,” or “client.” Medical care starts with the patient-physician relationship. Health care is the wedge that drives itself between the patient and physician: an amalgam of entities including third-party payers, hospital administration, corporate business, legislators, and bureaucrats. During the seven-plus years in medical school and residency, physicians are trained in the incredible breadth and depth of human disease, but there is scarce opportunity to teach “health care” education. Most physicians complete their training without gaining the practical skills to maneuver in the industrial “sick care” complex, how to advocate for our patients, nor how to fight those entities exploiting physicians’ service and sacrifices for their own gain. Physicians strive for a balance between the intellectually challenging science of medicine and the humane art of healing. Health care creates “providers,” who are encouraged to mindlessly follow algorithms and are trained in maximizing reimbursement via “jumping through all the hoops.” Health care has commoditized physicians’ work. Some physicians of past and current generations have been complicit in creating this system, which is now sucking the joy (and sometimes, quite literally, the life) out of physicians and patients. The rest of us are complicit by our participation: keeping it humming and growing by not disrupting or even questioning it. Health care has commoditized patients’ health and lives. The metamorphosis into “health care” began when Americans ceded the financial responsibility for their medical care (via participating in employer-sponsored health insurance). Most Americans have not known any other system during their adult lives. And with handing over the financial reigns, patients (myself included) gave up our autonomy. Before you complain that your deductibles and copayments are evidence of your financial responsibility, please realize that those amount to chump change in this system. Those expenses were created merely to disincentivize patients from spending the insurance companies’ money. And so here we are. As a whole, our entire population, including physicians, is physically, mentally, and emotionally unwell. Our population health outcomes are the worst among developed countries, despite health care being the biggest business in the U.S. Physicians have the highest suicide rate of all professionals, are suffering “burn out” and “moral injury” at epidemic rates, and it seems most are looking for exit plans despite our severe physician shortage. Almost half of every federal government dollar goes toward health care spending. Employee health insurance costs are a huge (and rising) expense for employers. Out of pocket health care expenses are increasing for insured employees faster than their incomes, despite stable utilization. Our “sick care” system is bloated beyond reason, but physicians’ salaries account for <8 percent of health care expenditures. For every one physician in the U.S. health industry, there are 16 non-physicians, of whom six are clinical workers (nurses, allied health professionals, aides, care coordinators, etc.), and ten are purely administrative or management staff. The purpose of those 10 “sick care” industry jobs is to administer and manage the 7 of 17 of us who do patient-care. Those ten non-patient-care jobs exist due to burdensome government regulations and the intentional complexity created by insurance companies, which profit when they can deny patients’ access to care or deny reimbursement for care. Ironically, I continue to work in health care so that I can afford to provide health care insurance for my family, in case of catastrophic need. But, my goal for my family is to stay out of the “sick care” system as much as reasonably possible, because I know that this system swallows up patients, too. It is a system that feeds and benefits from our human frailties and anxieties, both as patients and as physicians. As an emergency medicine physician, I am well aware of the unfairness, randomness, and frequency of serious illness and death. I am grateful to the generous people who donate their remains for the education of first-year medical students learning human anatomy. I may donate my body to science, but I will not donate my body to an ignoble “sick care” system. Many physicians I know do not want their bodies nor their families’ emotional or financial well-being abused by the sick care system if death is inevitably close. Think about this. The very people who are cogs in the sick care machine are the most hesitant to want that type of care for themselves. I do not wish health care for all, but, rather good health for all. My advice as a physician? Be physically and mentally active. Maintain a healthy weight. Turn off the screens. Read books, join a book club. Call a friend. Listen to or create music. Meditate or pray. Write an annoying blog. Get involved in your community, and enjoy your family to ward off depression. Volunteer. Adopt a shelter animal. Adopt a child. Wear your seatbelts. Do not smoke, drink to excess, nor use recreational drugs. Get annual check-ups, cancer screenings, and immunizations. Avoid toxic relationships. Consider paying out of pocket for care from a direct primary care (DPC) physician or price-transparent surgeons. When you do need to access the “sick care” system, demand a physician; do not settle for anyone who has acquiesced to be a “provider.” Practice mindfulness, kindness, and gratitude. Have reasonable expectations of medicine and health care. Take ultimate responsibility for your health. Live your best life every day. Tomorrow is promised to no one. These are this doctor’s orders. Mercy Hylton is a pediatric emergency physician. Source
