Medical Students can handle the truth, Academics should be more open with it

Medical School is rough.  Fortunately there is a recent movement to make Medical Education more humane.  The movement to bring humanity, ethics, and love back into the molding of our future physicians is crucial.  Personally, I felt my medical school was on the forefront of this push.  Perhaps it was because we had Jesuit Priests for Attendings and the institution’s motto of “We also treat the human spirit” was also filtered into the treatment of students.  Whether it was something about myself or my medical school, I was fortunate to never experience the depression, competitive urges, burnout and isolation that is so prevalent during American medical school years.

But there is an underlying and hidden truth that is never spoken about, or at least wasn’t to me, in Medical School.  As students we are warned how tough medical school is and furthermore how absolutely draining residency is.  When we’re in the thick of either in even the most uplifting programs and schools, we are monitored for burnout, offered services to prevent it, and given support in ways students and residents of the 20th century never were.  More frequently now, we are prepared for these harsh realities  But what we’re not told, ever, is that even if and when we make it through medical school and residency/fellowship to attending physicians we may well find it’s still not greener on the other side.  We may still first experience burnout when we’re supposed to be summitting our Everest Mountain of medical training.  As many mountain climbers will tell you, often the way down from the peak is just as hard if not harder than the climb up.

After having spent a year in private practice, a year in Academia, and now venturing out on my own, I wonder what it is or why we aren’t more open about it?  Perhaps it’s because many lifelong Academicians are indeed sheltered from much of the non-doctoring paperwork and data entry that private physicians are forced to do.  That said, Academia is still full of challenges unique to itself.  Getting grants, getting published, tenure, institutional and field specific sexism……to name a few.  As Medical Students, it’s completely hit or miss if you’re exposed to a mentor or physician in private practice.  You may get lucky in your 1st year Patient Centered Medicine group and get a group leader who is actually a private doc volunteering their time, but it’s unlikely.  And even so, we docs are told to keep quiet about our struggles for fear of turning people away from the profession.

Maybe it’s just my personality.  I don’t like surprises, and I have found over and over that if I am prepared for something ahead of time (whether it be emotional stress or physical) that I am far more able to cope with it when and if it happens.  I don’t think however this is unique to me.  As a physician, I have found my patients are far more able to handle hiccups or side effects if I appropriately forewarn them to anticipate them, normalize their feelings, counsel on what they do if those unpleasantries happen, and encourage them to call me if they’re concerned.  Turns out, I get less calls in the middle of the night and my patients feel empowered, and less alone.  I’ve also been a patient and I find the same is true.

It was the amazing mentors in Family Medicine at my medical school that made me jump from a path intent on Internal Medicine then Geriatrics to doing Family Medicine as my route to Geriatrics.  Yet, I wish they had forewarned me that my potential salary and earnings as a Geriatrician would be lower in some places just because I was Family Med trained instead of Internal Med trained.  I was also never informed of the heavy burden of Maintenance of Certification testing and modules that Family Medicine would make me do that are irrelevant to the Geriatric population.  I wish some of the female mentors would have given me the heads up on the truth, that sexism in medicine, even fields like family medicine, is alive and well.  Had they, perhaps I would not have felt so affronted and demoralized when I first experienced it as a new attending.  I wish I had known how prevalent burnout is among attendings (of all fields) so that when I experienced it for the first time in what I thought would be my dream job, I wouldn’t have felt so alone.  I wish I had known that those of us in time-based fields (Geriatrics) are actually punished for taking time for and with our patients.

To Medical Educators and those in Academia:  Consider bringing in outside private docs as lecturers.  Bring in diverse physicians who will speak truth and bring transparency.  It will help Medical Students trust that the profession they are bleeding for is trying to be honest with them.  To Medical Students:  Know yourself early and seek help often.  Reach out to anyone willing, and be prepared for the reality that, even if you make it through residency and med school without a hitch, you may find yourself still struggling to find meaning in your vocation in this American Healthcare System.  But also know this:  You are not alone, it’s normal and you will have legitimate cause if you feel that way.  It’s not something wrong with you.  In fact, you are probably a physician that cares if you’re negatively affected by the system.  And most importantly, there is hope for a better future for medicine for both ourselves and our patients.






