The Stupidity of American Healthcare

I have watched in fascination this week as our broken political system has churned out yet another foolish creation, the passage by the House of Representatives of a useless healthcare bill that has no chance of becoming law. Dysfunction is bipartisan, as Republicans gathered at the White House to celebrate their lack of accomplishments and Democrats gleefully hung on to the sinking Titanic of Obamacare. Neither side offers a viable solution and the American people suffer.

How did we end up with such a mess? The answer is simple. We voted for it.

Conservatives crow about getting the government out of Medicine, stupidly ignoring the reality that 132 million Americans are covered under government insurance already (58 million Medicare and 74 million Medicaid). That amounts to 40% of Americans. I hate to be the bearer of bad news Republicans, but we will never get the government out of medicine. That ship has sailed.

Democrats ignore the failures of Government medicine, which is expensive, inefficient and for the 74 million Americans on MediCaid, of remarkably low quality. A large majority of the 180 million Americans who are not covered by the government rightfully fear the quality of their health care will decrease if they lose their private insurance.

Both parties seem to be angling for a solution that caters to enough people to keep them in power instead of a solution that addresses the fundamental problems that plague our healthcare system.

Republicans need to address the reality that health insurance is increasingly out of the reach of the typical American family. It is not uncommon for health costs to consume a massive portion of a family’s income. In Huntington Beach a family of four making $80,000 a year will pay $13,000 a year for health insurance. Rent is $30,000 a year and state and federal income taxes are $10,000. Basic math says that after taxes and rent, one-third of the family’s remaining income is health insurance! The average American family simply cannot afford coverage.

Conservative “solutions” such as allowing insurance to be purchased across state lines are farcical. The savings achieved will be so small as to be irrelevant. They hate to hear it, but the only way to lower costs is by lowering coverage in the form of higher deductibles and limited benefits. Wealthy families can afford to take such risks in a way that lower income families cannot.

Democrats need to address the poor quality care and service rendered under many government programs. Medicaid pays hospitals and physicians so poorly that access to care is severely limited. This limited access increases the use of emergency rooms for routine care, driving up costs. In many parts of the country, ObamaCare is failing. Iowa is down to one insurance provider and it is threatening to leave the state. Doing nothing is not an option.

Both parties stay on their side of the aisle and holler at the other, accusing them of abandoning the American people, ignorant that they are all to blame. Their refusal to work together to accomplish things for the people they were elected to serve is the reason we have an orange president.

Bart

Medical Advice from Vin Scully

Her life was at a crossroads. At the age of 27 she was barely making ends meet. She was working two jobs, at Disneyland and at an office, making just enough to pay her portion of the rent for the 2 bedroom apartment she shared with a roommate. With only a high school education she did not think she would be able to afford Orange County living much longer. She was debating moving back to her family home in New England. She did not have a job there, but she had family and a lower cost of living.

I asked her if she was going to school or had considered it. Her reply surprised and saddened me.

“I don’t have much self confidence,” she said, “I am afraid that I will not do well in school.”

It wasn’t just the reality of her low self worth that bothered me, it was the fact that her sense of worth was tied more to academic achievements and professional accomplishments than it was to who she was as a person. This attitude, when combined with her anxiety disorder, was paralyzing her. She felt badly about herself and she wasn't sure her fragile sense of self could withstand the threat of failure she associated with college.

I thought of how I could encourage her. I gained inspiration from an unexpected source. What came to mind were words I had heard Vin Scully, the great announcer for the Dodgers, say during a baseball game many years ago. The Dodgers had fallen behind after a fielder had dropped a ball. After commenting how the game would have been different if the ball had been caught, he said, “The saddest words of tongue or pen are those that read, ‘What might have been.’”

I shared the story with her, that regret at previous mistakes need not consume her, and that fear of future failings not lead to lifetime of regret, how sad it would be if later in life she found herself wondering how her life would have been different if she had only tried going to school. I encouraged her to consider counseling to help her overcome here low self-esteem, anxiety and fear.

I shared with her that I had similar self doubt when I started college. I thought I was smart enough for college but I was certain that I was no where near intelligent enough to pursue a career in medicine. I was interested in health care and, thinking I could be a registered nurse, signed up for a course in anatomy and physiology. The class included two weekly physiology lectures and a Wednesday evening anatomy lab course.

Each week in the lab included a quiz on the previous week’s instruction. To my surprise, I went 11 weeks in a row without missing a question. The professor recognized my potential and each week asked me, “Are you going to go to medical school?”

Each week I answered, “I can’t go to medical school.”

Each time he answered back, “You should go to medical school.”

His words stuck. A year later, after Lisa and I had been married for about 6 months, I found myself wondering, “Could I go to medical school?” The words of Vin Scully gave me motivation. I did not want my future self to look back wondering what might I been. I decided that I had to try. I feared failure, but I faced those fears.

I encouraged her to think about trying. It seems to me that failing to try is worse than trying and failing.

Bart

It was the Patient's Fault

Doctor House was right. Everybody lies. Well, almost everybody.

She was a poorly controlled asthmatic.  Perfectly controlled asthmatics can often make do with one inhaler a year. She consistently used 200 puffs a month. She was not doing well.

I had quizzed her on her need for inhalers at multiple previous visits. Over and over that she was doing everything I had asked her to do. She had gotten rid of her cat and avoided triggers. She was taking her medications exactly as prescribed. Her recurrent asthma attacks were a mystery it took me months to solve out. In the end the answer was simple- She was lying to me.