Subliminal Sexism in Medicine

For the most part, the sexism in medicine is not subliminal at all.  It’s quite overt.  However, unless you’re a female physician, you probably are unaware that it’s still an ever-present reality for us.  I do want to note that there are very good men out there who are trying their best to be advocates for equality in our field even though they can not fully appreciate the female physician plight.  My father is one.  My husband, an Anesthesiologist, is one.  The male physician-entrepreneur I met with last week to discuss a partnership in my new solo practice with his clinic system is one.  These men are the “He’s for She’s” of medicine.  And yet, the hurdles are massive even once we women have finally made it to attending status.

Examples of overt sexism abound.  As this article notes, the pay discrepancy for the exact same job and hours worked is blatant (>$100,000 difference).  Physicians in specialties such as ER and Anesthesia may not appreciate this, as their shifts might be salaried per hour.  However in fields that require a lot of non face-to-face patient care and fields which weigh “productivity” aka patient face-to-face volume and turnover heavily in the pay, women are often paid significantly less.  I’d contend it’s because in many non-procedural fields females more often take the time necessary for patients despite the sacrifice to their productivity earnings.  We women, frankly, tend to care more about the patient than our paycheck.  And yes, there is evidence to back this up.  A Harvard study released in JAMA this year showed conclusively that elderly patients admitted to the hospital had lower death rates and readmission rates when treated by female internists compared to their male counterparts.  While the numbers are overt, the subliminal sexism is written into the RVU methods of physician reimbursement.  Those who care enough to take the time to do the job well inevitably get punished financially.

Let’s forget about numbers.  There is overt sexism we women experience daily in how we are addressed and spoken to.  Frankly, a man would never tolerate without a complete fit the words and tones I have had to take from coworkers, bosses, and patients alike.  Last week I had a meeting with a hospital system in my town who has been trying to get me to agree to work for them for months without retainer.  We finally met and I told them about starting my own solo-practice instead of employment, but also to discuss how I’d be happy to assist with medical directorship for their SNFist program and inpatient Geriatric care improvements.  The female care manager told me how she didn’t think what I could offer was necessary from a physician and the male physician said,”I just don’t think you’re going to get anyone to pay for your care out of pocket when it’s something medicare covers” (I’m opting out of medicare).  I don’t think they’re aware of how this came off.  What they were trying to communicate is that they aren’t looking for a medical director at this time and they are concerned for my financial viability solo.  That’s what they would have said to me if I were a man.  Never would they have insinuated that my expertise as a physician and Geriatrician, something unique to this community, were not wanted or needed (it actually very much is), or that my care was comparable to the the care provided by the non-physician providers who go to the nursing homes and assisted living facilities here (it’s not comparable, my care is better because I am trained at a much higher level to care for this vulnerable population).  No, Medicare doesn’t actually cover the quality of care I provide.  So this is blatant.  This kind of thing also happens routinely to female physicians of every specialty.

Let’s get to the truly subliminal content.

My husband opened my American Academy of Family Physicians CME advertisement in the mail and brought to my attention the fascinating pictures.  Here are 6 of the 8 pictures, including all of the pictures featuring women.

I guess I don’t know if these truly are subliminal because it was my husband who pointed out to me how sexist this seemed.  He’s not one to catch subtlety.  The pamphlet has a ratio of men to women pics of 6:2.  So the numbers already don’t reflect the reality of family medicine.  However, in the entire pamphlet, there are only pictures showing men as smiling, engaging physicians/leaders/teachers.  The women pictured are either facing away or with an expression that says, “I am a passive recipient, incapable of worthwhile thoughts of my own or engaging discussion.”  Then there is the woman staring at the painful computer CME module with the pen in her mouth.  Is she a secretary enthralled by data entry?  Why is there not a single picture that depicts a woman physician smiling, engaged, like someone you would want to talk with, or care for you, or capable of teaching you?  And this is not a testosterone driven surgical specialty.  This is family medicine people!  Where women are actually more prevalent in the field!  Also, it’s not like the pictures are showcasing the keynote speakers (although that is something that is also far too male-dominated).  It’s advertising how the AAFP envisions its audience.  Even the AAFP does not view women as equally capable of being physicians, leaders, and teachers.  Their marketing tells us so.

Still today in medicine, even in the fields full of women, the message sent is that men lead in education, discussion, and patient care.  But truly, it’s the women making the most impact in time-based fields and giving our heart and souls to do so.  We are just as capable, just as engaging, and it’s time to demand that our fields recognize this before we continue to break our backs in the trenches.



“Sorry, I Ain’t Sorry”

At first listen, Beyonce’s Lemonade album seems to purely be about her, and her relationship with herself and her husband.  However, as I’ve had it literally on replay for the last week in the midst of facing a major Professional decision, I can’t help but feel it’s so much more for women.  For me, it can help me find the confidence, self-love and inner strength to know that I really don’t need a man, or an organization run by men, to be successful and to do what only I can do.

I am still in the midst of the decision.  Do I accept an employed job as the only Geriatrician in an entire hospital system run  on a fundamentally corrupt physician payment model and subsequently poor patient care model just for the salary?  Or, do I do what I know will make me most happy and opt-out of Medicare and start my own practice doing medicine my way (the right way……where I spend time with patients and families, listen, counsel, diagnose, and walk with) despite the likely low financial return?  If anyone’s reading this, they’re probably thinking, “This seems obvious…….do what will make you happy, go for option number 2.”  I wish it were that simple.

I am a female caregiver through and through.  I became a wife and mother right as I became a physician.  I am terrible at putting myself first, even when it’s essential.  Part of taking care of oneself is knowing how to and when to avoid abusive relationships.  It’s from learning from our past mistakes.  Whether it’s with spouses, friends, employers, businesses, or any type of relationship, knowing one’s strengths and failings is crucial.  Often it takes making the mistakes first to learn our own strengths and weaknesses.

My strengths are these.  I’m smart, and also extremely caring.  I empathize truly and deeply.  I do feel the pain of my patients and their families, and the joys too.  I’ve been a patient also, so I don’t have to work too hard to put myself in the shoes of my patients.  I’m honest and transparent.  Authentic perhaps?  I can’t lie, nor can I fake things.  This leads me to my weaknesses:  I am incapable of being “political”.  If I see something that isn’t right, I can’t keep my mouth shut to save-face for someone else.  When I try, I become testy.  I don’t suffer foolishness among colleagues well at all.  I will fight for my patients and doing what is right for them at all costs…….usually at the cost of reimbursements from Medicare.  I am intensely bothered by the difference in how female physicians (myself included) and male physicians are treated by those we care for, work with and among, and are employed by.  And I am unlikely to get over that.

Where is this exercise going and why is Beyonce’s “Sorry” the current song-de-jour on repeat?  Despite the above, I still have this nagging voice telling me I should take the job with the hospital system.  It’s the voice of fear, of feeling bad for saying no to them, of repeated patterns of delving into a relationship for security and not for what is right for me, and of the problematic thinking on my part that constant self-sacrifice is a good thing.  Here is what I know.  The job will not make me happy.  It would allow me to stay in Medicare, but in a very toxic practice environment.  It won’t afford me the flexibility I want to be the best mom and doctor I can be.  I know I’m unlikely to last in that environment as I can’t keep my mouth shut about things that are wrong but I also don’t like pissing off all my colleagues.  I don’t like that kind of competition.  For a geriatrician, opting out of medicare is such a huge deal.  Telling my future patients that I won’t take their free insurance (because Medicare is a narcissistic regulator of physicians) is scary, even when it allows me to give them better quality of care.