Her secret was revealed to me as I drove the mile from my office to visit my grandmother in her assisted living facility. As I waited at a light I saw my patient standing on the corner waiting to cross the street. In her right hand was the smoking gun, a smoking cigarette. 

I drove through the intersection and pulled over, waiting for her to cross the intersection to where I was. As she approached I got out of my car. She did not look happy to see me. “You are so busted!” was my less than tactful greeting.

She was visibly embarrassed. She lowered the cigarette, trying to hide it from my view behind her leg.  “This is my first cigarette,” she proclaimed, “I have been under a lot of stress lately!”

“So throw it away then,” I replied. She did, apologizing profusely and telling me that she was not going to smoke anymore.

She was lying again.

I found out two days later when my nurse saw her at another intersection, again with a cigarette again in her hand. At her next visit I was finally able to address the real reason for her asthma problems. Sine then, her need for inhalers has decreased dramatically.

Her story reminds me of a basic truth in medicine. Doctors are only as good as the information we get from our patients. Patients who lie get poor care.

Doctor House was right.

Bart

Thanks for reading and thanks for liking and sharing with friends. Comments and questions are welcome.

Happy Easter! Or Not.

People hedge their bets.

I do this as a doctor. Often when I give a diagnosis, I give several alternatives, so that if the first diagnosis isn’t correct I don’t come across as a complete fool when I am proven wrong.

“Based on the location of the pain in your knee, the mechanism of injury, and the tenderness on exam, I believe you have torn your medical meniscus. Either that or it is a sprain. Or arthritis. Or a rare parasitic infection.”

I feel like someone who bets on every horse in the Kentucky Derby so when the race is over I can tell everyone that I picked the winner.

We are all like that. No one wants to be proven wrong, no one wants to be embarrassed, so we avoid all or none statements. We like to have options.

This may be comfortable, but it is not always possible. Some things in life are either true or they are not. Some questions have only one answer.

The question of Easter is a one answer question. Either Jesus of Nazareth rose from the dead, or he didn’t. The claims of the Christian faith are valid or they are not. There is no room in the middle. People have to pick a side.

No one understood this better than the Apostle Paul, the Jewish Rabbi who became the greatest missionary of the early Christian church.

Paul based his entire life on his belief that Jesus had risen from the dead. His commitment to Christianity cost him his faith, his career and ultimately his life. His investment was either incredibly wise or terribly foolish. There is no middle ground.

This dichotomy was not lost on Paul. He himself expressed this reality in a letter he wrote to fellow believers in the Ancient Grecian city of Corinth, saying, “If Christ has not been raised, our preaching is useless and so is your faith.”

Paul’s words are no less true today. Everything about the Christian faith hinges on a single event on a single day almost 2000 years ago. An event that either happened, or it didn't.

Christians proclaim that Jesus was not just a man, that he was actually God become man, that he lived a perfect life and then allowed himself to be put to death in a brutal fashion as payment for “sins”, rebellious acts against God, committed by every person who ever lived. As evidence for these remarkable claims Christians offer a single proof, Jesus’ resurrection from the dead. This is a risky position.

If Jesus did not rise from the dead then he is not the Son of God. His words are no more valuable or meaningful than any other moral teacher. People like Paul who make tremendous sacrifices for their faith are fools, complete, total and pathetically deluded fools.

If the resurrection of Jesus isdisproven, then all of Christianity comes crumbling down. Yet, if Jesus did rise from the dead, then He is everything Christians claim he is to be.

Given the profound implications, it seems that thoughtful, prudent people would take the time to explore the evidence put forth in support of the Christian teaching on the resurrection of Jesus. The matter is too important, the consequences too significant, to be dismissed out of hand. The question, “Did Jesus really live, die and rise again?” May be the most important any of us will ever answer.

Something to think about on Easter. 

- Bart

Thanks for reading and commenting. Questions are always welcomed.

A Question that Will define Your Life

The patient presented for depression, an unexplainable feeling that things weren't as they should be. He came to me for help, unsure of what he could do to improve his situation. He had achieved every goal he had set for his in life but something was missing. He had a beautiful wife and well-behaved children, a good paying job, a nice car, and a comfortable home. He had arrived at the destination he had been working toward since he graduated high school, he had checked off every box on his list, but he wasn’t happy.

He came to see me wondering if he was depressed. He wasn’t. It took only a few minutes of conversation to identify the problem. He was unfulfilled. He had met his goals but failed to find his purpose. He had not addressed life’s most important question. He had not asked himself, “What happens next?”

He had fallen into the trap that has ensnared so many. He had lived his life thinking that once he checked off all of the items  on the list of attributes of a successful life that he would be happy. He believed the lie that if he could simply achieve his life’s goals that he would then be content. When he had achieved those goals and not found happiness he did not know what to do with himself.

His fate is the fate that awaits all who believe that earthly success can bring happiness. It is a pursuit that ends in despair. News reports and reality TV provide overwhelming evidence of the fact that the rich and famous are not fulfilled and happy people, yet our pursuit of wealth and fame continue unabated. For life to have meaning, more is required. For life to have meaning, there must be more to life than this life offers.

The question for our lives is “What happens next?” for it is eternity that matters. Living for eternity, with the awareness of what happens when this live is over, can keep us from empty pursuits.  When we die it will be the only question that matters. The most fulfilling and truly successful lives are lived by those for who the answer to the question is “I will spend eternity with God.”

-          Bart

Thanks for reading and sharing. The greatest reminder of why this question is significant is just a week away, when Christians all over the world celebrate the enduring evidence for life after this one, the resurrection of Jesus Christ.