So, I have been gearing myself up for the moment when I finally make the right choice for me.  This hospital system has been literally leading me on for months now.  They are apparently finally going to show me the proposed contract and letter of intent soon.  And I want to be ready to do what is right for me.  I don’t want to close any doors prematurely, so I’m waiting to see the contract before I do anything definitive.  However, based on their behavior thus far (poor communication, asking me to wait on them without any guarantees or retainers, clear resistance from other physicians I’d be working with), I have no reason to believe that this is a group or organization I want to be part of, particularly when I’d be one of the only female physicians doing what they’re asking me to do.  Just like people, organizations don’t change unless they see the need for it and seek it out themselves.  Medicare and many of the businesses of healthcare are indeed narcissistic.  While many good people work for and within them, the overall company culture is one that is incapable of empathizing with those who work for it while simultaneously being hyper-sensitive and reactionary due to a fragile sense of self (or lack of any true mission beyond money making).  These are the kind of relationships that are so trying.

I don’t know if I’m ready yet.  However, it’s not a matter of if, just when.  And when I finally am ready, I will serenade Medicare with Beyonce’s words, “Sorry, I ain’t sorry…….middle fingers up, put em hands hi.  Wave em in his face, tell him boy bye……I don’t feel bad about it, it’s exactly what you get, stop interrupting my grinding.”  Instead of a boy, it’s Medicare in my mind, and the health systems.  And my “grinding” is my doctoring.  Because I am one bad-ass physician, and just about every patient I’ve ever had will tell you that.  Medicare, regulators, politics and those who just care more about the Benjamins have been interrupting my doctoring…..and I’m sick of it.  And I ain’t sorry when I finally leave them.


This Geriatrician wants single-payer universal coverage, but expanding Medicare in its current form is not a good idea.

Thankfully, the GOP did not pass Paul Ryan’s unfortunate excuse for a repeal and replace bill for Obamacare.  Immediately after, I saw a headline hopefully concluding, “Medicare for all may be next.”  In Medicare’s current form, this would be devastating for the health of America.  I am a young Geriatrician, I know a heck of a lot about Medicare.  Most people don’t.  They just see it as a great perk of turning 65 in America and the social healthcare we offer to elderly and disabled.  I did too, until I became a physician who only sees Medicare patients.

Medicare originated in 1966 in recognition that we needed to do a better job as a nation at caring for our aging and disabled who could not get employer provided insurance.  In 1989 the Omnibus Budget Reconciliation Act established a fee schedule for Medicare payments.  This assigns “Relative Value Units” or RVU’s to everything we do for our patients in medicine.  The formula that determines RVU’s disproportionately favors procedural care to time-based care.  Essentially, Medicare pays and incentivizes Medical Providers to do things to patients and actually dis-incentivizes physicians from taking their time with patients.  If you wonder why the doctor-patient relationship is not doing well right now, wonder no more.  Trust takes time.  Even family doctors who take Medicare have to turn their practice into a patient or low-risk procedure mill to make ends meat.  Medicare will pay a physician between 70-80$ to freeze off a wart, a procedure that takes about 2 min  to do, and 1 minute to document in an EMR.  In contrast, I can spend an hour with an elderly patient with multiple complicated issues, addressing their concerns, reviewing and adjusting their many medications, and coming up with a plan and then having to take 30 minutes later to document what happened and get paid essentially the same amount (about 80$) had I just spent 3 minutes removing a wart and sending them out the door.  Is it any wonder that Geriatrics is a dying field?

There was a time, however, when despite the RVU working against physicians who primarily use their time and knowledge to diagnose and care for patients, physicians still did it because they could make a decent living while being fulfilled in the solace they were helping.  But times have changed.  My father is a Geriatrician.  He went to the equivalent of his state medical school from 1978-1982 for $5,000 a year in tuition.  No loans needed.  Had I gone to my state school (same as his) from 2006-2010, in-state tuition would have been 25,000$ per year.  I came out of medical school with roughly 200,000$ in debt at anywhere from 7 to 15% interest that accrues quarterly, and I’m lucky.  The physicians today in their 50ies – 70ies truly can not comprehend the financial sacrifice new physicians make when committing to primary care today.  But, it’s not all about the money.  There is far more paperwork, tracking of useless data, non-patient care related work that we are forced to do that merely detracts from the already limited time we have to see patients and develop a relationship.  And we have to deal with this burden from day 1 of our practicing lives.  Many of the older docs have moved into administrative roles yet still remember clinical practice how they experienced it.  In turn, they create detrimental policies and regulations to feed metrics in the name of “quality” all while being clueless as to what it is like to actually treat patients in the modern era.

Some might argue that by expanding medicare for all, it would cover less complicated patients so the current model shouldn’t be a problem.  I’d also beg to differ on that one.  Doing things to people, even prescribing medications, is dangerous and should not be taken for granted.  Medicare still incentivizes doing more invasive things for the least complicated patients.  Say we expand it to everyone, and a 22 year old comes in with the cough she’s had for 5 days.  It’s viral.  Viruses are the worst.  There is no treatment other than time and support.  But convincing patients of this when they know I have the power to prescribe a Z-pack and they always get better on the Z-pack (20% of effect of any treatment is placebo) takes a long empathetic conversation.  Ya know what is quick and easier?  You got it, just writing the darn script and moving on to the next person so I can get paid more.  And then we have massive bacterial resistance to azithromycin (the Z-pack) and C. diff is on the rise.

The numbers on all accounts point to the reality that Medicare’s RVU system of paying providers is causing worse outcomes, is unsustainable in cost, and is not attracting young talented physicians to the most needed primary care fields.  I wonder how many of the new family docs will inevitably succumb to 10 min visits with high procedures and more referrals to costly specialists or ultimately opt-out of medicare and insurance for direct-primary-care?  Medicare spent 650 billion dollars in 2015.  An underestimate suggests 200 billion dollars (or 30%) was spent on beneficiaries in their final year of life.  That means we as a medical community, despite probably knowing the patients were dying, kept doing procedures and tests and more treatments to people because that is what we are paid to do.  American culture indoctrinates us that death is optional.  It’s really not.  But why would a physician take the time explain to a patient and family the reality of their situation, a conversation that is exhausting and challenging for everyone involved, when they are paid about 5x more to just offer another procedure or test and move on?  And then we spend billions of dollars doing things while ignoring the essentials that require time, and we get the worst outcomes.   The current Medicare, if expanded to all, will only exacerbate the costly failures of our current system.  A single-payer universal coverage system?  Yes, please!  But not Medicare as we know it.  Heed the Geriatricians now while you still can.  We’re the most needed physician endangered species.






The Best of Both Worlds – A Capitalistic Case for a Public Single Payer Option and Private Sector for Health Care in America.

I think I’ve bitten off more than I really can chew with my first idea for a post, but I am going to go for it anyway.  As a family doc geriatrician, I have treated people from literally every arena (medicaid, medicare, private insurance in all it’s variety, and uninsured).  I know first hand the risk of a federally provided program that is over-regulated and that does not actually put money into quality relative to the population’s needs (yes I am talking about Medicare).  I also completely recognize that whether it be a “right” or not, healthcare is a business.  Money is involved, whether at the government level or the private insurer level.  Yet if we truly are a country that believes first and foremost in everyone’s inalienable rights of life, liberty, and the pursuit of happiness, than how can we as a nation not provide some minimum standard of healthcare for all it’s citizens?  What one thing does everyone need to live, to have liberty and be truly free to pursue happiness?  Their HEALTH (mental and/or physical)!  I am not advocating for a single payer system publicly funded that pays for EVERYTHING.  However there are a number of basic things that are non-controversial that can easily be agreed upon that yes, our government and our taxes should pay for so that everyone in our society can have their best chance at success.  If you want to bring free-market economics into it, then allow for the private sector.  But when people are desperate and feel their lives depend on something (whether they really do or not) they will pay anything, say yes to anything, and ultimately competition and free-market choice just don’t apply.  The American Healthcare system already rations care.  Insurance, private docs, medicaid and medicare all have rules as to what they deem valuable and will or will not do or pay for.  I’d contend however that despite our highly polarized country, there are very basic healthcare and medical needs that Democrat and Republican alike could agree on to be covered for everyone in a nationally funded and provided healthcare system.  Some of these include basic preventative measures like vaccines, pap smears, contraception for women (note I differentiate contraception from abortion……they are different, very very different), basic health literacy education, screenings for treatable chronic conditions and treatable cancers, etc.  Then there are common ailments that are easily treatable (at a certain age) no one expects to get but also should not financially ravage a person or a family if they do, such as an appendicitis, a pneumonia, a traumatic incident or a heart attack.  If the primary panel that determined the type of care needed was made mostly of PCP’s and General surgeons, I’d wager a million to one they’d come up with a bipartisan agreement on what should be covered.  And no, not everything would be covered under a national healthcare system.  Just like in the public school system, not everyone gets a voucher to go to whatever expensive private school they like.

Ok so say we do this (I am an idealist and a cynic at the same time…..I know we aren’t going to do this)?  Who would work in that system?  Most American Doctors are extremely FED UP with the regulations, oppressive burdens of medical school debt, bad technology at our disposal, administrative burdens, I could go on forever, that distract from our ability to care and form relationships with our patients.  For this kind of thing to work, we’d have to step outside of our bubble and not be constrained by the many issues of our current private and public Health sectors.  We’d need to take the good things from other countries of comparable standing and be willing to use what could work for us.  Meanwhile we could tap into the amazing resources and technologies we do have in brain power in our own country.  So what could this look like?  Let me tell you.

  1. Scrap Medicare and Medicaid, completely, and start over with a United States National Health System (USNHS).  This would be similar to Medicaid in that it would be a Federal and State program.  Certain minimums would be mandated by the Federal government that would be agreed are basics that must be provided and the current Federal social security tax/medicare federal would essentially become the USNHS tax.  This won’t be enough though for coverage of everyone and therefore allow the States to both administer the plan and levy taxes in whatever ways they feel will work best relative to their respective State needs.  We have 50 vastly different states in this country.  To assume that the needs of one are the same as all is just naive.  Therefore in setting this up, allow for some State autonomy.
  2. Will this be something we can afford to fund with taxes? – Heck yes.  Again it should NOT pay for EVERYTHING.  The USNHS should cover acute, chronic, and preventable healthcare needs agreed upon by experts in medicine and public health (I’d contend mostly family physicians from both urban and rural settings) based on age and likelihood of successful prognosis with treatments.  Yes there will be rationing, as there already IS in every single aspect of healthcare.  However when people find their income is much greater because they did not have to elect for the employer covered private insurance benefits that make healthy people pay for very sick people who over-use the system they’ll find that despite a slight increase in taxes, they’re coming out ahead.    The payment for the physicians and other medical providers should be time-based relative to their expertise and degree level, rather than volume and procedural based.  If payments are time based (like an hourly salary) then physicians are more likely to take the time to explain things, to get a proper history so we don’t just order costly tests, to take the time to talk to other health team members, and to re-establish the sacred relationship between a doctor and patient.  If time-based then we don’t need the Electric Health Records that were built based on cumbersome and business minded ICD-9 or 10 codes.  The USNHS could establish a nationwide EMR created with 80% input from medical providers and 20% from computer coders and engineers that would allow easy documentation the way providers need and want it.  Also, because it would be national, if a patient stays within the NHS, it would be visible from any USNHS site.  So if they seek care, there would not be more ordering of unnecessary, costly and sometimes risky tests because providers in the USNHS would be able to see results and notes from other providers, even in other states.
  3. Who would work in this system and will a time-based salary make people lazy? – If set up correctly, it would be very attractive and no, it won’t make medical providers lazy.  First of all, I am not advocating (because it’s far too much of a long shot) for almost free medical school education (like many of the countries with socialized healthcare have).  However, we could very easily incentivize people to work for the USNHS if we offered complete loan repayment for those who dedicated at least 4 years (or maybe however many years their residency/fellowship training was) to the USNHS.  Just for reference, I took out over $150,000 of loans at 7% interest that started accruing immediately after med school and annualized quarterly.  I also had a few loans at higher interest rates.  I did 4 years of training (3 years residency, 1 year of fellowship all working about 80 hours a week getting paid 50,000$ per year).  Now, as a full fledged expert Geriatrician with a job at 80% time (part-time is actually not a thing as a primary care doc) I get paid 120,000$.  Before you tell me to stop whining, do the math of my loan payments and hourly wage based on time worked (and inquire into what other professionals of comparable IQ and education level get paid relative to debt burden).  If I were not married to an Anesthesiologist, I would not get out of debt and be able to cover basic costs for living and my one child for near 30 years.  If it were a true national program, then there wouldn’t be horrible constrictions on where people would be placed, because likely there would be an opening near where they want to be (currently you can get your student loans paid for if you commit to being placed in literally wherever, often Native American Indian Reservations, Alaska, or the most challenging Federally Qualified Clinics, for at least 4 years after residency).  Also, if the USNHS is set up correctly, many quality family doctors and altruistic health providers would be attracted to the concept of getting the time necessary to establish relationships, educate people about their health and healthy living, and less administrative burdens that I would bet a number of people would stay on with the USNHS despite the overall lower salary paid than the private sector.  There would certainly be more Geriatricians.  And the argument that salaries make people lazy……sorry but no.  No medical providers make it through our training system (whether it be nursing, physician, Nurse prac, PA, etc) by being lazy.  If they get burned out by our current awful system and start doing less, yeah it’s the system.  Medical providers are not inherently lazy people and salary paying the altruistic ones who work for the USNHS will likely only improve care.
  4. What about Capitalism and the Free Market and Competition and the Private Sector – Good news!  We’re America.  People are easily swayed that they need fancier things, treatments to make them live longer, look younger, look skinnier, or even that just because it’s more expensive it’s somehow better.  And the people want choices!  Why do you think Dr. Oz is so successful?  There will always be a free market for healthcare if the basic needs are already met (like with a USNHS).  Why do you think plastic surgeons who do boob jobs (clearly not a basic necessity) always make bank and have a steady supply of patients?  That’s maybe an extreme example.  Here are some more.  There will always be cosmetic Dermatologists that people will pay for if they have the means.  There will always be fertility specialists offering IVF if you can pay for it.  There will always be someone willing to do your surgery for the right price even if you are risky and it’s not an emergent medical need.  And there will always be doctors willing to keep you alive on machines, or perform a code on your 85 year old Grandma, or offer you chemo they know will not help because you have a strong Faith in God and miracles.  And they will charge you what the market will bear.  And yeah, they’ll have to be better because they will be competing with the USNHS, which will only control costs, improve care, and make for happier Americans all around.
  5. How would this approach support Capitalism, Free market exchange of goods and ideas, entrepreneurship, etc etc etc? – I’m frankly dumbfounded that this isn’t more obvious to politicians and economists.  But then I recall that many politicians and rich business people respond more to the needs big business and big money than the average American working class, rural or urban.  They also are not physicians……or at least the physicians that are on the front-lines of healthcare.  How many of you reading this (I’m hoping I’m getting other views than just medical professionals) have wanted to start your own business, or have an awesome idea that you really think could work, but also have a family to provide for?  How many of you work for an employer who you don’t love, isn’t particularly fair, does not necessarily inspire you, but does provide for basic healthcare benefits so you and your children can get vaccines and basic care if someone breaks a bone or gets an appendicitis?  How many of you know that if you started your own small business it would be successful enough for just the right amount of profit that you wouldn’t qualify for medicaid?  I bet there are a number of you thinking, “yeah, heck yeah, that’s me.”  But, you stay in your corporate big business job and never bring your awesome ideas to our “free market” because your health and your family comes first and you can not take the risk that their healthcare needs and your benefits wouldn’t be met.  So how is this system of no true basic minimum of healthcare met publicly helping capitalism and the “free market”?  It’s not.  It’s helping the already rich corporations solidify their monopoly on ideas and the market.  It’s helping the already billionaires eliminate competition because we are not allowing our true potential to be met.  By trying to force a basic human need, such as minimum healthcare standards, into a private free market capitalistic system, we are actually harming capitalism, the free market, and fostering monopolies.  Did this system make sense at one point?  Yes, it did.  But that was years ago.  Our medical knowledge, treatments, and possibilities and treatable issues have changed drastically.  So it’s time we get up to speed with the times and change to.
  6. How could this be bipartisan? – First of all take a deep breath and try to use reason, logic, and empathy.  Remember the First Amendment that separates church from state.  For a USNHS to be publicly funded, we would need to come up with a compromise of funding non-controversial things.  I will say, abortion and physician assisted suicide should NEVER be publicly funded with our tax dollars.  They are issues that are controversial, rooted in human life and dignity, and never anyone’s real choice as when women or persons find themselves in those situations it’s because they are desperate.  However, contraception is a thing that should be funded publicly with our taxes, as it gives women autonomy and agency over their bodies.  This is coming from a devout Catholic who has never used contraception.  It should also cover free sex education for everyone starting in 8th or 9th grade as part of the federal mandate, including what it’s for, the risks, respecting others and how to choose responsibly to engage in it.   It’s reasonable to cover it publicly, and if we did, and provided a USNHS that actually gave free preventative healthcare and education to women (but not abortion), we’d essentially eliminate the arguments for funding Planned Parenthood as the only thing they’d provide that women couldn’t get at their USNHS clinic would be abortion.  Think about it!  Likewise, hospice and palliative care for terminal conditions should ALWAYS be covered.  If you are someone that insists the medical field do absolutely everything invasive for yourself or loved one despite a dire prognosis or clearly terminal condition because you think it’s God’s will for a miracle……GREAT!  But don’t expect the state USNHS to fund that with American tax dollars.  Miracles are for God, the Churches and religion, not the publicly funded health system.  Pay yourself or get your church to fund-raise.  It’s your choice, it’s a free country.  I could go on and on about medically rational and reasonable things based on science, evidence, epidemiology and experience to cover publicly and not, but this is already way too long.  The point is, don’t let emotion and blind following cloud your potentially well-educated and informed opinion of this issue.

In conclusion (few she’s almost done……bravo to you if you’re still reading this), don’t let the media, people who know nothing of health and medicine, or those who are medical providers but are also practicing in fields of narrow scopes while making out like bandits cloud your judgement.  We are in dire straights right now in this country and it isn’t sustainable.  We need a real solution and our health is not something that fits into supply and demand economics and free market capitalism.  It just doesn’t work that way.  There is a better way, a compromise of both (Obamacare was doomed from the get-go because to get support from Republicans it had to enmesh the big business health insurance industry as its means to expand coverage……it didn’t work).  I know this probably won’t be read (it’s far too long), that this kind of thing is not in our horizon.  I have good reason to be cynical.  But I can dream.  I refuse, as a woman, mother, Family Physician/Geriatrician, healer, wife, sister, daughter, educator, athlete, granddaughter, Christian, to accept that the status quo is our future.  And I’ve had a long day and my eyes can’t take anymore screen to go back and edit this for grammar and whatnot……Here goes nothin.